Abstract

PIP: Arguing that the states would have "enhanced responsiveness to local needs," the Reagan administration proposed in 1981 to repeal some 40 categorical health programs, to reduce their funding, and replace them with block grants to the states. This responsiveness argument is examined within the context of the national family planning program, which was funded by several diverse federal grants and which serves 4,500,000 women each year. 3 questions are addressed: did experience prior to the Reagan Administration suggest that state administered, discretionary federal funds would be more responsive to individual state family planning needs than were federally administered categorical grants; how have the different types of grants performed during the Reagan Administration; and are state administered block grant programs more responsive to local needs than are other types of state administered federal grants. State expenditure data were used to examine the variation in the responses of different funding sources to states' needs for 2 periods: fiscal years 1976-81, the 6-year period prior to the Reagan Administration; and fiscal years 1982-83, the first 2 full budgetary years after Reagan assumed office. From fiscal 1976-81, Title V of the Social Security Act (the Maternal and Child Health Block Grant) annually contributed between 7-11% of all federal funds for family planning. The categorical program, Title X, was the largest single contributor to the federal family planning effort; its annual contribution ranged from 48-54% of all federal expenditures. The Medicaid program, Title XIX, accounted for the 2nd largest contribution to federal expenditures for family planning, ranging from 15-38%. Title XX funds, which were allocated to states on the basis of total population, accounted for 17-22% of all federal expenditures for family planning. It was hypothesized that: prior to the Reagan Administration, state administered federal grants were more responsive to states' family planning needs than were federally administered categorical grants; during the Reagan Administration, state administered federal grants have been more responsive to states' family planning needs than have federally administered categorical grants; and during both periods, block grants were more responsive to states' family planning needs that were other state administered federal grants. The findings failed to support the hypotheses, i.e., the analysis did not support the contention of the Reagan Administration that shifting health funding from federally administered categorical programs to state administered block grants would enhance states' responsiveness to local needs. State administered block grants demonstrated considerably less responsiveness to women's family planning needs than did Title X of the Public Health Service Act, the federally administered categorical program.