Reducing Poverty by Reducing Children, Part III

Earlier I mentioned parts I and II of Daniel Patrick Maloney’s series at Public Discourse on reducing poverty by reducing the number of poor children. In part III Maloney, a former FT associate editor, examines the Medicaid policies that result from this belief and how they could be changed. A sample:

In 1993, the Clinton Administration approved a plan whereby states could expand Medicaid’s free family planning services to those who were too rich to be eligible for Medicaid. There was a catch, however—a state could have access to Medicaid’s contraception money only if it could promise that it would save the government money in the long run by “averting births” of children who were likely to be a drain on the welfare system. The Guttmacher Institute had been publishing papers since the 1970s arguing that averting the births of the poor would save money set aside for helping the poor; now the federal government was demanding that the states adopt this perverse argument in order to have access to more of Medicaid’s millions . . . .

As long as Medicaid is structured this way, Pelosi’s eugenicist statements will accurately describe the intellectual justification for U.S. contraception policy. Congress could fix that with three modest changes: reimburse family planning services at the same rate as other services in Medicaid, make contraception an optional part of a state’s Medicaid plan (like most other services in Medicaid), and defer to the states’ policies on parental notification and consent. In other words, it could stop giving contraception special treatment, so that promoting the health of the poor would become at least as important a national priority as preventing them from having children. In that case, federal policy would treat contraception as an individual’s choice for which the state provides moderate financial assistance, rather than as a government priority with which the person on welfare is pressured to cooperate. There are stronger measures that could be taken, and many would dispute that Medicaid should pay for contraception at all, but these three steps would be enough to distance the federal government from an unsavory policy with a dark history.