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Family Planning Services Signed Title X Into Law, There Was No Partisan Within the Next Five Years to All Those Who Want Divide on the Issue of Contraception

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Family Planning Services Signed Title X Into Law, There Was No Partisan Within the Next Five Years to All Those Who Want Divide on the Issue of Contraception SENSELESS: THE WAR ON BIRTH CONTROL FEBRUARY 2019 UPDATE ACKNOWLEDGEMENTS: The Population Institute wishes to gratefully acknowledge the contributions to this report that were made by two Duke University students, Natali Rey and Sam Ditesheim. I 3 I SENSELESS:©2019 Population THE WAR ONInstitute BIRTH CONTROL Table of Contents Introduction .................................................................................................................................................................2 PART ONE Expanding Access to Birth Control: 1965–2010 .......................................................................................... 4 PART TWO Denying Access to Birth Control (2011–2016) .............................................................................................. 9 PART THREE The Trump/Pence Offensive: The First Two Years .................................................................................... 15 PART FOUR The Shifting Rationales behind the ‘War’ ...................................................................................................... 19 PART FIVE What ‘Victory’ Would Look Like For Birth Control Opponents ......................................................... 24 Endnotes .................................................................................................................................................................... 28 I 1 I SENSELESS: THE WAR ON BIRTH CONTROL INTRODUCTION Senseless: The War on Birth Control I 2 I SENSELESS: THE WAR ON BIRTH CONTROL Since the introduction of the ‘pill’ more than half a century ago, modern methods of contraception have had a transformative effect on the lives of women in the U.S. and all around the world. On so many levels, contraception has been a game changer. The ability to prevent unwanted pregnancies has empowered women, enabling them to complete their education, plan their families, and work outside the home. In developing countries, the use of contraception has significantly lowered maternal and infant mortality rates and helped families escape poverty. Public opinion polls in the United States show that Americans, regardless of their age, gender, faith, or party affiliation, support access to contraception, and research indicates that the overwhelming majority of women in the U.S. use some form of contraception at some point in their reproductive years. And that is what makes the war on birth control so surprising … and senseless. I 3 I SENSELESS: THE WAR ON BIRTH CONTROL PART ONE Expanding Access to Birth Control: 1965–2010 I 4 I SENSELESS: THE WAR ON BIRTH CONTROL It has been more than a half a century since the U.S. Supreme Court in 1965 declared in Griswold v. Connecticut1 that access to contraception is constitutionally protected by “the right to marital privacy.” The Griswold decision, which struck down a Connecticut law prohibiting any person from using “any drug, medicinal article, or instrument for the purpose of preventing conception,” was a landmark case. In 1972, the U.S. Supreme Court, in Eisenstadt v. Baird,2 extended this right of privacy to unmarried couples. Today, constitutional experts regard access to contraception as “settled law.” And that judicial consensus reflects a broader public consensus about the value of contraception. Since the Griswold decision was handed down At the White House signing ceremony, in 1965, governments at all levels have created, Nixon said: funded, and administered programs aimed “It is noteworthy that this landmark legislation at improving public access to birth control, has had strong bipartisan support. I am and the creation of these programs occurred confident that by working together—at federal, with the strong support of Republicans and state, and local levels—we can achieve the goal Democrats alike. In 1970, when President Nixon of providing adequate family planning services signed Title X into law, there was no partisan within the next five years to all those who want divide on the issue of contraception. One of the them, but cannot afford them.” biggest champions of the bill in the U.S. House of Representatives was a Republican from Texas: With strong bipartisan support, Title X,3 then-Rep. George H. W. Bush. In the House became the cornerstone of a nationwide effort debate, Bush declared that, “If family planning is to expand and improve access to contraception, anything, it is a public health matter.” and over the course of four decades much progress has been made toward the goal of providing family planning services “to all those who want them, but cannot afford