H.R. 4193 (eh) Making appropriations for the Department of the Interior and related agencies for the fiscal year ending September 30, 1999, and for other purposes. ...

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108th CONGRESS
  2d Session
                                H. R. 4192

   To expand access to preventive health care services and education 
 programs that help reduce unintended pregnancy, reduce infection with 
   sexually transmitted disease, and reduce the number of abortions.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 21, 2004

Ms. Slaughter (for herself, Ms. DeGette, Mr. Greenwood, Mrs. Johnson of 
Connecticut, Mr. Allen, Mr. Baird, Ms. Baldwin, Ms. Berkley, Mr. Bishop 
of New York, Mr. Blumenauer, Mr. Brown of Ohio, Mrs. Capps, Mr. Cardin, 
  Mrs. Christensen, Mr. Crowley, Mr. Davis of Illinois, Mrs. Davis of 
   California, Mr. DeFazio, Ms. DeLauro, Mr. Doggett, Mr. Dooley of 
 California, Mr. Emanuel, Mr. Filner, Mr. Frank of Massachusetts, Mr. 
    Frost, Mr. Gonzalez, Mr. Grijalva, Ms. Harman, Mr. Hinchey, Mr. 
  Hoeffel, Ms. Norton, Mr. Holt, Mr. Honda, Ms. Hooley of Oregon, Mr. 
Inslee, Mr. Israel, Ms. Jackson-Lee of Texas, Mr. Jackson of Illinois, 
Mr. Kennedy of Rhode Island, Ms. Kilpatrick, Mr. Larsen of Washington, 
   Ms. Lee, Ms. Lofgren, Mrs. Lowey, Mrs. Maloney, Ms. Majette, Mrs. 
   McCarthy of New York, Ms. McCarthy of Missouri, Ms. McCollum, Mr. 
 McDermott, Ms. Millender-McDonald, Mr. Moran of Virginia, Mr. Nadler, 
  Mr. Olver, Ms. Pelosi, Mr. Rothman, Ms. Roybal-Allard, Ms. Linda T. 
   Sanchez of California, Mr. Sanders, Ms. Schakowsky, Mr. Scott of 
Virginia, Mr. Serrano, Mr. Shays, Mr. Simmons, Ms. Solis, Mr. Tierney, 
Mrs. Jones of Ohio, Mr. Udall of Colorado, Mr. Van Hollen, Ms. Waters, 
 Ms. Watson, Mr. Waxman, Mr. Weiner, Mr. Wexler, Ms. Woolsey, Mr. Wu, 
and Mr. Wynn) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
  Education and the Workforce and Ways and Means, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
   To expand access to preventive health care services and education 
 programs that help reduce unintended pregnancy, reduce infection with 
   sexually transmitted disease, and reduce the number of abortions.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Putting Prevention 
First Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
             TITLE I--TITLE X OF PUBLIC HEALTH SERVICE ACT

Sec. 101. Short title.
Sec. 102. Authorization of appropriations.
              TITLE II--FAMILY PLANNING STATE EMPOWERMENT

Sec. 201. Short title.
Sec. 202. State option to provide family planning services and supplies 
                            to additional low-income individuals.
Sec. 203. State option to extend the period of eligibility for 
                            provision of family planning services and 
                            supplies.
 TITLE III--EQUITY IN PRESCRIPTION INSURANCE AND CONTRACEPTIVE COVERAGE

Sec. 301. Short title.
Sec. 302. Amendments to Employee Retirement Income Security Act of 
                            1974.
Sec. 303. Amendments to Public Health Service Act relating to the group 
                            market.
Sec. 304. Amendment to Public Health Service Act relating to the 
                            individual market.
      TITLE IV--EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION

Sec. 401. Short title.
Sec. 402. Emergency contraception education and information programs.
         TITLE V--COMPASSIONATE ASSISTANCE FOR RAPE EMERGENCIES

Sec. 501. Short title.
Sec. 502. Survivors of sexual assault; provision by hospitals of 
                            emergency contraceptives without charge.
                    TITLE VI--FAMILY LIFE EDUCATION

Sec. 601. Short title.
Sec. 602. Findings.
Sec. 603. Assistance to reduce teen pregnancy, HIV/AIDS, and other 
                            sexually transmitted diseases and to 
                            support healthy adolescent development.
Sec. 604. Sense of Congress.
Sec. 605. Evaluation of programs.
Sec. 606. Definitions.
Sec. 607. Appropriations.
                TITLE VII--TEENAGE PREGNANCY PREVENTION

