Dollars and Sense

News, Winter 2017

How a Family Planning Bill Could Save Nebraska Millions

BY SARAH WENGERT

When Nebraska State Senator Paul Schumacher sees an idea that saves dollars and makes sense for Nebraska communities, he mobilizes.

On Jan. 6, 2017, Schumacher introduced LB120, a Family Planning State Plan Amendment (SPA) that would provide medical assistance coverage for family planning services. It utilizes public funding already available through Medicaid to increase access to family planning services for low-income Nebraskans. Schumacher says the bill will be similar to LB782, which he introduced in January 2016, and which was indefinitely postponed in April 2016.

“There are very, very few things which are consistent with the many very diverse philosophies that are operating these days,” says Schumacher, a Republican. “And this, from the very beginning, struck me as a bill in which a lot of the thinking of very diverse groups aligns. You have the desire of one segment of the population to have increased family planning for perhaps health or personal economic reasons, you have another group that wants to save tax money, another group that wants to balance the budget… so you have a bill that has distinctly conservative elements and distinctly more moderate to even liberal elements to it. It’s a well-balanced bill and the bottom line is: It saves money.”

In fact, according to numbers provided by the federal government and through peer-reviewed research based on national trends, Nebraskans stand to see annual saving of more than $48 million by adopting this permanent SPA. The savings come largely through utilizing already available Medicaid funds, through which the state would see a 90/10 federal funds match. While the bill takes advantage of funds already available via Medicaid, it should not be confused with Medicaid expansion.

“For every $1 Nebraska puts in, the federal government puts in nine,” says Meg Mikolajczyk, Nebraska public affairs manager for Planned Parenthood of the Heartland. “So it’s a really great investment for Nebraska, and the end result is incredible for the state because we know that for every dollar—state or federal—invested in the program, we save about $7.09. Over five years, it’s likely to save the state at least $200 million. And there’s a lot of research to back up that $7 figure.”

According to the American Journal of Public Health (AJPH), half of all U.S. pregnancies are unintended—with unintended pregnancies heavily concentrated among low-income women. The AJPH stated in 2014 that “decades of research have documented the reach and impact of publicly supported family planning services in the United States,” and, “the public investment in family planning programs and providers not only helps women and couples avoid unintended pregnancy and abortion, but also helps many thousands avoid cervical cancer, HIV and other sexually transmitted infections, infertility and pre-term and low birth-weight births.”

That’s a substantial impact on individual lives, entire communities and taxpayer purse strings.

A 2013 Guttmacher Institute study showed that, in 2010, with 8.9 million low-income women receiving publicly supported family planning services, an estimated 2.2 million unintended pregnancies were avoided, also averting 1.1 million unplanned births, 760,000 abortions and 360,000 miscarriages. This also gave the government a net savings of $13.6 billion in 2010, which breaks down to the $7.09 saved for every one public dollar spent, cited by Mikolajczyk.

Researchers are quick to point out that these already sizeable impacts tell only a portion of the story, as other studies have dug even deeper to include public cost savings related to avoiding costs for social services for infants and young children.

“If anything our cost savings estimates are probably too low,” says Mikolajczyk. “Because the impact over time of preventing an unintended pregnancy and giving someone the freedom to get through school or space pregnancies to have healthier outcomes and make sure they’re able to work when they want to work and able to pay for day care—those results are sort of immeasurable, so the impact will be longer lasting and has way more savings than we can even calculate.”

Approximately 85,000 Nebraska women ages 20 to 44 do not have private insurance and are in need of publicly funded family planning services.

“What [the Family Planning SPA] would do is raise the ceiling for family planning services to 185 percent of the federal poverty level, which would bring in tens of thousands of Nebraskans who would be able to get long-acting reversible contraceptives (LARCs) and sexually transmitted infection (STI) and health screenings. It would really be an amazing economic bill for the state of Nebraska and I think that’s something we have to focus on,” says Mikolajczyk. “Increasing access to healthcare, helping people decide what their family is going to look like and when, and saving the state money are the three key benefits of this bill.”

