I 108th CONGRESS 2d Session H. R. 4192 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. Sánchez 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.

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

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.