Sec. 701. Short title.
Sec. 702. Teenage pregnancy prevention.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Although the Centers for Disease Control and Prevention 
        (``CDC'') included family planning in its published list of the 
        ``Ten Great Public Health Achievements in the 20th Century'', 
        the United States still has one of the highest rates of 
        unintended pregnancies among industrialized nations.
            (2) Each year, three million pregnancies, nearly half of 
        all pregnancies, in the United States are unintended; and half 
        of unintended pregnancies end in abortion.
            (3) In 2000, 34 million women--half of all women of 
        reproductive age (ages 15-44)--were in need of contraceptive 
        services and supplies to help prevent unintended pregnancy, and 
        half of those were in need of public support for such care.
            (4) The United States also has the highest rate of 
        infection with sexually transmitted diseases (``STDs'') of any 
        industrialized country: in 2000 there were approximately 18.9 
        million new cases of STDs.
            (5) Increasing access to family planning services will 
        improve women's health and reduce the rates of unintended 
        pregnancy, abortion, and infection with STDs. Contraceptive use 
        saves public health dollars: every dollar spent on providing 
        family planning services saves an estimated $3 in expenditures 
        for pregnancy-related and newborn care for Medicaid alone.
            (6) Contraception is basic health care that improves the 
        health of women and children by enabling women to plan and 
        space births.
            (7) Women experiencing unintended pregnancy are at greater 
        risks for physical abuse and women having closely spaced births 
        are at greater risk of maternal death.
            (8) The child born from an unintended pregnancy is at 
        greater risk of low birth weight, dying in the first year of 
        life, being abused, and not receiving sufficient resources for 
        healthy development.
            (9) The ability to control fertility also allows couples to 
        achieve economic stability by facilitating greater educational 
        achievement and participation in the workforce.
            (10) The average American woman desires two children and 
        spends five years of her life pregnant or trying to get 
        pregnant and roughly 30 years trying to prevent pregnancy; 
        without contraception, a sexually active woman has an 85 
        percent chance of becoming pregnant within a year.
            (11) Many poor and low-income women cannot afford to 
        purchase contraceptive services and supplies on their own. 12.1 
        million or 20 percent of all women aged 15-24 were uninsured in 
        2002, and that proportion has increased by 10 percent since 
        1999.
            (12) Public health programs like Medicaid and Title X, the 
        national family planning program, provide high-quality family 
        planning services and other preventive health care to 
        underinsured or uninsured individuals who may otherwise lack 
        access to health care.
            (13) Medicaid is the single largest source of public 
        funding for family planning services and HIV/AIDS care in the 
        United States. Half of all public dollars spent on 
        contraceptive services and supplies in the United States are 
        provided through Medicaid and approximately 5.5 million women 
        of reproductive age--nearly one in ten women between the ages 
        of 15 and 44--rely on Medicaid for their basic health care 
        needs.
            (14) Each year, Title X services enable Americans to 
        prevent approximately one million unintended pregnancies, and 
        one in three women of reproductive age who obtains testing or 
        treatment for STDs does so at a Title X-funded clinic. In 2002, 
        Title X-funded clinics provided three million Pap tests, 5.2 
        million STD tests, and 494,000 HIV tests.
            (15) The increasing number of uninsured, stagnant funding, 
        health care inflation, new and expensive contraceptive 
        technologies, and improved but expensive screening and 
        treatment for cervical cancer and STDs, have diminished the 
        ability of Title X funded clinics to adequately serve all those 
        in need. Taking inflation into account, funding for the Title X 
        program declined 57 percent between 1980 and 2003.
            (16) While Medicaid is the largest source of subsidized 
        family planning services, many States have had to make 
        significant cuts in their Medicaid programs due to budget 
        pressures putting many women at risk of losing coverage for 
        family planning services.
            (17) In addition, eligibility for Medicaid in many States 
        is severely restricted leaving family planning services 
        financially out of reach for many poor women. Many States have 
        demonstrated tremendous success with Medicaid family planning 
        waivers that allow them to expand access to Medicaid family 
        planning services. However, the administrative burden of 
        applying for a waiver poses a significant barrier to States 
        that would like to expand their Medicaid family planning 
        programs.
            (18) Many private health plans still do not cover 
        contraceptive services and supplies. The lack of contraceptive 
        coverage in health insurance plans places many effective forms 
        of contraception beyond the financial reach of many women.
            (19) Including contraceptive coverage in private health 
        care plans saves employers money: not covering contraceptives 
        in employee health plans costs employers 15 to 17 percent more 
        than providing such coverage.
            (20) Emergency contraception is a safe and effective way to 
        prevent unintended pregnancy after unprotected sex. It is 
        estimated that the use of emergency contraception could cut the 
        number of unintended pregnancies in half, thereby reducing the 
        need for abortion.
            (21) In 2000, 51,000 abortions were prevented by use of 
        emergency contraception; increased use of emergency 
        contraception accounted for up to 43 percent of the total 
        decline in abortions between 1994 and 2000.
            (22) Access to comprehensive sex education is critical to 
        reducing rates of unintended pregnancy, abortion, and STD 
        infection among teens. Over 60 percent of teens have had sex 
        before they graduate from high school and nine out of ten 
        people have sex before they get married. 822,000 teenagers 
        become pregnant each year; 35 percent of teen girls become 
        pregnant at least once before turning 20; and 78 percent of 
        teenage pregnancies are unintended. Nearly half (48 percent) of 
        new STD cases are among people ages 15-24, even though these 
        youth make up only a quarter of the sexually active population.
            (23) The American Medical Association, the American Nurses 
        Association, the American Academy of Pediatrics, the American 
        College of Obstetricians and Gynecologists, the American Public 
        Health Association, and the Society for Adolescent Medicine, 
        support responsible sexuality education that includes 
        information about both abstinence and contraception.
            (24) Comprehensive sex education protects adolescent 
        health. A recent survey found that only 15 percent of American 
        parents believe that schools should just teach about 
        abstinence.
            (25) A recent study showed that teens who took pledges to 
        remain virgins until marriage were just as likely to contract 
        STDs as teens who did not take virginity pledges and that 
        although teens taking the pledges delayed sexual debut, they 
        were less likely to use condoms once they were sexually active.
            (26) Teens who receive sex education that includes 
        discussion of contraception are more likely than those who 
        receive abstinence-only messages to delay sex and to have fewer 
        partners and use contraceptives when they do become sexually 
        active.