them.” I 5 I SENSELESS: THE WAR ON BIRTH CONTROL In the 45-year span between 1965 and 2010, the federal government, in partnership with the states, developed— with bipartisan support—a network of policies and programs that have served to improve access to family planning services and information at home and abroad. It is, almost certainly, one of the great—and relatively unsung—success stories of the past half-century. I 6 I SENSELESS: THE WAR ON BIRTH CONTROL IMPROVING ACCESS TO n States are required to provide family CONTRACEPTION AT HOME planning services and supplies to Medicaid- AND ABROAD eligible individuals of child-bearing age, and, depending on state law, state Medicaid TITLE X FAMILY PLANNING SERVICES programs can provide contraceptives to sexually active minors. Since its enactment in 1970, Title X, with support from both the federal government and n The Centers for Medicare and Medicaid state governments, has been providing family Services, which administers the Medicaid planning and other vital health care services to program at the federal level, started granting low-income communities. The program, which state family planning “waivers” beginning is administered by the Office of Population in 1993. Waivers permit states to provide Affairs (OPA) in the Department of Health and family planning services under Medicaid to Human Services (HHS), has helped tens of populations who are not otherwise eligible. millions of low-income households. The waivers, which are time-limited, have allowed states to expand coverage to a n Ninety percent of Title X funds are used variety of populations, including households to support clinical services. In 2015, there with incomes above the federal poverty line. were 91 Title X grantees, including 46 state, Prior to the adoption of the Affordable Care local and territorial health departments, Act in 2011, more than 20 states had applied community health agencies, and Planned for and received temporary waivers.8 Parenthood affiliates.4 n In addition to family planning, services CONTRACEPTIVE COVERAGE UNDER include cancer screenings and tests for THE AFFORDABLE CARE ACT (ACA) sexually transmitted infections (STI), including HIV. Obamacare has expanded access to reproductive health services, including family n Title X-funded clinics serve approximately 4 planning services, to millions of women. million clients annually. Services are provided free to households below the federal poverty n Under the ACA, non-grandfathered, private line, while families with incomes between health insurance plans are required to cover, 100 percent and 250 percent of the federal without cost sharing, “preventive health poverty line are charged on a sliding scale. services.” This includes what is popularly known as the “contraceptive mandate,” n In FY2018, Title X received $286 million which requires coverage of family planning in federal funding. In most states, Title services without cost sharing. X-supported clinics also receive funding from the state government.5 n In addition to expanding private insurance coverage of contraceptive services, the n Title X accounts for about 10% of all ACA has also increased the number of federally supported family planning and Americans receiving family planning family-planning-related services.6 benefits under Medicaid. This expanded coverage stems, principally, from two aspects of the ACA: MEDICAID-SUPPORTED FAMILY PLANNING SERVICES States are incentivized under the 1 Medicaid, created in 1965, is a federal-state ACA to expand their state Medicaid partnership providing medical and health- Coverage. To date, 37 states, including related services to over 70 million low-income the District of Columbia, have elected and disabled people. to expand Medicaid eligibility up to 138% of the federal poverty line. Under n Medicaid-compensated expenditures today the ACA, all Medicaid recipients are account for approximately 75% of all family eligible to receive family planning 9 planning services supported by the federal services without cost sharing. 7 government. I 7 I SENSELESS: THE WAR ON BIRTH CONTROL 2 States are still permitted under the INTERNATIONAL FAMILY PLANNING ACA to expand Medicaid-compensated AND REPRODUCTIVE HEALTH family planning services to populations For over a half century, the United States has that are not otherwise covered by been a global leader in the provision of family Medicaid in their state. Instead of planning and reproductive health services receiving a time-limited “waiver” from to women in developing countries. Since the the federal government, states are launch of USAID’s family planning program in now permitted to enact a permanent 1965, families have been better able to feed, extension of benefits. While 10 states clothe, educate and provide healthcare for still have “waivers,” 15 states now have their children. USAID reports that modern adopted a State Plan Amendment contraceptive use in the 27 countries with
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