The Obama Budget: Weak on Reproductive Health

There were hopes that the president would request a significant increase for Title X – the nation’s only program dedicated to providing quality, affordable reproductive health services – and also the repeal of the Hyde Amendment, a 1976 law that prohibits women from using federal health benefits such as Medicaid to pay for abortion, except in cases of rape, incest, or life endangerment. But Obama did neither.

Given conservative control of Congress, President Obama’s budget has little chance of being passed as is. But as John Cassidy pointed out in the New Yorker this week, the budget is as much a political document as it is an economic one. “The White House is using it to frame the political debate for this year and for the run-up to the 2016 Presidential election – an effort that began with the State of the Union address,” Cassidy wrote. Obama had an opportunity to show that reproductive health is a critical component of any agenda meant to lift up low-income families, and one the federal government must invest in if their other efforts are to bear fruit. But he missed that opportunity.

The president’s $300 million request was a modest increase from last year’s budget of $286.5 million – Title X’s first increase since 2010 – but still leaves the program woefully underfunded. Title X has still not recovered from the drastic cuts it endured between 2010 and 2013, when lawmakers cut the budget from $317 to $278 million, and as a result prevented 667,000 patients from receiving care. Family planning experts estimate that in order to completely fulfill the nation’s unmet need for reproductive health care, Title X would require somewhere in the ballpark of $800 million, a far cry from today’s budget.

Title X is like the little engine that could of public programs. It prevents more than one million unintended pregnancies annually, and thereby avoids nearly 600,000 unplanned births and more than 400,000 abortions. Without Title X, the U.S. unintended pregnancy and abortion rate would be 35 percent higher among adult women and 42 percent higher among teens. Not to mention that in 2010 every dollar invested in Title X saved $5.68. How’s that for a return on investment?

Not only is the program underfunded, but in states across the country conservative lawmakers have implemented restrictions that have prevented Title X funds from actually going to family providers, effectively chipping away at what was once a robust health safety net and exacerbating a pre-existing shortage of reproductive health providers. It is largely low-income women, women of color, immigrant women, and young women who are left without anywhere to turn for preventative care.

And what happens when those women find themselves needing to terminate a pregnancy? Between the restrictions set forth under the Hyde Amendment and the rapidly shrinking network of abortion providers, they have few options. In 1976 – just three years after the Supreme Court’s Roe v. Wade decision legalized abortion – Congress passed the Hyde Amendment and made abortion the only medical procedure ever banned from Medicaid. Ironically, Medicaid covers all the costs related to family planning and pregnancy.

By this point, you might be thinking this is all irrelevant, thanks to the Affordable Care Act (ACA). If only. While the ACA has extended care to scores of women who were previously uninsured, conservative opposition has diluted its potential impact and many people will remain without health coverage. Indeed, nearly four million women will be left without coverage this year thanks to conservative opposition to expanding Medicaid. In addition, federal restrictions ban many immigrants from Medicaid, the contraceptive mandate has been compromised and contraception is now your boss’s business, and this term the Supreme Court may very well take federal subsidies away from millions who need them in order to afford health insurance.

We need an increased investment in reproductive health now more than ever. If we are serious about improving the circumstances of low- and middle-income U.S. families, we must extend critical care and services to all of those who need and want them, and also shape the political debate in a way that will give all women and families all of the tools – not just a select few – that they need to thrive.

When the president, who espoused his support for reproductive rights in his State of the Union address, doesn’t push for a significant expansion of reproductive health care while he is putting his political capital behind broader education, income, and work-family supports, it signals that reproductive health, perhaps, is not as critical as these other issues. It suggests that with other supports women can lead economically secure lives, even if they cannot control their fertility and determine the timing and size of their families. That is simply not the case.

An agenda without bold investments in reproductive health is not a comprehensive agenda for women and families. And if women cannot access quality and affordable health care, they will not be able to make the most of the other important initiatives the president has proposed.