Mikolajczyk also notes the success of states like neighboring Colorado, which saw substantial results from its Colorado Family Initiative, a five-year pilot program that, through a private donation of $25 million, offered no- or low-cost LARCs to low-income women via 68 clinics statewide. According to data from the Colorado Department of Public Health, birth and abortion rates among Colorado teens declined by 48 percent between 2009 and 2014 when the policy was piloted. State officials also noted nearly $79 million was saved between 2010 and 2012.

“So, we know increased access to family planning works because of incredible results like those,” says Mikolajczyk. “It was good for people and the state saved an enormous amount of money.”

Although the specifics vary, 27 states already have some type of Medicaid Family Planning Program in place.

“These kinds of measures allow individuals, particularly women, to lead healthier lives and to be independent,” says Sofia Jawed-Wessel, Ph.D., assistant professor in Public Health and Women’s & Gender Studies at University of Nebraska Omaha, and associate director of the Midlands Sexual Health

Research Collaborative. “People often think such measures will make people dependent on the government, but no, this is what makes folks independent, by allowing individuals to decide when they want to have children and, if they choose to do so, to be able to do so independently.”

Jawed-Wessel notes that she herself is a success story, having benefited in this way from accessing assistance with contraception and family planning when she was in her early 20s.

“I wouldn’t be where I am today if I didn’t have that access,” she says. “I’m lucky I was able to navigate that, but we should make that available for everybody, not just people who already have a full-time job with access to good insurance that allows them access to reproductive care and family planning services.”

Schumacher agrees that a Family Planning SPA in Nebraska would aid independence and economic self-sufficiency, with positive ripple effects throughout communities.

“To the extent that people are able to plan their reproductive lives and avoid pitfalls of unplanned events and able to complete their education and create a stable family situation prior to having children, that’s an immense quality of life issue and it’s good for everyone to be able to have that control over their well-being, their future, and their employment,” says Schumacher. “At the same time, by not having adequate and reasonably economical access to the tools to be able to do that, you create situations where children are born into worlds where there’s just not enough time, financial resources or skills in order to raise them properly, and that has an effect on our educational system, on our criminal justice and juvenile systems, and it causes us additional expenses for various social welfare and aid programs—all of which impact the taxpayer at a time when there is a real shortage of government resources and tax money.”

Jawed-Wessel says adopting a Family Planning SPA in Nebraska would trigger a positive “domino effect” for individuals and communities where reducing unintended pregnancies that result in births is also statistically likely to reduce the number of children in foster care or up for adoption, lower the number of families that need government assistance, and reduce unemployment rates.

“That’s good for the community because that’s money that can be spent in other ways,” she says. “Once again, it also leads to individuals who are more likely to thrive, be in school, stay in school, be educated, get the job they want, be able to support themselves, and have healthier pregnancies when they do occur. It frees up resources so that we can pay attention to other areas that don’t have a solution yet. We have a solution for this, so let’s use the solution that statistically we know is going to work.”

Jawed-Wessel adds she would support the Family Planning SPA even if it didn’t offer such dramatic cost savings to the state, because public health improves communities in other impactful ways.

“I want everyone to have as much access to their independence and their health as possible,” says Jawed-Wessel. “If we want a better, more thriving community we need healthy people.”

In 2014, Nebraska reportedly had 14,000 unintended pregnancies, which is about 41 per every 1,000 women in the state. Beyond the benefits of contraceptives offered by the Family Planning SPA, increased STI screenings and treatments are particularly meaningful in Douglas County, which, since 1998, has consistently reported gonorrhea and chlamydia rates well above state and national rates.

“What’s meant by family planning in terms of this policy is contraceptives, LARCs, and well-woman checks,” says Mikolajczyk. “Part of the bill will be that none of these funds can be used for abortion. We saw this get derailed two years ago [when Senator Jeremy Nordquist introduced a similar bill, LB77] because people were panicking that the funds would be used for abortion. Medicaid funds, under the Hyde Amendment, cannot be used for abortion anyway, and the policymakers in Nebraska have pretty historically said that state funding will not go toward abortion. So people should rest easy that these funds will only be used for preventing pregnancies from happening in the first place.”

Additionally, Jawed-Wessel says research backs up the fact that greater access to family planning services and contraceptives greatly reduces the number of abortions—which should give the Family Planning SPA greater appeal to those in the anti-choice camp.

