Texas versus the U S State and Federal Funding for Family Planning

Women’s Rights and Funding for Family Planning at the National and State Levels

The debate over whether women actually need any special legal protections beyond those enumerated in the U.S. Constitution as well as proper funding levels for family planning needs has been a source of concern among policymakers at the state and federal levels for decades. State-level proponents of increased federal funding cite the continuing disparities in earning between male and female workers in the United States, but they also argue that additional family planning is an absolute necessity in order to address this broad-based problem because of the additional burdens that unplanned children place disproportionately on American women, most especially those who are already struggling to survive below the national poverty level despite working at a full-time minimum wage job. Conversely, national policymakers maintain that simply throwing more money at the problem without other social programs and incentives is a waste of scarce taxpayer resources and the states should do more if they feel it is needed. Against this backdrop, it is important to identify the antecedents of this policy relationship in order to formulate optimal strategies for the future. To this end, this paper reviews the relevant juried literature together with reliable supplementary resources to describe the major issues facing the U.S. and Texas governments with respect to women’s rights and funding for family planning followed by an analysis concerning the most salient reasons for initiating changes to the existing policy. In addition, a description of the options that must be considered together with an assessment of their respective pros and cons are followed by a discussion concerning the optimal option for the future. Finally, a summary of the research and the key findings that emerged from the peer-reviewed and supplementary literature concerning these issues are provided in the paper’s conclusion.

From a strictly pragmatic perspective, the major issues facing state governments include the need to receive more federal money than states pay the U.S. government. For instance, Scarboro points out that, “State-level taxes may be the most visible source of state government revenues for most taxpayers, but it’s important to remember that they are not the only source of state revenue. State governments also receive a significant amount of assistance from the federal government” (2). Moreover, some states such as Mississippi consistently receive far more federal money than other sometimes-donor states such as Texas, making this a highly disputatious issue at the state and federal levels. For example, studies sponsored by the Kaiser Family Foundation have determined that, “The federal government pays 90% of all family planning services and supplies, and states pay 10%. This is considerably higher than the federal match that states receive for most other services, which ranges from 50% to 78%, depending on the state” (Ranji, Salganicoff and Sobel 4).

Because the type of initiative or capital investment projects that are involved in states securing federal funding have a major effect on their approval, controversial issues such as women’s rights and funding for family planning naturally stand a lesser chance of succeeding in obtaining federal funding, especially if states have significantly different laws and regulations on their books in these areas compared to the national government. As Bailey emphasizes, “Family planning policies (i.e., those increasing legal or financial access to modern contraceptives and related education and medical services), have grown increasingly controversial over the last decade” (343).

The origins of the current controversy over federal support for women’s reproductive rights and funding for family planning, though, date back to the mid-20th century. Some evidence in support of this timeline can be discerned form an early debate over federal and state funding levels for family planning, with some states attempting to apply what can only be described as social engineering to the problem. For example, according to Welch, “In the 1960s, calls for women\\\'s reproductive rights swelled, birth-control advocates demanded that poorer women be granted greater access to contraception. But these demands were tailored to the federal government\\\'s growing focus on fighting poverty and a national perception that ‘overpopulation’ had become a problem, rather than speaking the language of women\\\'s rights” (221). In sum, despite the purported intentioned goals of federal funding for family planning, state-level policymakers – and even federal lawmakers from such states – have consistently attempted to subvert the process to the detriment of the intended lower-income female beneficiaries of these programs. Indeed, according to Welch, during the 1960s:

Expanded access to birth control was essential to limiting the numbers of poor people. Arkansas\\\'s example illustrates how, historically, choices about whether and when to have children have been inextricably linked to women\\\'s economic situation and how birth control initiatives were often justified as instruments of control rather than individual self-determination. (223)

