Dear Speaker Boehner, Minority Leader Pelosi, Majority Leader Reid, Minority Leader McConnell, Chairman Ryan, Ranking Member Van Hollen, Chairman Conrad and Ranking Member Sessions:
As organizations committed to advancing access to reproductive and other health care services for poor and low-income individuals, we are writing to voice our strong opposition to attempts to cap or reduce funding for the Medicaid program, or to in any way weaken its coverage of family planning services and supplies.
We are deeply concerned by the proposal made in the House Budget Committee?s Fiscal Year (FY) 2012 budget, authored by Chairman Ryan, to convert the Medicaid program into a block grant. Medicaid is the cornerstone of health care for the poor and low-income; more than 58 million Americans are currently enrolled in Medicaid.
Medicaid is the largest source of public funding for family planning services and supplies, helping to pay for contraceptive services and supplies, annual exams, breast and cervical cancer screenings, and STD/HIV screening. According to the Guttmacher Institute, publicly funded family planning services, such as those provided through Medicaid, helped prevent nearly 2 million unintended pregnancies in 2006, nearly half of which would have ended in abortion. Without these services, the number of unintended pregnancies among poor women would nearly double.
The need for publicly funded family planning services and supplies has increased dramatically in recent years. The recession has caused millions of Americans to lose their jobs, resulting not only in the loss of wages but also in the loss of employer-based insurance. According to recent data from the Guttmacher Institute, the number of American women aged 15?44 who were covered by private insurance fell by 2.3 million between 2008 and 2009. This decrease was accompanied by significant increases in the number of women who were on Medicaid?in 2009, 14.8 percent of women of reproductive age were on Medicaid, up from 13.2 percent in 2008. Publicly funded family planning services and supplies prevent unintended pregnancy, a critical component of public health. Unintended pregnancy is associated with an increased risk of morbidity for women and increases the likelihood of low birth-weight babies and infant mortality. In recent years, more than half of all states have expanded eligibility for family planning care under Medicaid. These states have demonstrated that spending more on Medicaid-funded family planning results in improved contraceptive use, fewer unintended pregnancies, and longer intervals between births. In fact, the proven effectiveness in increasing the spacing between births led the National Governors Association to take the position that expanding Medicaid eligibility for family planning is an important step states can take to improve birth outcomes. Along with being good public health, helping women and men prevent unintended pregnancy is economically responsible: every $1 spent on family planning saves $3.74 in public costs for pregnancy-related health care.
The House Budget Committee?s FY 2012 budget proposes to turn Medicaid into a ?block grant,? which would provide states with a fixed or capped amount of money for their Medicaid programs each year. The budget proposal claims that turning Medicaid into a block grant will give states more ?flexibility,? but the reality is that states already have significant flexibility in administering their Medicaid programs. States are currently given broad discretion over defining benefits, choosing delivery care models, and adjusting how providers and plans are paid.
Contrary to what proponents of the House-passed budget claim, converting Medicaid into a block grant would only shift risks and costs to states and reduce needed funding, forcing many poor and low-income individuals to go without care or to seek care in our nation?s emergency rooms, resulting in increased health care costs. In addition, capped federal funding would leave states unable to respond to changes in the economy, such as when a recession causes more people to be in need of and eligible for Medicaid. Moreover, the House budget would fund the block grant well below the current federal funding level, which would force states to either cut benefits or lower Medicaid eligibility levels, or both.
Today, Medicaid is explicitly designed to respond to a state?s fluctuating needs. States can, consistent with federal standards, tighten eligibility criteria, but they cannot ration coverage on a first-come, first-serve basis. Maintaining the current federal/state matching structure, where the federal government pays a portion of states? costs in providing care to Medicaid enrollees, is integral to ensuring coverage for millions of people and continuing vital public health services.
The goals of reducing the national deficit and improving public health are not mutually exclusive?in reality, sound public health policy is the cornerstone upon which sound economic policy can be built. Nowhere is this more apparent than in public funding for family planning. Medicaid is essential to the health and well-being of millions of poor and low-income Americans, and to ensuring a healthy workforce and healthy children. We strongly urge you to oppose any attempt to cap or reduce funding for the Medicaid program, or to in any way weaken the coverage of family planning services and supplies.
National Family Planning & Reproductive Health Association
National Health Law Program
Advocates for Youth
American Association of University Women (AAUW)
American Congress of Obstetricians and Gynecologists
American Medical Student AssociationAmerican Nurses Association
American Public Health Association
American Social Health Association
American Society for Emergency Contraception
Asian & Pacific Islander American Health Forum
Association of Reproductive Health Professionals (ARHP)
Black Women?s Health Imperative
California Primary Care Association
Catholics for Choice
Center for Reproductive Rights
Community Health Councils
Family Planning Councils of America
Ibis Reproductive Health
Illinois Maternal and Child Health Coalition
Medical Students for Choice
NARAL Pro-Choice America
NARAL Pro-Choice Oregon
National Asian Pacific American Women's Forum (NAPAWF)
National Association of Nurse Practitioners in Women's Health (NPWH)
National Coalition of STD Directors (NCSD)
National Council of Jewish Women (NCJW)
National Council of Jewish Women, California
National Latina Institute for Reproductive Health
National Organization for Women
National Partnership for Women & Families
National Women's Health Network
National Women?s Law Center
New Mexico Center on Law and Poverty
Physicians for Reproductive Choice and Health
Planned Parenthood Federation of America
Public Health Solutions
Raising Women's Voices for the Health Care We Need
Religious Coalition for Reproductive Choice
Reproductive Health Technologies Project
Sexuality Information and Education Council of the U.S. (SIECUS)
State Family Planning Administrators
Union for Reform Judaism
Unitarian Universalist Association of Congregations
U.S. Positive Women's Network (PWN)
Wisconsin Alliance for Women's Health
Women Organized to Respond to Life-threatening Disease (WORLD)