“Increased access to family planning services decreases unintended pregnancies, and out of all unwanted pregnancies, about 40 percent lead to abortions. So family planning access measures like this reduce the number of abortions,” she says.

Schumacher says discussion on LB77 was also derailed by concerns about providers.

“It got bogged down in who would be the providers of the services: the family planning information, facilities and the actual IUDs or contraceptive pills and such. That pulled us off on a tangent that had religious overtones and it went nowhere,” he says.

But in 2017, Schumacher hopes to keep the focus on how fiscally conservative and socially responsible a Family Planning SPA would be.

“I’m approaching this from a very conservative perspective: What happens if we don’t provide the legislative bill? We pay the bill,” says Schumacher. “The focus should come down to: How do you provide contraception access—and avoid effectively paying the bill down the road—to a population who could have their quality of life substantially improved [through this bill].”

“It’s important to separate out the politics from recognizing that people need access to good healthcare,” says Mikolajczyk. “For people on the border of poverty, this may be the thing they need to be self-sufficient. That has a huge impact to the well-being of Nebraskans—just general quality of life—and I truly believe every Nebraskan wants a good quality of life for other Nebraskans. We are ‘Nebraska Nice,’ right? It’s just how we get there…so we have to use every argument in our toolbox to talk about this piece of legislation, to appeal to what matters to each senator.”

Jawed-Wessel also believes people care about their fellow Nebraskans, and advises we speak up on each other’s behalf.

“We need to be vocal about it. Everyone says this over and over again, but it’s so true: Calling your local legislators and policymakers is important. They need to know that you care. People need to make their voices heard. Especially in this case, where this is something that’s actually going to save us money and provide important preventative care. It’s in everybody’s best interest, not just women’s best interest. It’s a no-brainer,” she says.

Because of the wide financial appeal of this policy, Mikolajczyk suggests being ready to bring it up when discussing a number of other fiscal issues.

“People can advocate by meeting their senators where they’re at and explaining why it’s important for their districts and why as a constituent you hope they will get on board. Find more people that care and have them do the same thing,” she says. “Be ready to talk about it and pivot to it. We’re talking about a billion dollar budget deficit—every time that budget deficit comes up, we can all take the time to bring up this bill and how it saves money that could then be spent elsewhere. This is something we can pivot to on a variety of topics, like prison reform, for example. We should all care about the fact that this bill is going to save our tax dollars and allow us to use them to fund the projects we need.”

Mikolajczyk sees an opportunity here for nonprofit organizations, medical professionals, business owners, faith leaders and others in Omaha and throughout the state to rally together around this policy to see common goals achieved. In this respect, she says, communication is essential to success. She also stresses the importance of sharing personal stories relevant to the issue.

“We need to know how people who didn’t have access to family planning were impacted in a positive or negative way, and if there were financial or health implications as a result,” she says. “We need to people to share their stories about why this is so important and really put a face with it as well.”

Schumacher echoes the importance of personal testimony in front of the legislature.

“I think that folks showing up at the public hearing on a bill, showing public support and giving short testimony is extremely helpful in educating a constantly changing group of senators,” he says. “And, particularly in this age, focusing on how something is financially a smart idea goes a long way.”

Beyond discussions with Nebraska lawmakers, Jawed-Wessel says when advocating for any issue we care about, we should all take more time for good, old-fashioned conversations with our friends and family.

“We need to spend more time talking to one another, because we’re forgetting to bring other people along with us by engaging them. Those face-to-face conversations can mean so much, and we shouldn’t be so afraid to talk politics with our families and friends. The personal is political, and often when we do have these conversations, we find there’s a lot more middle ground than we’d have guessed. For example, people hear ‘family planning’ and think abortion, but that’s actually not a part of this legislation at all. It’s about health care and contraception. So having that conversation and educating someone about what this bill is and is not about can be really important and helpful. When you do end up sharing the facts, people tend to agree more than they disagree,” she says. “Not just a Facebook post, not just a message, we need to talk to one another. And we can’t expect change to happen overnight—we need to have these conversations repeatedly.” W

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