The Obama Budget: Weak on Reproductive Health

Feb 9, 2015Andrea Flynn

Family planning is both vital for econoimc stability and a solid investment with strong returns, so why wasn't it better funded in the President's budget?

Family planning is both vital for econoimc stability and a solid investment with strong returns, so why wasn't it better funded in the President's budget?

Last week President Obama unveiled a 10-year budget that reflects the ambitious and progressive agenda he laid out in his State of the Union address. With investments in infrastructure, education, and economic supports for the middle class, the President’s funding plan aims to lift up low-income families and address the growing and historic U.S. class divide. But Obama has fallen short on one area that is critical to women and families: reproductive health.

There were hopes that the president would request a significant increase for Title X – the nation’s only program dedicated to providing quality, affordable reproductive health services – and also the repeal of the Hyde Amendment, a 1976 law that prohibits women from using federal health benefits such as Medicaid to pay for abortion, except in cases of rape, incest, or life endangerment. But Obama did neither.

Given conservative control of Congress, President Obama’s budget has little chance of being passed as is. But as John Cassidy pointed out in the New Yorker this week, the budget is as much a political document as it is an economic one. “The White House is using it to frame the political debate for this year and for the run-up to the 2016 Presidential election – an effort that began with the State of the Union address,” Cassidy wrote. Obama had an opportunity to show that reproductive health is a critical component of any agenda meant to lift up low-income families, and one the federal government must invest in if their other efforts are to bear fruit. But he missed that opportunity.

The president’s $300 million request was a modest increase from last year’s budget of $286.5 million – Title X’s first increase since 2010 – but still leaves the program woefully underfunded. Title X has still not recovered from the drastic cuts it endured between 2010 and 2013, when lawmakers cut the budget from $317 to $278 million, and as a result prevented 667,000 patients from receiving care. Family planning experts estimate that in order to completely fulfill the nation’s unmet need for reproductive health care, Title X would require somewhere in the ballpark of $800 million, a far cry from today’s budget.

Title X is like the little engine that could of public programs. It prevents more than one million unintended pregnancies annually, and thereby avoids nearly 600,000 unplanned births and more than 400,000 abortions. Without Title X, the U.S. unintended pregnancy and abortion rate would be 35 percent higher among adult women and 42 percent higher among teens. Not to mention that in 2010 every dollar invested in Title X saved $5.68. How’s that for a return on investment?

Not only is the program underfunded, but in states across the country conservative lawmakers have implemented restrictions that have prevented Title X funds from actually going to family providers, effectively chipping away at what was once a robust health safety net and exacerbating a pre-existing shortage of reproductive health providers. It is largely low-income women, women of color, immigrant women, and young women who are left without anywhere to turn for preventative care.

And what happens when those women find themselves needing to terminate a pregnancy? Between the restrictions set forth under the Hyde Amendment and the rapidly shrinking network of abortion providers, they have few options. In 1976 – just three years after the Supreme Court’s Roe v. Wade decision legalized abortion – Congress passed the Hyde Amendment and made abortion the only medical procedure ever banned from Medicaid. Ironically, Medicaid covers all the costs related to family planning and pregnancy.

By this point, you might be thinking this is all irrelevant, thanks to the Affordable Care Act (ACA). If only. While the ACA has extended care to scores of women who were previously uninsured, conservative opposition has diluted its potential impact and many people will remain without health coverage. Indeed, nearly four million women will be left without coverage this year thanks to conservative opposition to expanding Medicaid. In addition, federal restrictions ban many immigrants from Medicaid, the contraceptive mandate has been compromised and contraception is now your boss’s business, and this term the Supreme Court may very well take federal subsidies away from millions who need them in order to afford health insurance.

We need an increased investment in reproductive health now more than ever. If we are serious about improving the circumstances of low- and middle-income U.S. families, we must extend critical care and services to all of those who need and want them, and also shape the political debate in a way that will give all women and families all of the tools – not just a select few – that they need to thrive.

When the president, who espoused his support for reproductive rights in his State of the Union address, doesn’t push for a significant expansion of reproductive health care while he is putting his political capital behind broader education, income, and work-family supports, it signals that reproductive health, perhaps, is not as critical as these other issues. It suggests that with other supports women can lead economically secure lives, even if they cannot control their fertility and determine the timing and size of their families. That is simply not the case.

An agenda without bold investments in reproductive health is not a comprehensive agenda for women and families. And if women cannot access quality and affordable health care, they will not be able to make the most of the other important initiatives the president has proposed.

Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn.

