On February 4, 2008, President Bush submitted his Fiscal Year (FY) 2009 Budget Request—the last of his presidency.  The budget request totaled $3.1 trillion and cuts billions of dollars from federal health programs.  The budget proposes increases in spending for abstinence-only-until-marriage programs and global health programs but would eliminate or reduce spending for a myriad of other health-related programs.  The President says this is necessary in order to reach his goal of balancing the budget by 2012; however, advocates and many policymakers expressed grave concern that this budget, if enacted, would leave America’s health and education programs woefully underfunded.

Abstinence-Only-Until-Marriage Programs

The Budget of the United States Government, Fiscal Year 2009,included $141 million in funding for Community-Based Abstinence Education (CBAE) grants, an increase of $27.7 million from this year. CBAE, which is already the largest federal funding stream for abstinence-only-until-marriage programs, provides grants that are paid directly to community organizations by the federal government.  In total, the president asked for $204 million in abstinence-only-until-marriage funds; $141 million for CBAE, $50 million for Title V abstinence-only funding, and $13 million within the Adolescent Family Life Act for abstinence-only-until-marriage programs.

“This proposed increase is the swan song of the Bush administration’s failed abstinence-only-until-marriage policy,” said William Smith, vice president for public policy at the Sexuality Information and Education Council of the United States (SIECUS).  “They know they’re on their way out, so no one can hold them accountable for continuing to champion this absurd waste of money.”

In Fiscal Year 2008, the president’s budget request included an identical increase for CBAE funding.  The House of Representatives agreed to the funding level at the increased amount, while the Senate decreased funding by the same level.  After months of politicking, Congress passed the Fiscal Year 2008 Omnibus in December, keeping CBAE’s funding at the same level as it was in the prior year ($113 million).  Sexual and reproductive health advocates, including SIECUS, are requesting that the program be zeroed out for FY09.

Title X Family Planning Program

President Bush’s proposal provides $300 million for the Title X family planning program in FY 2009, the same level as FY 2008. Family planning advocates are disappointed that the Title X program did not receive an increase in the budget request noting that had Title X family planning funding merely kept up with inflation since FY 1980, the year the program was created, the funding level would be now be at $759 million. Title X is the only federal program dedicated solely to funding family planning and reproductive health care services.  Title X clinics offer low income women voluntary contraceptive services, prenatal care, treatment for sexually transmitted diseases (STDs), and other services.   Family planning advocates are requesting that funding be brought up to a level of $400 million for FY09.

Centers for Disease Control and Prevention (CDC)

The President’s budget proposal cuts the Centers for Disease Control and Prevention’s (CDC) budget by $412 million.  This includes a proposed cut to the CDC’s HIV/AIDS and sexually transmitted disease (STD) prevention programs, which develop, implement, and evaluate effective domestic prevention programs for HIV/AIDS, Viral Hepatitis, STDs, and tuberculosis. While on its face, the President proposed a minimal decrease to the CDC’s HIV/AIDS programs overall, he proposed cutting HIV- prevention programs by $40 million, shifting those funds to the President’s HIV testing initiative.

“Increased funding for HIV testing is necessary, however, it should not come at the expense of other HIV- prevention programs that are designed to help individuals protect themselves from the virus,” said Smith.  “Congress should not follow the President’s lead in only increasing funding for HIV testing.  They need to provide adequate resources for all evidence-based HIV-prevention programs,” said Smith.

Ryan White CARE Act

The Ryan White CARE Act, which funds primary healthcare and support services for people living with HIV/AIDS, received a disappointing increase of only $1 million, or .004%, in the FY09 budget request.  HIV/AIDS advocates are concerned because the increase fails even to keep up with inflation, does not meet the needs of those who are living longer with the disease, and does not address the fact that infections are still on the rise.  The President’s proposal includes a $7.7 million decrease for Title I, which provides funds to eligible metropolitan areas, level funding for Title III, which funds community-based organizations, and level funding for Title IV, which provides grants that target women, infants, children, and youth with HIV/AIDS.  Last year, Title II’s base, which funds grants to states to provide clinical care, received the largest reduction in the history of the program.  This year, the President proposed this section to receive a minimal increase of $8.2 million.  The AIDS Drugs Assistance Program (ADAP), a part of Title II, is proposed to receive an increase of $6 million.

Global HIV/AIDS and Reproductive Health Programs

Global health programs fared a bit better than did domestic programs.  President Bush’s budget proposal allocating $4.8 billion for the Global HIV/AIDS Initiative, which forms the bulk of funding for the President’s Emergency Plan for AIDS Relief (PEPFAR).  The total request for PEPFAR’s fifteen focus countries is 4.1 billion in FY 2009.  The budget proposal would allocate a total of $500 million for the Global Fund to Fight AIDS, Tuberculosis and Malaria within the Global HIV/AIDS Initiative account—$200 million through the Office of the Global AIDS Coordinator (OGAC) and $300 million as a pass through from the National Institutes of Health (NIH), which was otherwise level funded at $29.2 billion.

Furthermore, the President recommends a significant cut of more than 25 percent to the USAID family planning program. 

“This budget reveals how out of touch the administration is with the priorities of this country,” said Smith. “We sincerely hope that Congress stands strong and funds programs that are based on evidence and that meet the health and education needs of America and the world,” continued Smith.

Congress is now engaged in completing its own budget, which is expected to be voted on by the end of March, and is in the early work of appropriations. Speaker of the House Nancy Pelosi (D-CA) said that, “Democrats reject the misplaced priorities of the President’s budget, which once again is a step backwards for our nation…While we cannot support the budget the President proposes, Democrats stand ready to work in a bipartisan way to craft a budget that better reflects America’s values and priorities and prepares us for a more prosperous future.”²

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