While it is ultimately up to Congress to shape the 13 annual spending bills that fund the federal government, President Bush's first budget, made public on April 9, serves as a blueprint that the Republican congressional leaders are likely to follow closely during the FY 2002 appropriations process.

The centerpiece of the president's proposed $473 billion budget for the Department of Health and Human Services is a much-touted 13.5% funding increase for the National Institutes of Health, which includes a 27% increase for AIDS-vaccine research. Community health centers (CHCs)—which provide primary health care services, including in some cases family planning, to low-income people—also would receive a substantial funding increase. This funding boost would support the provision of services to an additional one million clients—a significant down payment on the president's five-year goal to double the CHC patient population and to increase the number of CHCs from 3,300 to 4,500.

The budget proposes funding for two new programs, one to support maternity group homes for pregnant and parenting teens and the other to promote responsible fatherhood, successful parenting and stronger marriages. Consistent with the president's desire to promote "charitable choice," funding under both of these new programs could go to faith-based organizations. Furthermore, the budget contains $89 million for a "Compassionate Capital" fund, which would provide start-up grants and technical assistance to charitable groups that seek to expand social service delivery, as well as $3 million to fund the Center for Faith-Based and Community Initiatives in the Department of Health and Human Services (see related story).

One surprise, given his campaign promises, was that the president did not propose an increase in funding for abstinence-only education. Nor did he propose any cuts or restrictive policy language to the Title X family planning program, but instead asked that its existing funding level of $254 be maintained. Yet lurking in the fine print is a provision that would permit states to shift between programs up to 20% of the total funding allocated to them under the Public Health Service Act and under the maternal and child health block grant. Family planning and public health advocates are seriously concerned that such a proposal, promoted in the name of "state flexibility," could provide the states a backdoor mechanism to override congressional spending priorities and divert funding from critical health programs such as Title X.

In a far less subtle attempt to appease the conservative wing of his party, the president proposes to eliminate the requirement that all federal employees' health insurance plans include coverage for contraception. The contraceptive coverage requirement, which has enjoyed bipartisan support since it was first enacted in 1998, was targeted without explanation. Ironically, the Office of Personnel Management (OPM), which administers the Federal Employees Health Benefits Program, in January reported that the implementation of the contraceptive benefit for 1.2 million women of reproductive age "occurred smoothly and without incident"; moreover, OPM had not adjusted premiums "since there was no cost increase due to contraceptive coverage." Combined with the president's action on his first day in office to reimpose the so-called global gag rule, this administration appears to have launched a frontal assault not just on abortion rights, but on family planning as well.—C. Dailard