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Daily Digest - February 9: Replacing Obamacare Without Real Care

Feb 9, 2015Rachel Goldfarb

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Under GOP Plan, Pay More for Junk Insurance, Leave More Uninsured (The Hill)

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Under GOP Plan, Pay More for Junk Insurance, Leave More Uninsured (The Hill)

Roosevelt Institute Senior Fellow Richard Kirsch breaks down the Republican plan for replacing the Affordable Care Act, which he says will allow barebones high-cost plans instead of real coverage.

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Much Stronger Job Growth is Needed If We’re Going to See a Healthy Economy Any Time Soon (Working Economics)

Elise Gould shows just how slowly the labor market is catching up to pre-recession levels at current rates. At 257,000 jobs per month, we'll be waiting until May 2017.

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Matt O'Brien points out that while the unemployment rate, which only accounts for those actively looking for work, isn't perfect, we don't have better measures of unemployment.

Consumer Protection Agency Seeks Limits on Payday Lenders (NYT)

Jessica Silver-Greenberg says that since payday lenders continue to morph their practices to evade state regulation, federal regulation has the potential to create broader change.

New on Next New Deal

The Obama Budget: Weak on Reproductive Health

Roosevelt Institute Fellow Andrea Flynn argues that when the president chooses not to push for better funding for reproductive health programs, he's saying the issue isn't critical.

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Get Young People Involved to Reduce Chronic Disease

Feb 6, 2015Raymond Dong

A youth advisory committee for the Department of Health and Human Services has the potential to reduce the costs of chronic disease for generations to come.

A youth advisory committee for the Department of Health and Human Services has the potential to reduce the costs of chronic disease for generations to come.

In the United States, chronic diseases including heart disease, stroke, cancer, diabetes and obesity are among the most common, costly, and preventable of health problems. Half of all adults have one or more chronic health conditions, and seven out of the top ten causes of death in 2010 were chronic. As chronic disease is projected to increase to 171 million patients by 2030, the $2 trillion in healthcare spending in this arena is also projected to skyrocket. The CDC says that eliminating three risk factors (poor diet, inactivity, and smoking) would prevent 80 percent of heart disease and stroke, 80 percent of type II diabetes, and 40 percent of cancer. Recent research by University of Chicago Nobel laureate economist James Heckman shows that high-quality childhood development programs with health care and nutritional components can prevent or delay the onset of chronic disease.

The U.S. government has instituted policy and programs targeting lifestyle changes in youth, such as Let’s Move and the Health Hunger-Free Kids Act. The Let’s Move campaign strives to solve childhood obesity through healthier foods and more physical activity; the Health Hunger-Free Kids act let the Department of Agriculture set portions and nutrition standards for school lunches.

These two programs have not had tremendous success. Many schools have complained about the food portions being too small and the food tasting bad, to the extent that many students are refusing to eat these meals and go hungry. Wealthier schools are even backing out of the national program to self-fund food students prefer. When students do not eat the revised federal school lunches, schools also lose money, which may lead to budget cuts in other programs. Meanwhile, a 2012 CDC survey showed that merely one in four U.S. kids aged 12-15 met the criteria for physical activity recommended by Let’s Move.

Although youth are in a powerful position to understand the rationale behind lifestyle decisions of their peers, there is currently very little youth representation in the Department of Health and Human Services. Youth have the potential to help create innovative projects and policy to address these childhood lifestyle issues, but lack the voice to do so.

It would be extremely beneficial for the HHS to create a youth advisory board to the U.S. Department of Health and Human services to increase youth engagement in preventing chronic diseases. In order to guarantee a diverse board, HHS would operate a national competition and a rigorous interview process to select a ten-member advisory board. A staff member from HHS would be designated the task of constructing this board and advising it. This proposal stems from the impact the U.S. National Commission for UNESCO’s youth advisory board has had in areas in which older adults have been unable to serve. The youth board utilized technology and social media to connect over 1,500 youth from 120+ countries in conversation on culture, science, and education.

The proposed HHS youth advisory board would be largely unfunded, as they would implement inexpensive projects. They would engage youth with policy and programs centered on improving lifestyles harmful to long-term health. The first project could be a social media campaign (Twitter chats, Google Hangouts, Facebook groups) to spread awareness and to promote conversation on the importance of exercise, nutrition, and banning tobacco in order to prevent chronic disease. After hearing conversations from youth across the country, the board could then work with the HHS to implement specific programming at their local schools. This could include giving schools recommendations on adding healthier food options or incorporating more nutrition education into classes.

