Increased access to family planning, preventive health services proposed

A bill that would expand eligibility for the state’s publicly funded family planning services and increase access to preventive health care was heard March 15 by the Health and Human Services Committee.

LB120, introduced by Columbus Sen. Paul Schumacher, would require the state Department of Health and Human Services (DHHS) to submit a state plan amendment to the federal Centers for Medicare and Medicaid Services no later than Sept. 1, 2017, to provide medical assistance for family planning services to individuals with a family earned income at or below 185 percent of the federal poverty level.

Under the bill, family planning services would include coverage for all federally approved family planning methods as well as training in parenthood and education in the financial, career and generational implications of pregnancy and child rearing.

Schumacher said low-income individuals often do not understand the long-term consequences of unplanned pregnancies and become mired in a cycle of poverty.

“Anything we can do to help people from being trapped in the world of dependency – which limits their potential for their own development and for their contribution to society – we should try to do,” he said.

The bill also would appropriate $500,000 in general funds in fiscal year 2017-18 and FY2018-19 to DHHS. The funds would be directed to the Every Woman Matters program for services including mammograms, breast examinations, Pap smears, colposcopy, associated laboratory costs and education and outreach.

Testimony focused on the portion of LB120 that would expand family planning services.

Sarah Ann Kotchian, testifying on behalf of the Holland Children’s Movement, supported the bill, saying it would improve health outcomes, reduce unintended pregnancies and save the state money.

Citing a report on teen pregnancy in the state, Kotchian said the economic impact of those pregnancies is stark. She said the cost to the state of the 1,411 children born to Nebraska teenagers in 2014 is projected to be $279 million by the time they turn 18. That figure does not include public housing, foster care, incarceration or other likely costs, she said.

“Bottom line: unintended pregnancies come with a very real cost,” Kotchian said.

Dr. Sofia Jawed-Wessel, a public health professor at the University of Nebraska at Omaha, also testified in support. Providing expanded access to family planning services may seem costly, she said, but unwanted and mis-timed pregnancies have significant negative consequences for individual women, their families and society as a whole.

She said that 43 percent of all pregnancies in Nebraska are unintended and highly concentrated among poor women who need public assistance for the costs associated with their pregnancies.

“Access to modern contraception, screening for sexually transmitted infections and preventative screenings are a vital component of public health,” Jawed-Wessel said.

Bryn Willson, a senior medical student at Creighton University School of Medicine, testified in support of the bill as well. Having children too soon or without sufficient time between pregnancies has negative outcomes for women and children’s health and family self-sufficiency, she said.

“Women spend the majority of their reproductive years wanting to avoid pregnancy,” Wilson said. “Allowing women to determine whether and when to have children is a social imperative.”

Calder Lynch, director of the DHHS Division of Medicaid and Long-term Care, testified in opposition. While the bill may result in savings in future years, he said, the up-front costs are known and significant. The division would need eight additional staff members to process applications for an anticipated 15,000 new enrollees, he said, at a cost to the state of approximately $1.95 million in the first fiscal year.

“We can’t count on the savings, but we can count on the costs,” Lynch said.

Tom Venzor, testifying on behalf of the Nebraska Catholic Conference, also testified in opposition to the bill. He said studies show that state-financed expansion of access to contraception has not always reduced unintended pregnancies or resulted in cost savings.

In addition, he said, research shows that women choose not to use contraception because of its failure rate and side effects, not because they cannot afford it. For example, he said, a Guttmacher Institute study showed that only 13 percent of women cite lack of access – which includes high cost – as a barrier to using birth control.

“The cost-savings argument behind this bill is deeply flawed,” Venzor said. “There is also no meaningful data to support the claims that free contraception causes improved women’s health.”

The committee took no immediate action on LB120.