Sunday, October 26th, 2014

The Obameter

Increase efforts to reduce unintended pregnancy


"Obama will work to reduce unintended pregnancy by guaranteeing equity in contraceptive coverage, providing sex education and offering rape victims accurate information about emergency contraception."

Updates

Significant action in all three areas of promise

During the presidential campaign, Barack Obama said he would "work to reduce unintended pregnancy by guaranteeing equity in contraceptive coverage, providing sex education and offering rape victims accurate information about emergency contraception."

An announcement on Aug. 1, 2011, represented a landmark advance for this promise.

The Department of Health and Human Services announced new guidelines that would allow women to receive preventive health services at no additional cost. "Developed by the independent Institute of Medicine, the new guidelines require new health insurance plans to cover women"s preventive services such as well-woman visits, breastfeeding support, domestic violence screening and contraception without charging a co-payment, co-insurance or a deductible,” the department announced.

The guidelines are scheduled take effect for plan years beginning on or after Aug. 1, 2012.  

The announcement "has a similar effect to ‘guaranteeing equity in contraceptive coverage" but goes even farther because in addition to saying plans must cover contraception, it also means they must do so without cost-sharing for the consumer,” said Andrea Kane, senior director for policy at the National Campaign to Prevent Teen and Unplanned Pregnancy, an advocacy group.

Because of the controversial nature of reproductive health policy, the department also released "an amendment to the prevention regulation that allows religious institutions that offer insurance to their employees the choice of whether or not to cover contraception services.”

Separately, the administration has pushed for funding for teen pregnancy prevention programs that fall under the category of "evidence-based" -- a clear shot at the preference during the prior administration for abstinence-based models. Indeed, the budget eliminated $95 million in funding for Community-Based Abstinence Education and $50 million for mandatory Title V abstinence education grants to states.

Congress approved the administration"s request for $110 million in funding for evidence-based teen pregnancy prevention programs for fiscal year 2010. It was reduced by $5 million in fiscal year 2011 in the agreement on the continuing resolution, but the grant program remained largely intact, Kane said.

The funding supports a competitive grant program under the Department of Health and Human Services' Administration for Children and Families, largely intended to fund "grants for programs to replicate curriculum-based models that have been shown through strong evaluation ... to be effective in reducing teen pregnancy, delaying sexual activity, or improving contraception use” without increasing sexual activity. Other portions of program are "used to fund grants for demonstration programs to develop, replicate, refine and test additional models and innovative strategies for preventing teen pregnancy."

According to the National Campaign, more than 1,000 organizations submitted applications, and 100 received grants.

One initiative -- to expand Title X, a program that offers family planning services, including counseling and contraception -- fared less well in the budget wars. The fiscal year 2010 appropriations bill included a $10 million increase for Title X, and the president proposed an additional $10 million increase for fiscal year 2011. However, the program ended up getting cut by $17 million after House Republicans had proposed eliminating it entirely.

Meanwhile, the administration has fully implemented language that would let states opt to expand eligibility for Medicaid family planning services to low-income individuals who do not qualify under current rules

Finally, on the issue of "offering rape victims accurate information about emergency contraception,” HHS issued a final rule on federal health care conscience protections -- protections that allowed health care providers to opt out of participating in medical procedures that violate their moral and religious beliefs.

A rule issued during George W. Bush"s administration had caused controversy because some suggested that it effectively expanded the scope of the provider conscience statutes beyond abortion to contraception.

By contrast, the new rule says that "provision of contraceptive services has never been defined as abortion in federal statute. There is no indication that the federal health care provider conscience statutes intended that the term ‘abortion" included contraception. The Department rescinds the definitions contained in the 2008 Final Rule because of concerns that they may have caused confusion regarding the scope of the federal health care provider conscience protection statutes.”

The political sensitivity of each of the elements of this promise make them susceptible to changes in the future, including outright reversal. However, for now, they represent a fulfillment of Obama"s promise. We rate it a Promise Kept.

