Publicly funded contraceptive care: a proven investment.

This year has been a difficult one for the nation's publicly funded family planning programs, which have faced unprecedented threats. Some of these threats appear driven primarily by policy makers struggling to close budget deficits, many of whom have set their sights on Medicaid. During FY 2011, 43 states attempted to reduce Medicaid costs through such steps as cutting provider reimbursement, lowering drug costs or reducing benefits; nearly all governors have proposed additional cuts for FY 2012 [1]. And with Medicaid the dominant source of public support for family planning services, proposals to restructure the program and curtail its public costs would have an enormous impact on family planning providers and clients [2]. Other threats have been in the form of more overtly ideological attacks. In February, the House of Representatives moved to eliminate funding for the Title X program, the only federal program devoted to family planning. A separate provision would have denied all federal funding — notably including Medicaid reimbursement — to Planned Parenthood affiliates. Both extreme positions were blocked by Senate Democrats and President Obama. Family planning opponents have emulated both approaches on the state level, with some success. Montana completely eliminated its family planning budget line item, and New Hampshire and Texas cut family planning funding by 57% and 66%, respectively. Five states— Indiana, Kansas, North Carolina, Texas and Wisconsin — also moved to either limit or deny funding to Planned Parenthood affiliates specifically or specialized family planning providers more generally, although several of those policies are being challenged in court [3].