Washington State Slashing Family Planning, Maternity Care

Low-income pregnant women, women who rely upon Medicaid for family planning and other reproductive health care, and children in Washington state will soon feel the force of a crippling recession and a budget which desperately needs balancing.

The Department of Social and Health Services (DSHS) in Washington announced budget cuts last night, across the board, for what are deemed “optional” services. From Take Charge, the family planning program which provides free birth control and family planning to low-income women and men, to Maternity Support Services, which covers one out of every three pregnant women in the state, Medicaid programs are being slashed. Included in the cuts are subsidized health insurance coverage for children, pharmacy benefits and dental care for adults, hospice care and much more. According to The Olympian, state Medicaid director, Doug Porter, considers the cuts “devastating” and “radically altering the face of the medical programs” created by Medicaid.

Washington state’s pro-choice Governor Gregoire may have little choice but to move ahead with these cuts. The state is facing an immediate $520 million budget shortfall and with a state mandate to have a balanced budget, this round of cuts is just the first. Governor Gregoire will review the cuts proposed by DSHS and make her announcement sometime between October 1st and October 15th.

It’s hard to imagine, however, how the state’s most vulnerable women and children will access crucial health care otherwise. When it comes to prenatal care for pregnant women, including referrals for domestic violence services, drug treatment, breastfeeding, nutritional services and more; as well as family planning programs; and health care for children, the initial investment saves money down the road. Will these cuts to critical interventions mean short-term savings with no long-term benefit?

MaryAnne Lindeblad, Director of the Division of Healthcare Services for DSHS in Washington State, told RH Reality Check, in essence, that may be true:

“The state has a constitutional requirement to operate a balanced budget and we have to make cuts to get to the end of the fiscal year. Medicaid is even more limited. Cutting optional services is our only choice. It’s hard to quantify but there will be outcomes from that, which will end up costing us in the long run. It’s hard to put a number on it, but yes.”

But Planned Parenthood of the Great Northwest’s political action arm, Planned Parenthood Votes! Washington, as well as Public Health of Seattle and King County can put specific numbers on it.

According to Planned Parenthood Votes! Washington, cutting the state’s Take Charge program will will save, reportedly, only $1.2 million per year, but will result in new costs of $50 million per year associated with unintended pregnancy. Cutting this family planning program for those who are not eligible for other Medicaid programs and who do not have insurance, also means turning down federal matching dollars. The Washington State Take Charge program receives nine dollars in federal funds for every $1 the state invests. Without the state expenditure, the state will no longer receive federal funding for Take Charge.

Who will feel the brunt of the cuts to the Take Charge program?

The 43,000 women and men per year who rely on the family planning program to avoid unintended pregnancy. Since 2001, 400,000 Washington residents have used Take Charge to protect against unintended pregnancies. According to the Guttmacher Institute, without the program, this translates into approximately 17,000 abortions per year.

And while Lindeblad told RH Reality Check that some of these clients can still utilize community health centers, family planning clinics or purchase contraception over-the-counter at pharmacies, there are sliding-scale payments or full payments associated with all of these options, if Take Charge isn’t available. If one’s options are “choosing” between paying for food, rent and clothing for ones’ family or paying for contraception, it’s not hard to see the impact of slashing a program like Take Charge on the lives of Washingtonians. In fact, notes PP Votes! Washington, this program “supports families teetering on the edge of poverty, for whom the costs associated with an unintended pregnancy could mean hunger, homelessness or worse…”

The proposed budget cuts to family planning, therefore, mean more births and more births to those women living in the lower income levels of the state, which means more women who must rely on Medicaid funding for prenatal services, costs associated with childbirth care, and postpartum care. However, funding for the First Steps Program (which includes Maternity Support Services (MSS), Childbirth Education and Infant Case Management) is also being cut.

According to DSHS, they have proposed $6.4 million dollars in cuts from programs designed to help low-income pregnant women and their infants in the state. One out every three women who give birth in the state receive support from MSS. In 2009, the program served 30,000 women in one single county alone. The program helps ensure better birth outcomes by providing a range of services for pregnant women including nutritional services, physician referrals, childbirth education, health screenings, tobacco cessation assistance, drug treatment and more. These sorts of programs are also crucial to improving infant health, preventing low birth weight births and lowering infant mortality rates. Cutting funding for this program places women and infants at risk.

And, as with Take Charge, Maternity Support Services receives federal matching dollars. Without the state funds for this program, millions of federal dollars which help support low-income pregnant women and families in the state also disappear.

