Congress and family planning advocates could take a lesson from Princess Dagmar of Denmark. Wife of Russian Tsar Alexander III, the princess moved the comma in a prisoner's written condemnation and changed the meaning from "Pardon impossible" to "Pardon, impossible to be sent to Siberia."

The grateful prisoner was freed and the princess demonstrated that to get results in the empire, a technically subtle approach might be successful where a direct approach might fail.

Now how about freeing access to reproductive health care for women in a half-dozen states who are receiving services under Medicaid Family Planning Waivers that will end before the term of the current "tsar" on January 20, 2009?

On December 7 Senator Hillary Clinton (D-NY) distributed a letter for cosigning to senators from the 26 states currently authorized to provide family planning services through Medicaid 1115 Family Planning Waivers. These Family Planning Waivers allow low and moderate income women who would otherwise be ineligible for Medicaid coverage until pregnant to receive Medicaid-paid family planning services before they become pregnant and before they have children. In the joint letter to House and Senate Leadership, she described the Waiver approval process states must go through:

Unfortunately, the current waiver process has proven increasingly unworkable. Over the last decade, only seven of the 20 proposals for income-based eligibility expansions approved by CMS have been approved within a year of when they were submitted by the state. Six applications took between one and two years for approval, and seven languished for two years or more before finally being approved. Particularly given the well-established value of these demonstrations, the current approval and re-approval required under federal law wastes critical staff resources, hamstrings states' ability to meet changing needs, and limits our efforts to reduce unintended pregnancies and meet reproductive health needs in our states.

Wisconsin is first up to the chopping block and our Department of Health and Family Services is locked in eleventh-hour plea-for-pardon negotiations with the Centers for Medicare and Medicaid Services (CMS) on behalf of health care for the 75,000 women enrolled in the program ending December 31, 2007. Beyond Wisconsin there are hundreds of thousands who would be helped in the six other states and beyond that, if Senator Clinton's proposal passes, women in the other 43 states and territories could quickly benefit as well.

Medicaid Family Planning Waivers save money by reducing more costly Medicaid-paid births by preventing unintended pregnancies. By expanding the program as Senator Clinton is proposing, the Congressional Budget Office has estimated an annual federal savings of up to $400 million. The Guttmacher Institute estimates even greater savings as well as benefits to maternal and child health.

It would be better to have a reasoned discussion of Medicaid-paid family planning services through full Congressional deliberation and passage of the Unintended Pregnancy Reduction Act (S. 1075 – H.R. 3162). But in the waning days of this empire, the women in the seven states with "Waiver execution dates" won't care whether it's a comma's position or a full debate that renders the result.

So pardon us, Mr. President.

Help win a pardon for family planning programs and a reprieve for women everywhere:

Let legislators know that the family planning expansion and access provisions of the Unintended Pregnancy Reduction Act (S. 1075 and H.R. 3162) must be included in the Medicaid physician reimbursement bill.

1) Contact members of the House Energy and Commerce subcommittee on Health and in the Senate Finance Committee. Use the ‘contact us' link at the House Energy and Commerce Committee subcommittee on Health's website at: http://energycommerce.house.gov/Subcommittees/health.shtml

2) Contact members of Senate Finance Committee at its website at http://www.senate.gov/~finance/.

3) Visit the ‘Write Your Representative" website at http://www.house.gov/writerep/ and the "Find Your Senator" website at http://www.senate.gov/general/contact_information/senators_cfm.cfm.

4) Ask friends and organizations who support expanded access to primary care, including reproductive care, to contact Congress. Direct them to this website and ask them to help spread the word.

Visit our website at www.FPHS.org if we can be of help or to learn more about us. If you do contact your legislator, let us know at [email protected]. Thanks for your help!