The board could also spend time simplifying WHO, CDC, and World Bank reports on health and chronic disease to make them directly pertinent to youth. The committee could also host a nation-wide competition (in conjunction with private and public partners) to encourage youth to submit innovative ways to improve health practices. Similar competitions have been hosted by the U.S. Federation of UNESCO Clubs to engage hundreds of youth around the world on pressing social issues.

There are certainly a few potential obstacles that could hinder the creation of an HHS youth advisory board. One possible concern is that youth do not have the experience or capability to contribute to HHS projects on a national scale. This can be addressed by looking at the impact that many other youth advisory committees have had. When Dell wanted to enhance technological environments in the classroom, they called upon a youth advisory board to launch a national competition to help achieve the goal. The U.S. National Commission for UNESCO wanted more youth engagement in culture, science, and education; they called upon 10 young people to spearhead a global project connecting teens to UNESCO’s ideals.

A second concern would likely be that the youth advisory board requires a member of the HHS to advise them. This will require a significant time and commitment for that staff member during the initial formation of the group, but afterwards the advisory role would be much lighter. The current advisor to the UNESCO board sits in on one conference call every 2-3 months and is copied on emails to keep up with the board’s projects. Of course, the advisor would have to approve new appointments to the board every year as older members transition out of the board. Asking for time from a staff member is justified because the advisory board has the potential to increase information dissemination and penetration into an increasingly important youth audience.

A last concern would be how to fund the committee. Most of the projects and initiatives can come at a low cost since spreading awareness and information dissemination can largely be done over social media. In the case that money is needed to execute a program in a school, the federal government should allocate funds to such ideas to promote youth innovation and awareness in these healthcare issues.

It is important for the department of HHS to listen to such a proposal asking for an increased youth presence. Youth represent 14 percent of the total U.S. population and have a very large stake in total healthcare costs and outcomes nationwide. If youth become motivated to live healthy lifestyles, the cost savings over their lifetimes will be incredible.

Raymond Dong is a senior at the University of Chicago studying Economics and Biology

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Daily Digest - February 6: If Government Cares About the Next Generation, Where Are Their Ideas?

Feb 6, 2015Rachel Goldfarb

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Youth Agenda a Glaring Omission in Rauner's State of the State (State Journal-Register)

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Youth Agenda a Glaring Omission in Rauner's State of the State (State Journal-Register)

Campus Network members Rachel Riemenschneider and Samuel Wylde point to the NextGen Illinois youth policy agenda as a collection of young people's concerns that are being overlooked.

Amherst College's Roosevelt Institute to share in $750,000 MacArthur Award (MassLive)

Diane Lederman reports on the Campus Network's MacArthur Award, quoting two students from the Amherst College chapter, Joshua Ferrer and Pierre Joseph.

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The Democrats in Opposition (TAP)

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Jobs-Day Guide: January Surprise, U.S. Wages, Participation Rate (Bloomberg Business)

Victoria Stilwell predicts that the latest jobs numbers will fall below projections, as they often do at the beginning of the year. The annual payroll revision numbers will also be worthy of attention.

How the American Family Was Affected by the Great Recession (Pacific Standard)

The most noticeable differences, writes Philip N. Cohen, are in birth rate and divorce rate, which both saw sharp drops at the beginning of the recession and have since rebounded.

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Daily Digest - February 5: Congratulations, Campus Network!

Feb 5, 2015Rachel Goldfarb

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Winners of 2015 MacArthur Awards for Nonprofit Organizations (AP)

Click here to subscribe to Roosevelt First, our weekday morning email featuring the Daily Digest.

Winners of 2015 MacArthur Awards for Nonprofit Organizations (AP)

The Roosevelt Institute | Campus Network is among this year's recipients of the 2015 MacArthur Award for Creative and Effective Institutions.

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We're Jailing the Wrong People. We Need to Jail More of the Right Ones: Corporate Criminals (TAP)

Robert Kuttner says that misclassifying workers as contractors – or rather, payroll fraud – should be punished with jail time, just like other forms of deliberate fraud.

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Daily Digest - February 4: Looking to History to Understand Today's Civil Rights Movement

Feb 4, 2015Rachel Goldfarb

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How Radical Change Occurs: An Interview With Historian Eric Foner (The Nation)

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How Radical Change Occurs: An Interview With Historian Eric Foner (The Nation)

Roosevelt Institute Fellow Mike Konczal interviews Eric Foner about teaching the Civil War online and the relevance of the Civil War and Reconstruction eras to our current political moment.

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Americans Overestimate Class Mobility (Pacific Standard)

Tom Jacobs reports that in four new studies, Americans overestimate the extent to which working more or going to school can increase wealth by about 23 percent.

