In Maine, women can have publicly funded health care cover the medical costs associated with pregnancy if they earn up to $23,340 annually. But those same women are not eligible for coverage for birth control or other preventive services.
The incomplete policy has harmed lives and the state’s Medicaid program, MaineCare. About half of all pregnancies in the state are unintended, according to the Guttmacher Institute. And two-thirds of the births resulting from unintended pregnancies are covered by MaineCare.
Maine should not prefer to pay for expensive care when it could instead pay far less for preventive measures, help women avoid pregnancies they don’t want and improve the health and living standards of families.
The Maine Department of Health and Human Services has the power to initiate a change on its own. It could submit a Medicaid state plan amendment to the federal Centers for Medicare and Medicaid Services to request coverage for preventive and reproductive health care for those earning up to 200 percent of the federal poverty level.
Doing so would provide the same level of coverage for family planning services that Medicaid already provides for pregnant women. The federal government would pay 90 percent of the cost. It has met that high match rate since 1972.
The LePage administration is unlikely to request this change on its own, however. So most in the Legislature want to make DHHS do it. LD 1247, sponsored by Rep. Jane Pringle, D-Windham — a doctor — would direct the department to submit a state plan amendment to expand Medicaid coverage for family planning services to adults earning up to 200 percent of the federal poverty level.
Doing so would improve access to contraception, pap smears, breast cancer and cervical screenings, testing and treatment for sexually transmitted infections, and wellness exams for those who are not eligible for Medicaid. The nonpartisan Office of Fiscal and Program Review estimates the change would save money: It would cost between $215,000 and $538,000 annually and save between $1.9 million to $3.3 million annually.
Abortion would not be covered under the bill. People who are pro-life should find this legislation easy to support because it would help reduce the number of unintended pregnancies and, therefore, the number of abortions. About 31 percent of unintended pregnancies in Maine result in abortion.
And it is those living in poverty who are seeking them: Nationally, 42 percent of women obtaining abortions have incomes below 100 percent of the federal poverty level, and 27 percent of women obtaining abortions have incomes 100-199 percent of the federal poverty level.
Birth control can be highly effective. U.S. women who do not use contraception consistently or at all account for 95 percent of unintended pregnancies, according to Guttmacher.
Opponents may say people should instead get private coverage through the insurance exchange under the Affordable Care Act. While some Maine residents will be able to get those subsidized plans, the poorest will not be able to afford them. Maine could opt to expand Medicaid to cover all services for low-income individuals — not just reproductive health — and then LD 1247 wouldn’t be as necessary. But if the Maine Legislature fails to approve the full expansion, at least people could still have this family planning coverage.
There are no good reasons to make it difficult for those with low incomes to access preventive care. This basic matter should have been settled years ago, freeing up the state to focus on other important issues, such as how best to ensure provider availability or perform outreach.
The Maine House voted 92-48 on Wednesday in favor of the bill. The Senate — and Gov. Paul LePage — should follow its lead.