             TITLE I--TITLE X OF PUBLIC HEALTH SERVICE ACT

SEC. 101. SHORT TITLE.

    This title may be cited as the ``Title X Family Planning Services 
Act of 2004''.

SEC. 102. AUTHORIZATION OF APPROPRIATIONS.

    For the purpose of making grants and contracts under section 1001 
of the Public Health Service Act, there are authorized to be 
appropriated $643,000,000 for fiscal year 2005, and such sums as may be 
necessary for each subsequent fiscal year.

              TITLE II--FAMILY PLANNING STATE EMPOWERMENT

SEC. 201. SHORT TITLE.

    This title may be cited as the ``Family Planning State Empowerment 
Act''.

SEC. 202. STATE OPTION TO PROVIDE FAMILY PLANNING SERVICES AND SUPPLIES 
              TO ADDITIONAL LOW-INCOME INDIVIDUALS.

    (a) In General.--Title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.) is amended--
            (1) by redesignating section 1935 as section 1936; and
            (2) by inserting after section 1934 the following:

  ``state option to provide family planning services and supplies to 
                   additional low-income individuals

    ``Sec. 1935.
    ``(a) In General.--A State may elect (through a State plan 
amendment) to make medical assistance described in section 
1905(a)(4)(C) available to any individual not otherwise eligible for 
such assistance--
            ``(1) whose family income does not exceed an income level 
        (specified by the State) that does not exceed the greatest of--
                    ``(A) 200 percent of the income official poverty 
                line (as defined by the Office of Management and 
                Budget, and revised annually in accordance with section 
                673(2) of the Community Services Block Grant Act) 
                applicable to a family of the size involved;
                    ``(B) in the case of a State that has in effect (as 
                of the date of the enactment of this section) a waiver 
                under section 1115 to provide such medical assistance 
                to individuals based on their income level (expressed 
                as a percent of the poverty line), the eligibility 

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