General Articles

Congress Completes Fiscal Year 2010 Appropriations

On December 8, 2009, Congress released the final appropriations bills for Fiscal Year 2010. The $446.8 billion Consolidated Appropriations Act of 2010 combines six of the seven remaining spending bills, which includes the three appropriations bills that fund important domestic and global sexual and reproductive health care efforts. Advocates for sexual and reproductive health and rights were pleased that the bill takes several steps toward properly promoting and funding programs that will improve the sexual and reproductive health for young people across the country, though that there is still room for improvement. 
Teen Pregnancy Prevention Initiative, Office of Adolescent Health, and Abstinence-Only-Until-Marriage Programs 
Included in the bill is an allocation of $114.5 million toward teen pregnancy prevention initiatives that are medically accurate, age-appropriate, and discuss abstinence as well as contraception. Of the $114 million appropriated, $110 million will go towards “competitive contracts and grants to public and private entities to fund medically accurate and age appropriate programs that reduce teen pregnancy.” Of this $110 million, a minimum of $75 million must be used to replicate teenage pregnancy prevention programs that have been proven effective through rigorous evaluation. Funding for programs that address the behavioral risk factors that underlie teen pregnancy will also be available.
In addition, at least $25 million must be available for “research and demonstration grants to develop, replicate, refine, and test additional models and innovative strategies for preventing teenage pregnancy.” The conferee report language states that this smaller pot of funding is intended to go to programs that stress the value of abstinence and provide age-appropriate information to youth that is scientifically and medically accurate. The remaining $4.5 million is provided for program evaluation funding, including longitudinal evaluations, of teenage pregnancy prevention approaches.
These new funds will fall under the purview of the newly established Office of Adolescent Health (OAH) within the Office of the Secretary of Health and Human Services. The Office of Adolescent Health was created as part of the Preventive Health Amendments of 1992, however, this year marks the first time the Office has been given any funding. In 1992, OAH was charged with coordinating all activities within HHS that relate to adolescent “disease prevention, health promotion, preventive health services, and health information and education,” including program design, support, and evaluation, trend monitoring, adolescent health research projects, and training for health providers who work with adolescents. OAH was also designed to carry out demonstration projects to improve adolescent health. (PL 102-531).Without funding, however, the office was never established. This fall, SIECUS and over 100 local, state, and national organizations, including the American Academy of Pediatrics, Society for Adolescent Medicine, and the Association of Maternal and Child Health Programs (AMCHP), asked appropriators to support funding of OAH. We are pleased with its inclusion in the final bill, as well as the fact that it would be overseeing the new teen pregnancy prevention initiative.
In addition to creating the new office and teen pregnancy prevention funding stream, the appropriations bill eliminated all existing funding for abstinence-only-until-marriage programs, including funding for the Community-Based Abstinence Education (CBAE) grant program and the portion of the Adolescent Family Life Act (AFLA) that had been tied to the eight-point definition of abstinence-only programs. This bill marks the first time since 1981 that abstinence-only-until-marriage programs will not receive dedicated federal funding through the appropriations process.
“A new prevention initiative, the establishment of the Office of Adolescent Health, and the end of harmful abstinence-only-until-marriage funding are huge steps in the right direction and we commend Congress, particularly the leadership shown by Senator Tom Harkin and Representative David Obey, for these actions,” said Joseph DiNorcia, Jr., president and CEO of SIECUS. “However, we do think that by focusing the funding on teen pregnancy prevention, and not including the equally important health issues of STDs and HIV, Congress has missed an opportunity to provide true, comprehensive sex education that promotes healthy behaviors and relationships for all young people.”
Title X Family Planning Program
The Title X program received a $10 million increase for a total of $317,491,000.  This matches the increase in the President’s FY 2010 budget, the final House bill, and the Senate committee mark, however, advocates note that it still clearly falls short of adequately funding the program.  Title X is the only federal program exclusively dedicated to family planning and reproductive health services and offers low income women voluntary contraceptive services, prenatal care, treatment for sexually transmitted diseases, and other services. Family planning advocates will continue to push for more significant funding increases in the President’s FY 2011 budget request, which will be released in early February.
HIV/AIDS Prevention, Care, and Treatment
The Conferees increased funding for HIV prevention at the Centers for Disease Control and Prevention (CDC) by $36 million or 5.2 percent, which is significantly less than the $53 million proposed by the President and approved by the House. As noted by Carl Schmid, Deputy Executive Director, The AIDS Institute, “After several years of cuts and flat funding, it is good to see an increase; [h]owever, these funds are still far from what is needed.” Last year the CDC announced that over 56,000 people are infected with HIV every year in the United States, which is 40 percent higher than previous estimates. The CDC estimates it needs an increase of $877 million every year for five years in order to reduce HIV transmission by half by 2020.