Given that individual self-determination is at the heart of women’s reproductive rights, the rationale behind the bipartisan support of federal funding for family planning during the 1960s must be regarded as the results of a cold-blooded cost-benefits analysis that ignored these fundamental rights in an effort to reduce the more expensive long-term costs of welfare caused by unplanned pregnancies. In this regard, Welch reports that there was widespread bipartisan support for family planning funding by the federal government during the Kennedy and Johnson administrations for this very reason: “In the 1960s, both Democrats and Republicans supported federally funded family planning, hoping to contain rising welfare costs” (244). As discussed further below, even federal policymakers from states such as Texas were advocating federal funding for family planning specifically to reduce the welfare burden imposed by lower-income women, most especially minorities. As then-Republican congressman George H. W. Bush of Texas pointed at the time, “Our national welfare costs are rising phenomenally [and] that [blacks] cannot hope to acquire a larger share of American prosperity without cutting down on births\\\" (as cited in Welch 224).

These policy changes were regarded as being absolutely essential to the nation’s future since the percentage of recipients of public welfare assistance had increased significant in the preceding years following the amendment of the Aid to Dependent Children initiative in 1961 to include two-parent families at which point the legislation was renamed the Aid to Family with Dependent Children (Welch 225). This single policy change resulted in a dramatic increase in the numbers of federal welfare recipients. In fact, the number of federal public assistance recipients nearly doubled from 4.3 million in 1965 to more than 8.5 million by 1970 following the reform of the Aid to Dependent Children law (Welch 225). In 1970, support from Republican President Richard M. Nixon helped to pass the first federal legislation that authorized a national family planning program due to continuing increases in the welfare rolls (Bailey 343).

In response to these massive increases, bipartisan support for federal family planning funding came under increasing scrutiny during the 1980s and by the mid-1990s, the U.S. government began pursuing a number of additional initiatives that were targeted at improving the effectiveness of federal programs targeted at family planning at the state level, including initiatives such as the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 which was subsequently revised by the provisions of the Aid to Families with Dependent Children followed by the Temporary Assistance for Needy Families (TANF) initiative (Hawkins and Amato 502).

The TANF in particular represented a fundamental shift in policy because it provided states with greater flexibility in how they administered federal monies. For example, according to Hawkins and Amato, “Under TANF, the federal government provides funds to states in the form of block grants, and states have some discretion in how this money is used” (502). A noteworthy provision of the TANF initiative was the ability of states to apply these federal funds to family planning efforts, including the preservation of what was then regarded as the traditional American two-parent family. In this regard, Hawkins and Amato add that, “In addition to helping needy parents and children, states can use these dollars to . . . reduce the frequency of nonmarital pregnancies, and encourage formation and maintenance of marriages and two-parent families” (502).

The success of these federal policy goals encouraged growing numbers of states to identify additional opportunities to use federal TANF monies to preserve healthy two-parent families, a trend that received additional support after funding by the Administration for Children and Families (ACF) started supporting pilot research and demonstration programs in the early 2000s (Hawkins and Amato 502). These pilot programs included three large multi-state initiatives that were targeted at (a) evaluating the effectiveness of community-level support for healthy marriage initiatives; (b) low-income unwed expectant parents; and, (c) low-income married parents (Hawkins and Amato 502).

In 2006, the policy that provided federal money to support healthy marriage initiatives expanded further when the TANF program was reauthorized pursuant to the provisions of the Deficit Reduction Act of 2005 (Hawkins and Amato 502). This expansion, though, included a specific allocation of $100 million of federal money to support a 5-year voluntary educational program for healthy marriage initiatives as well as $50 million each year targeted at promoting responsible fatherhood initiatives (Hawkins and Amato 502). Although representing just a miniscule percentage of the total federal funding for health care services in the United States, these modest initiatives were found highly effective in promoting healthy marriages among the targeted recipients (Hawkins and Amato 502).