Sources:

Department of Health and Human Services, "Affordable Care Act Ensures Women Receive Preventive Services at No Additional Cost" (news release), Aug. 1, 2011

Department of Health and Human Services, "Statement from the Department of Health and Human Services on the Regulation for the Enforcement of Federal Health Care Conscience Protections" (news release), Feb. 18, 2011  

Federal Register, "Regulation for the Enforcement of Federal Health Care Provider Conscience Protection Laws,” Feb. 23, 2011

Centers for Medicare and Medicaid Services, State Medicaid Director Letter, July 2, 2010

National Campaign to Prevent Teen and Unplanned Pregnancy, "Summary of Federal Funding Relevant to Teen and Unplanned Pregnancy Prevention," accessed Oct. 24, 2011

National Campaign to Prevent Teen and Unplanned Pregnancy, "U.S. Department of Health and Human Services Announces Preventive Services for Women at No Additional Cost" (news release), Aug. 1, 2011

E-mail interview with Andrea Kane, senior director for policy, and Lisa Shuger, director of public policy, at the National Campaign to Prevent Teen and Unplanned Pregnancy, Aug. 15, 2011

Administration targets new money, programs at reducing unplanned pregnancies

During the presidential campaign, Barack Obama said he would "work to reduce unintended pregnancy by guaranteeing equity in contraceptive coverage, providing sex education and offering rape victims accurate information about emergency contraception."
 
The administration has done a number of things to reduce unintended pregnancy, advocates say, though not necessarily by the specific methods outlined in the promise.
 
Most notably, the administration's fiscal year 2010 budget request provides $178 million for teen pregnancy prevention programs. The administration requires that funding be used for "evidence-based" and other promising models -- a clear shot at the preference during the prior administration for abstinence-based models. Indeed, the budget eliminated $95 million in funding for Community-Based Abstinence Education and $50 million for mandatory Title V abstinence education grants to states.
 
The largest share of the teen pregnancy money comes from a $110 million competitive grant program under the Department of Health and Human Services' Administration for Children and Families. Of this sum, "at least $75 million will be used to fund grants for programs to replicate curriculum-based models that have been shown through strong evaluation ... to be effective in reducing teen pregnancy, delaying sexual activity, or improving contraception use (without increasing sexual activity) [and] at least $25 million will be used to fund grants for demonstration programs to develop, replicate, refine, and test additional models and innovative strategies for preventing teen pregnancy."
 
This language survived when both chambers of Congress passed an omnibus appropriations bill to fund HHS, and the president is expected to sign the bill.
 
In addition, the president's budget included a $10 million increase for Title X, a program that offers family planning services, including counseling and contraception. "Title X has a direct impact on reducing unplanned pregnancy by providing approximately five million low-income and uninsured individuals with access to high-quality contraceptive services, preventive screening, and health education," said Jessica D. Swafford, assistant director of public policy for the National Campaign to Prevent Teen and Unplanned Pregnancy. This provision was also included in the omnibus bill that the president is expected to sign.
 
Meanwhile, both the House and Senate health care reform have language that would let states opt to expand eligibility for Medicaid family planning services to low-income individuals who do not qualify under current rules.
 
Finally, Swafford said, the White House's Office of Faith-Based and Neighborhood Partnerships, the White House Council on Women and Girls and the Domestic Policy Council have reached out to "a wide range of organizations" to discuss ways to reduce teen pregnancy.
 
Swafford added that the administration has not focused on contraceptive equity or offering rape victims information about emergency contraception, two specific goals mentioned in Obama's promised. But it has done quite a few things to advance the more general policy goal of reducing unplanned pregnancies. So we rate this promise In the Works.

Sources:

THOMAS, text of fiscal 2010 omnibus appropriations bill, accessed Dec. 15, 2009

National Campaign to Prevent Teen and Unplanned Pregnancy, " Teen Pregnancy Prevention in the President"s FY 2010 Budget ," May 12, 2009

White House Office of Faith-Based and Neighborhood Partnerships, " Reducing Unintended Pregnancies, Supporting Maternal and Child Health, and Reducing the Need for Abortion ," accessed Dec. 16, 2009

The White House, "Obama Announces White House Office of Faith-based and Neighborhood Partnerships" ( news release ), Feb. 5, 2009

E-mail interview with Jessica D. Swafford, assistant director of public policy for the National Campaign to Prevent Teen and Unplanned Pregnancy, Dec. 15, 2009