For the Ryan White Care Act, which funds primary healthcare and support services for low-income people living with HIV/AIDS, the Conferees proposed an increase of $52.5 million, or 2.3 percent, which is very near the $54 million requested by the President and passed by the House. This includes a $20 million increase to the AIDS Drug Assistance Program.
Policy Change on Syringe Exchange
The appropriations package also included two significant changes with regard to the availability of funding for syringe exchange programs. Conferees agreed to end the ban on the use of federal funds for syringe exchange. Additionally, they agreed to allow Washington D.C. to use its own local funds for syringe exchange and to use federal funding under the same conditions as other jurisdictions. Advocates were overjoyed with the ending of the bans, noting that, it is long overdue.  “After 20 years of work, this historic vote finally signals that the United States now fully accepts the evidence of eight federal studies that syringe exchange reduces the incidence of HIV/AIDS and does not increase substance abuse,” said Rebecca Haag, AIDS Action’s executive director. She added that she hoped the change in policy would send a signal to the world that syringe exchange was an important part of comprehensive HIV/AIDS and viral hepatitis prevention policies. 
Policy Change on Abortion in Washington, DC
The final appropriations package also eliminated a long-standing prohibition on the Washington, D.C.’s use of locally raised tax dollars for medically necessary abortion care for low-income women.  This prohibition was first eliminated in the President’s budget, and, after a fight in both chambers’ Appropriations Committees as well as the House floor, was stripped from the House bill and the Senate committee mark. With this change, Washington, DC will, for the first time, be able to make the same decision as the 50 states about whether to use local funds for abortion care. 
International Appropriations
The omnibus included the State-Foreign Operations bill, with language on funding and policies for global health and child survival that included international family planning and reproductive health (FP/RH) programs and global HIV/AIDS funding. Funds for Global Health and Child Survival totaled $7.779 billion, coming in at $440 million above 2009 and $184 million above the presidential request.
The final funding level for HIV/AIDS prevention, care, and treatment programs came in at $5.709 billion which was $200 million above 2009 and $100 million above the  President’s request. Of this total, $750 million were allocated to multilateral programs through the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria. Bilateral and multilateral funding for FP/RH programs totals $648.5 million, an increase of more than $103 million above the FY 2009 enacted level and $55 million more than requested by the President. While the increase in funding levels were certainly of note, several key policy provisions relating to family planning and reproductive health also emerged in the omnibus.
The accompanying report language specifies that $55 million from the bill is earmarked for a U.S. contribution to the United Nations Population Fund (UNFPA), the first allocation since President Obama reinstated UNFPA funding shortly after entering office. Despite this achievement, several restrictions regarding how UNFPA may use U.S. funds remain For example, the UNFPA must maintain U.S. funds in a separate account which can not be allocated to support abortion services or programs in China. The U.S. will also deduct “dollar-for-dollar” from its contribution the amount that UNFPA plans to spend in China, diverting those funds instead to the Global Health and Child Survival account for bilateral family planning, maternal health, and reproductive health activities. 
In addition, Senator Frank Lautenberg (D-NJ) introduced and the Senate Appropriations Committee overwhelmingly adopted an amendment that would have permanently repealed the Mexico City Policy, also commonly referred to as the Global Gag Rule (GGR), barring its re-imposition by future administrations. The Global Gag Rule prevented organizations that provide medical services, counseling or referrals regarding abortion services from receiving U.S. foreign assistance funding. President Obama struck down this restriction to shortly after taking office so it is not presently in effect, however, this policy historically has been subject to political whims and this amendment sought to add long-term stability to the end of this policy. While negotiations surrounding this issues seemed favorable at the outset, in the end debates around related domestic issues resulted in the sacrifice of this amendment.
“The administration and Congress now seem to get the idea that policy and funding must move hand- in-hand in order to effect change,” continued DiNorcia. “While there is still room for improvement in both funding levels and policies focusing on broader sexual health issues, we are grateful to President Obama and Congress for clearly making sexual and reproductive health and the fight against HIV/AIDS here and abroad a priority.”  
The House passed the bill 221–202 on December 10th and the Senate passed the bill 57–53 on December 13th. The President is expected to sign the bill before December 18th.