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Daily Digest - February 3: A New Kind of Budget

Feb 3, 2015Rachel Goldfarb

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Budget Day Feels a Lot Like Groundhog Day (Marketplace)

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Budget Day Feels a Lot Like Groundhog Day (Marketplace)

Roosevelt Institute Fellow Mike Konczal says that year after year, the president's budget tried to compromise with Republicans from the start, but this year's has broken off that routine.

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  • Roosevelt Take: Roosevelt Institute Fellow Susan Crawford argues against the GOP's recent embrace of open Internet, which she says is a bait and switch.

Labor Pains (TNR)

Rebecca Traister, currently on maternity leave at The New Republic, explains the impossible career situations created for women who want children under U.S. laws.

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Kate Davidson looks at the results of a Federal Reserve survey of banks, which shows concern about the sub-prime auto loans that have become a larger and larger part of the market.

The City That Outlawed Free Food (The Nation)

Michelle Chen takes a close look at Fort Lauderdale, Florida's new policy restricting the distribution of free food. City officials claimed free food enabled homelessness.

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Daily Digest - February 2: Trade Shouldn't Mean Higher Drug Prices

Feb 2, 2015Rachel Goldfarb

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Don't Trade Away Our Health (NYT)

Roosevelt Institute Chief Economist Joseph Stiglitz argues that the Trans-Pacific Partnership's intellectual property agreements will raise drug prices unnecessarily and slow innovation.

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Don't Trade Away Our Health (NYT)

Roosevelt Institute Chief Economist Joseph Stiglitz argues that the Trans-Pacific Partnership's intellectual property agreements will raise drug prices unnecessarily and slow innovation.

Obama Veers Left (Politico)

Ben White speaks to Roosevelt Institute Fellow Mike Konczal about the president's budget. Konczal says this budget takes the focus off the deficit as a be-all,-end-all problem.

Obama's New Budget Proves the Grand Bargain is Finally Dead (Vox)

Matt Yglesias explains why the Obama administration has, in this budget, stopped playing to potential compromises and showdowns and focused on what the president actually wants to achieve.

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Max Ehrenfreund breaks down the main points in the Obama budget and explains how taxes would change in order to pay for programs like funded preschool and investment in infrastructure.

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Rupert Neate reports on the final numbers for the fourth quarter of 2014, which showed slower growth than economists had expected. Still, overall GDP growth for the year was higher than 2013.

How Tipping Helped Make Sexual Harassment the Norm for Female Servers (In These Times)

Jenny Brown says that workers who rely on tips often have no choice but to put up with harassment, as discussed in a new report from Restaurant Opportunities Centers United.

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In two different lawsuits, judges have indicated that they are unconvinced that drivers for these services are merely consumers of a software platform, reports Karen Gullo.

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Daily Digest - January 30: Where Did the Manufacturing Jobs Go?

Jan 30, 2015Rachel Goldfarb

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Wal-Mart’s Manufacturing Recovery? (The Hill)

Roosevelt Institute Senior Fellow Damon Silvers says that Wal-Mart's manufacturing initiative is really just an attempt to make people forget the company's influence on offshoring jobs.

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Wal-Mart’s Manufacturing Recovery? (The Hill)

Roosevelt Institute Senior Fellow Damon Silvers says that Wal-Mart's manufacturing initiative is really just an attempt to make people forget the company's influence on offshoring jobs.

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Stop Trying to Make Financial Literacy Happen (Slate)

Helaine Olen argues that the financial services industry pushes financial literacy because it's a way around true consumer protection models with legal backing.

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Daily Digest - January 29: Without Food Stamps, How Many Kids Would Go Hungry?

Jan 29, 2015Rachel Goldfarb

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Census Says 16m U.S. Children are Living on Food Stamps, Double the Number in 2007 (The Guardian)

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Census Says 16m U.S. Children are Living on Food Stamps, Double the Number in 2007 (The Guardian)

One in five American children would go hungry without food stamps, writes Jana Kasperkevic, which makes continued Republican efforts to cut the program especially worrying.

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  • Roosevelt Take: In his white paper on tax reform, Roosevelt Institute Chief Economist Joseph Stiglitz also argues against this loophole.

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Danny Vinik says that the Republican arguments claiming the recovery happened in spite of the president's policies are falling apart, leaving no other option but to give him credit.

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Rachel M. Cohen says that "housing first" policies are pretty clearly a more effective way to fight homelessness, but without sufficient funding and housing stock, can't be fully put into action.

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