It’s a dire situation and one only expected to get worse. The one sliver of hope, however, might be found in a state income tax proposal on the ballot this November. It’s backed by two of the state’s wealthiest – and most well-known names – Bill Gates, Sr. and Bill Gates, Jr.

Currently, public health funding in Washington state has no dedicated funding stream. It’s why cuts seem to be continually coming down the pike when it comes to health care (and education, as well). In 2009, maternity support services were already cut. And, when the state’s biennium budget is proposed soon, more cuts will likely be included.

There is no income tax in Washington state. Initiative 1098 establishes an income tax for the wealthiest citizens of Washington state, taxing individual incomes above $200,000 and couples with incomes above $400,000. It would raise approximately $2 billion in sorely needed funds for both healthcare and education in the state. While opponents argue that the lack of an income tax is partly what attracts talent to local companies like (ironically) Microsoft and Amazon, proponents say the time is not just right – it’s far past time. Under this current round of cuts, for example, 27,000 children in the state of Washington will lose health care coverage.

Most of the proposed cuts, if agreed upon by Governor Gregoire, are scheduled for January 2011, while some requiring legislative action won’t be in effect until March 2011.

For public health advocates, public health staff and Washington residents who rely on these programs, the cuts announced yesterday will have a devastating effects on people’s lives. With a multi-million dollar budget shortfall, however, many are wondering what’s next.

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  • radicalhousewife

    Really?  These kinds of services are OPTIONAL?  This is so infuriating. 

  • amie-newman

    they are, amazingly, considered optional. The larger issue in Washington State is that since there is no dedicated funding stream for these sorts of public health programs, residents (of which I am one) are constantly facing cuts. When we’re facing deficits or needing to cut something, it’s always health care which ends up on the chopping block. Education must be constantly funded by levies and such. We’re dependent upon “creative” solutions (we’ve already got an extremely high sales tax which helps fund public safety) like a potential state income tax (on the top 1% of earners in the state) to fund health care and education. It’s a mess and it ensures that, as many have said, we end up spending a whole lot more than we need to since funding prevention/preventative services is much more cost effective and when we cut state funds we’re also cutting our ability to receive federal funds!!!

  • leftcoaster

    Washington has always been among the most generous of all states in subsidizing reproductive health care and maternity care. They still are when it comes to offering free elective abortions to women who are above the poverty line. This is, as Amy says, a case of a dry revenue well. The state income tax initiative will not pass, because in this bizarre society, the lower-income masses have been inundated with hints that they, too, may be rich some day; or that imposing taxes on some and not others is “unfair” (not realizing they pay a FAR greater percentage of payroll taxes than do their wealthy counterparts).

    I left Washington this summer for California, another struggling state. But at least CA implements a more progressive tax-collection method.

  • leftcoaster

    that WA is one of the only — if not THE only — state which has on its books a citizen-passed law codifying the tenets of Roe, just in case a rightwing High Court overturns it. Abortion will always be safe and legal in Washington state.

  • amie-newman

    You are absolutely right that Washington state is an extremely progressive state in terms of our laws related to reproductive rights. We do have our own version of Roe v. Wade and we do have school health centers which provide care, referrals, birth control. We also, as you note, allow for Medicaid funded abortion care as well. I

    That said, as you mention, it’s extremely disruptive and ultimately not at all cost effective not to be able to rely upon public health funding. It’s a problem most of all, of course, for our state’s lower income women, men and children who rely upon these programs. When you cut public health programs and say, well, these folks can go to this location instead or go to this health center instead, you disregard the fact that transportation is an issue, the times at which these centers can serve certain populations vary, etc. I am always amazed at how many hoops those of us who do not have health care are told to jump through – if everyone in the U.S. needed to jump through these hoops for a single health care appointment, no one would ever go to the doctor!

    As well, it’s not as if we won’t pay for these health-care associated costs at some point – whether through emergency room care or maternity care after someone becomes pregnant or health care for infants born prematurely because pregnant women can no longer access affordable prenatal care.

    Finally, we’re also talking about (and I didn’t write about this) the public health staff who are laid off when cuts like these happen. They are also consistently under fire and afraid of losing or do lose their jobs. I really think this is about prioritizing all forms of public health and understanding how critically important this is, at the core of a healthy, functioning, equitable society. A progressive-led state like Washington should be a leader in this struggle!


  • leftcoaster

    It’s an age-old concept of funding things on the front end so they aren’t more expensive on the back end. That applies to family planning AND to health care in general. It’s all the more insidious that the Obama administration not only went along with restrictions on abortion coverage in his “reform” bill, but went farther even than Hyde in imposing bans on what states can cover with funding they get on a residual basis from the feds.


    If only you and I ran the state, Amie. :)

  • runningshoe