Despite the demonstrated effectiveness of these federal funding initiatives, there are several reasons for initiating changes to the existing policy. For example, some states such as Texas have relentlessly applied their own moral priorities to family planning by reducing funding levels for some initiatives and completely eliminating others at the risk of losing future federal funding which is regarded as a lesser priority (Bailey 342). In this regard, Bailey reports that, “In 2010 and 2011, congressional Republicans supported proposals to cut family planning funding through Title X of the Public Health Service Act, which funds U.S. family planning clinics serving over 4 million women” (342).

As noted above, however, federal funding for family planning had enjoyed long-term bipartisan support dating to the mid-20th century, and these Republican proposals represented a stark departure from this trend (Bailey 342). The nationwide network of public sector providers and family planning programs have provided support for millions of American women over the past several decades, but that network is currently crumbling in spots (Ranji et al. 3). At present, the reproductive planning provisions contained in Title X Family Planning Program, Section 330 of the Public Health Service Act and Medicaid are the main sources of federal funding for the national network of more than 10,000 so-called “safety-net clinics” that offer family planning services to women and families in need (Rangji et al. 2).

Recent rumblings in the U.S. Congress and Executive branch, however, signal a sea change in the bipartisan support that has existed for these services, even if the political impetus was focused more on reducing long-term welfare costs. For example, Rangji et al. emphasize that, “The Trump administration and the Republican leadership of the 115th Congress have proposed to block federal Medicaid funds from going to Planned Parenthood, a safety-net provider that delivers a wide range of reproductive health services and cancer screenings to more than 2.5 million women” (5). Further, the executive branch’s originally proposed budget for fiscal year 2018 would have slashed Title X and community health center funding for 18% if it had managed to pass congressional muster (Rangji et al. 5).

The president’s untimely proposed cuts to federal funding for family planning have been perceived as unfairly targeting the very people these programs are intended to help (Petruney, Wilson and Stanback 48). Any changes in policy that further reduce federal funding for family planning services will invariably have an inordinately adverse effect on already marginalized populations. As Rangji and her associates conclude, “Changes to these programs and funding to the clinics that provide family planning services could limit the availability of contraceptive services, sexually transmitted disease screenings and treatment, and preventive cancer screenings, along with other primary care services to low-income women” (5). Unfortunately, low-income women are also at greatest risk of contracting a sexually transmitted disease as well as becoming pregnant unintentionally and having an abortion, all the while lacking the same levels of access to family planning services as their more affluent counterparts (Ranji et al. 5)

Complex problems, of course, usually demand complex solutions and that is certainly the case with federal support for women’s reproductive rights and funding for federal planning. While the pundits and policymakers continue to debate the fine points, there are several options that can be considered at present. For example, one option to the resolution of the current controversy over federal funding of family planning at the state level would be to eliminate federal funding altogether and place this financial burden directly on the states where some authorities believe it belongs in the first place. A second option would be to provide family planning services through the federal government’s existing national network of Department of Veterans Affairs (VA) health care resources. A final option would be to retain the status quo and allow states to continue to administer federal funds for family planning according to their own priorities and refuse these monies when these priorities conflict.

Not surprisingly, there are some significant pros and cons that are associated with each of these alternatives. The main drawback to the first option, eliminating federal funding for family planning altogether, would adversely affect those most in need of such services. Critics of big government, though, charge that the federal government’s efforts to support women’s reproductive rights and fund family planning services at the state level are not only exorbitantly expensive, these efforts are ineffective and misplaced, preferring to allow states to assume this burden themselves.

The main advantage to the second option, transferring the responsibility for federally funded family planning services to the VA is the fact that this organization already has the infrastructure in place and women in every state could access these services irrespective of their respective state’s policies. Moreover, many VA facilities are located in rural regions of the country as well as in inner-city urban regions, making them readily accessible. This option is also consistent with existing federal legislation concerning how states must administer Medicaid funds for family planning: According to the Kaiser Family Foundation:

· Medicaid beneficiaries have “freedom of choice” to obtain family planning services from any provider participating in the program, even if the beneficiary is enrolled in a managed care plan and the provider is outside of the plan’s network; and,