Issue Position: Access to Reproductive Healthcare

Issue Position

Date: Jan. 1, 2019

Women deserve access to the full range of reproductive healthcare services. This is a fundamental, inalienable human right.
As Governor of Colorado, John Hickenlooper oversaw an innovative, comprehensive plan that significantly expanded access to long-acting reversible contraception (LARC) for women. LARC is highly reliable and requires a one-time doctor's visit to ensure long-term birth control, making it more convenient and effective than low-cost methods like the pill. But for too long LARC's high cost and lack of accessibility has kept this method of birth control out of reach for many women who want it.

In contrast to Alabama and the numerous other states currently pushing to restrict abortion, Colorado respected women's reproductive rights and expanded options for all women-regardless of age, income or geography. The result? Colorado saw a 64% drop in abortions and 54% drop in unintended pregnancies among young women. [1] They also realized over $70 million in savings to the state budget. [2]

As President, Governor Hickenlooper would expand Colorado's successful LARC program nationally-closing the gap for women who currently cannot afford or do not have access to LARC. Governor Hickenlooper believes we must protect the right of all women, regardless of income, geography, race or ethnicity, to control their own bodies. Governor Hickenlooper is committed to ensuring that every woman has access to the full range of contraceptive options, so she can choose the method that best fits her needs and preferences, and that providers are educated and trained to provide the full range of options in a way that respects decision- making and autonomy.

Background: The Colorado LARC Program-Access, Affordability & Education
A centerpiece of the Colorado effort was to eliminate barriers to long acting reversible contraception (LARC), making it accessible and affordable to all women. LARCs offer a one-time appointment for safe and effective contraception-and consequently have an effectiveness rate of over 99%. [3] But too often, women do not have access to these life-changing options. In addition to the significant cost of LARC for those women not covered by insurance, not all clinics or healthcare providers offer LARC. For women in rural communities, the distance required to reach a provider who offered LARC could be prohibitive. Low-income women with unpredictable work or childcare schedules faced similar hurdles. [4]

An important element of the Colorado program's success was its comprehensiveness and commitment to universal access. In addition to funding for LARC purchases, the initiative trained healthcare providers to offer LARC, and provided operational support for family planning clinics that enabled upgrades to equipment and billing procedures, added sites and increased hours; and provided support with community outreach. Enhancing the success of the program was a statewide public awareness campaign to educate young people about the importance of reproductive health and increase the visibility of family planning clinics and other health centers offering affordable reproductive health services. Colorado has minor consent, which allows a teen, no matter her age, to consent for her own contraceptive methods and procedures. [5]

The result of this effort to increase awareness, affordability and accessibility of LARCs:

Reduced the teen pregnancy rate by 54% [6]
Reduced Colorado's teen abortion rate by 64%, [7] and
Saved the state $70 million over five years in averted public assistance costs [8]
Despite this success, the LARC program originally faced significant partisan opposition in a politically divided, purple state. [9] Initially, the program was funded by a mix of public and private foundation funding but Governor Hickenlooper demonstrated the leadership to overcome partisan objections and earn the bipartisan support [10] necessary to make this a publicly funded, fully sustainable program.

Expanding Colorado's LARC Program nationally
In light of the systemic attack on women's reproductive rights in states across the country, a federal program which expands access to affordable effective contraception is even more necessary than when Colorado's LARC program began ten years ago. As President, Hickenlooper would subsidize the cost of LARCs for women who cannot afford it-and dramatically expand access to LARC for all American women who desire such method.

While Medicaid and the Affordable Care Act have made LARCs more affordable for millions of Americans, millions of women still fall into an insurance coverage gap. One in five American women with incomes under 200% of the FPL are uninsured. Women of color are at even greater risk of being uninsured, making up three quarters of all uninsured women. [11] And for four in 10 women who obtain their contraceptive care from a safety-net family planning center that focuses on reproductive health, that provider is their only source of care. [12]

Even for women who are covered by Medicaid, challenges remain. For example, differences in state programs may mean that women still face high costs and several state Medicaid programs "do not specify coverage for removal of LARC devices or follow-up care." [13] Further, even for women whose Medicaid or private insurance covers LARC, there are still major barriers to access-either because their health provider does not have adequate training or equipment, or because women are not educated on the benefits of LARC.

It's clear that a stronger federal role is required to ensure comprehensive family planning services for all women. As President, John Hickenlooper would increase Title X funding by $700 million to ensure that all women have access to family planning care. [14] Colorado has demonstrated the cost-effectiveness of expanded access to family planning services, achieving a savings of $5.85 in Medicaid costs alone for every dollar invested in the LARC initiative. [15]

Title X funding provides comprehensive family services to all who want and need them, with priority given to clients with low-income. Title X funding supports 4,000 health centers nationally and serves four million clients annually. Two-thirds of the clients served by Title X funding are below the federal poverty level, and nearly half are uninsured, even after the implementation of the Affordable Care Act. [16] President Trump has proposed to undermine the Title X program through funding rollbacks and onerous restrictions.

In addition to subsidizing the cost of LARC, Hickenlooper's plan would expand access to LARC nationally. As a first step, the Governor would repeal the Trump Administration's domestic gag rule, which bans vital organizations like Planned Parenthood from receiving Title X funding.

Next, the Governor would appropriate additional funds to ensure that more doctors and healthcare providers are sufficiently trained to offer LARC as part of their practices; and provide operational support for family planning clinics to upgrade equipment and billing procedures, add sites and increase hours; and provide support with community outreach. Hickenlooper's plan would also fund a public education campaign that dramatically raises awareness of LARC's benefits and provides training to professionals to ensure that they respect women's preferences and needs for contraceptive options. Funding is critical not only for LARC access but also to ensure removal for women who desire to discontinue using their LARC.