Abortion advocates and population planners eagerly promote the idea that preventing births saves money.
To the contrary and as was already demonstrated in a recent First Things article, the birth of anyone, poor or not, will yield substantial economic benefit. Specifically, in Texas the $11,000 Medicaid-birth cost will on average return $430,000, or thirty-nine times the investment , in the form of income, property, and sales taxes collected over a forty-five-year working life.
Although state-funded population planners find the cost savings claim self-affirming and program-justifying, it is bad math. My prior article explored the short-sighted approach of an expense-only focus and highlighted that the programs cost federal, state, and local governments significant amounts of foregone revenue. A new article, recently published in full in the Linacre Quarterly, critically explores the question of expense savings.
The methodology by which the Texas Women’s Health Program (TWHP) assesses and reports cost savings requires that the actual birth rate of TWHP enrollees be compared to an earlier, base year birth rate for all women with Medicaid-paid births, in order to calculate “births averted” for TWHP enrollees (which averted births are presumably the result of TWHP participation). These theoretically averted births are then multiplied by the average cost of a Medicaid-paid birth to derive “Savings Due to Births Averted.”
A TWHP report claims, “The program is considered cost neutral because Total WHP Expenditures are less than the Target Expenditure (ie, Savings due to Births Averted.)” This is a critical conclusion for TWHP because “Savings Due to Births Averted” must exceed the cost of the program. TWHP claims that the program meets this test; but the method used to arrive at these results is misleading.
The flaw lies in the comparison used to calculate savings. The problem is that a group comprised only of women who intend to prevent pregnancy (TWHP enrollees) is compared to a base year group comprised both of women open to pregnancy and those who seek to avoid it. As a group, women seeking to avoid pregnancy should experience markedly lower birth rates than a broader group of women, some of whom are open to pregnancy.
Consider the silliness of a museum curator or wine steward who proudly compares her collection to that of the average household, or the meaningless boast of an oncologist who compares his cancer cure rate to that of general practitioners. TWHP is setting a similarly low bar to trumpet its claims of effectiveness.
To calculate the true savings attributable to TWHP’s efforts, an apples-to-apples comparison must be made of (a) the birth rate attributable to TWHP’s enrollees in 2008, or 4.3 percent, and (b) the birth rate attributable to comparable women; specifically, Texas women seeking to avoid pregnancy in the base year period. As is detailed in the Linacre Quarterly article, using two methods and national health statistics from 2001, more comparable base year birth rates were estimated. These methods resulted in adjusted base year birth rates of 6% and 4.6%, substantially less than TWHP’s base year benchmark birthrate of 11.5%. In other words, TWHP overstates the standard it seeks to undershoot by 1.9-2.5x.
With the adjustments, TWHP is no longer cost neutral because program expenditures exceed “savings due to births averted” by multi-million dollar margins. Additionally, the second proposed adjustment method results in a birth rate that is very similar to the actual birthrate of TWHP enrollees (4.6% versus 4.3%), which suggests nearly complete TWHP ineffectiveness and calls into question the very reason for its existence.
These results are relevant beyond Texas. A total of 31 states offer Medicaid expansion programs for family planning services. Like Texas, most of those programs are offered through the CMS waiver process, making it likely that many states are reporting inflated results in a manner similar to Texas. If Texas’ 2008 miscalculation is any indication, CMS women’s health programs are materially overstating budgetary effectiveness.
We now know two things. From the first article, subsidizing new lives is a revenue-positive proposition; and, from the recent Linacre Quarterly article, preventing new lives is a money-losing venture. Perhaps taxpayers should take a closer look at the revenues lost and expenditures wasted on these programs.
Combined, the two articles strongly suggest that, instead of wasting and losing money by attempting to prevent births through contraception and abortion, states should dedicate more resources to real healthcare for growing families.
