In the months leading up to the passage of the Affordable Care Act in 2010, a number of pro-life policy analysts expressed concern that the legislation could increase the incidence of abortion. One major concern was that the Affordable Care Act would result in taxpayer subsidies of health insurance plans that cover abortion. Additionally, some feared that the Affordable Care Act would grant the U.S. Department of Health and Human Services the power to require that health insurance plans cover abortion inducing drugs. Finally, others were concerned that the Affordable Care Act would generate additional streams of federal revenue for Planned Parenthood. However, the Affordable Care Act could also increase the incidence of abortion in another way: specifically, it subsidizes the expansion of Medicaid.
As originally written, the Affordable Care Act required each state to expand its Medicaid program to cover all adults under age 65 whose household incomes are less than or equal to 138 percent of the federal poverty level. States that failed to expand Medicaid would risk losing all federal funding for their Medicaid programs. However, in June 2012, the U.S. Supreme Court ruled in National Federation of Independent Business v. Sebelius that the federal government could not require individual states to expand their Medicaid programs. That said, the federal government still encourages states to expand Medicaid by offering very generous subsidies. Overall, approximately 30 states have expanded their Medicaid program since 2012.
The federal Hyde Amendment limits the extent to which federal Medicaid funds pay for abortion. However, 17 U.S. states fund elective abortions though Medicaid with their own tax dollars. There is a considerable body of research which shows that Medicaid funding of abortion increases state abortion rates. In 2009, the Guttmacher Institute published a comprehensive review of the research on Medicaid funding of abortion. Of the 18 studies included in the literature review, 15 found that public funding of abortion through Medicaid resulted in statistically significant increases in the incidence of abortion. Additionally, in many states, the percentage of abortions funded by Medicaid is dramatically rising. For instance, between 1990 and 2010 the percentage of abortions performed in Washington state that were paid for by Medicaid increased from 24 percent to over 67 percent.
Medicaid expansion would only exacerbate this trend. For instance, one state that currently pays for abortion though Medicaid is Alaska. And this week the Alaska state legislature is considering a proposal by newly elected Governor Bill Walker to expand Medicaid eligibility. As I point out in a recently released Charlotte Lozier Institute policy analysis, Governor Walker’s proposal would place anywhere from 10,000 to 15,000 women of childbearing age directly on to a Medicaid program which covers elective abortions. Medicaid expansion would also result in some women who are on exchange plans which do not cover abortion – transferring to a Medicaid plan which does cover abortion. Finally, it would increase taxpayer funding for Planned Parenthood, the nation’s largest abortion provider and a provider of a significant number of abortions in Alaska.
Over the past 20 years the pro-life movement has made impressive progress. In 1995, a Gallup survey found that only 35 percent of people identified as “pro-life.” However, six of the past 10 Gallup polls taken since 2009 have shown “pro-life” outpolling “pro-choice.” Additionally since 2011, there have been 231 pro-life laws enacted at the state level. Most importantly, the number of abortions continues to fall. Overall, the number of abortions has fallen by approximately 34 percent since 1990 and the numbers continue to decline nearly every year. That said, aggressive expansion of Medicaid through the Affordable Care Act jeopardizes this progress. Good research shows that Medicaid funding increases state abortion rates. And in many states, the percentage of abortions funded by Medicaid is sharply increasing. All in all, pro-lifers would do well to oppose the expansion of state Medicaid programs.
Michael J. New is an Assistant Professor at The University of Michigan – Dearborn and an Associate Scholar with the Charlotte Lozier Institute. Follow him on Twitter @Michael_J_New. The views expressed are those of the author and not necessarily the Charlotte Lozier Institute.