I 111th CONGRESS 1st Session H. R. 463 IN THE HOUSE OF REPRESENTATIVES January 13, 2009 Ms. Slaughter (for herself, Ms. DeGette, Ms. DeLauro, Ms. Harman, Ms. Lee of California, Mrs. Lowey, Mr. Rothman of New Jersey, Mr. Waxman, Mr. Abercrombie, Mr. Ackerman, Mr. Adler of New Jersey, Mr. Arcuri, Ms. Baldwin, Ms. Berkley, Mr. Berman, Mrs. Biggert, Mr. Bishop of New York, Mr. Bishop of Georgia, Mr. Blumenauer, Mr. Boucher, Mr. Brady of Pennsylvania, Mr. Braley of Iowa, Mrs. Capps, Mr. Capuano, Mr. Carnahan, Mr. Chandler, Mr. Clay, Mr. Cohen, Mr. Connolly of Virginia, Mr. Crowley, Mrs. Davis of California, Mr. Delahunt, Mr. Dicks, Mr. Ellison, Mr. Engel, Mr. Farr, Mr. Fattah, Mr. Filner, Mr. Frank of Massachusetts, Ms. Giffords, Mrs. Gillibrand, Mr. Al Green of Texas, Mr. Gene Green of Texas, Mr. Grijalva, Mr. Hall of New York, Mr. Hare, Mr. Higgins, Mr. Hinchey, Ms. Hirono, Mr. Hodes, Mr. Holt, Mr. Honda, Mr. Inslee, Mr. Israel, Ms. Jackson-Lee of Texas, Mr. Kennedy, Ms. Kilroy, Mr. Kind, Mr. Kucinich, Mr. Langevin, Mr. Larsen of Washington, Mr. Levin, Mr. Loebsack, Ms. Zoe Lofgren of California, Mrs. Maloney, Ms. Matsui, Ms. McCollum, Mr. McDermott, Mr. McGovern, Mr. McNerney, Mr. Meeks of New York, Mr. George Miller of California, Mr. Mitchell, Ms. Moore of Wisconsin, Mr. Moore of Kansas, Mr. Murphy of Connecticut, Mr. Patrick J. Murphy of Pennsylvania, Mr. Nadler of New York, Mrs. Napolitano, Ms. Norton, Mr. Olver, Mr. Payne, Mr. Peters, Ms. Pingree of Maine, Mr. Price of North Carolina, Mr. Rangel, Ms. Roybal-Allard, Mr. Ruppersberger, Mr. Rush, Mr. Ryan of Ohio, Ms. Loretta Sanchez of California, Mr. Sarbanes, Ms. Schakowsky, Mr. Schiff, Ms. Schwartz, Mr. Serrano, Mr. Sherman, Mr. Sires, Mr. Stark, Ms. Sutton, Mrs. Tauscher, Mr. Thompson of California, Ms. Tsongas, Ms. Velázquez, Ms. Wasserman Schultz, Mr. Welch, Mr. Wexler, Ms. Woolsey, Mr. Wu, Mr. Yarmuth, and Mr. Van Hollen) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means and Education and Labor, 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 that help reduce unintended pregnancy, reduce abortions, and improve access to women’s health care.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Prevention First Act of 2009. (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—Equity in Prescription Insurance and Contraceptive Coverage Sec. 201. Short title. Sec. 202. Amendments to Employee Retirement Income Security Act of 1974. Sec. 203. Amendments to Public Health Service Act relating to the group market. Sec. 204. Amendment to Public Health Service Act relating to the individual market. Title III—Emergency Contraception Education and Information Sec. 301. Short title. Sec. 302. Emergency contraception education and information programs. Title IV—Compassionate assistance for rape emergencies Sec. 401. Short title. Sec. 402. Survivors of sexual assault; provision by hospitals of emergency contraceptives without charge. Title V—At-Risk Communities Teenage Pregnancy Prevention Act Sec. 501. Short title. Sec. 502. Teen pregnancy prevention. Sec. 503. Research. Title VI—Accuracy of Contraceptive Information Sec. 601. Short title. Sec. 602. Accuracy of contraceptive information. Title VII—Unintended Pregnancy Reduction Act Sec. 701. Short title. Sec. 702. Medicaid; clarification of coverage of family planning services and supplies. Sec. 703. Expansion of family planning services. Sec. 704. Effective date. Title VIII—Responsible Education About Life Act Sec. 801. Short title. Sec. 802. Assistance to reduce teen pregnancy, HIV/AIDS, and other sexually transmitted diseases and to support healthy adolescent development. Sec. 803. Sense of Congress. Sec. 804. Evaluation of programs. Sec. 805. Limitations on use of funds. Sec. 806. Definitions. Sec. 807. Authorization of appropriations.

2.

Findings

The Congress finds as follows: (1)Healthy People 2010 sets forth a reduction of unintended pregnancies as an important health objective for the Nation to achieve over the first decade of the new century, a goal first articulated in the 1979 Surgeon General’s Report, Healthy People, and reiterated in Healthy People 2000: National Health Promotion and Disease Prevention Objectives. (2)Although the Centers for Disease Control and Prevention (referred to in this section as the 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. (3)Each year, nearly half of all pregnancies in the United States are unintended, and nearly half of unintended pregnancies end in abortion. (4)In 2006, 36,200,000 women, more than half of all women of reproductive age, were in need of contraceptive services and supplies to help prevent unintended pregnancy, and nearly half of those were in need of public support for such care. (5)The United States has some of the highest rates of sexually transmitted infections (referred to in this section as STIs) among industrialized nations. In 2006, there were approximately 19,000,000 new cases of STIs, almost half of them occurring in young people ages 15 to 24. According to the CDC, in addition to the burden on public health, STIs impose a tremendous economic burden with direct medical costs as high as $14,700,000,000 each year in 2006 dollars. (6)Contraceptive use can improve overall health by enabling women to plan and space their pregnancies and has contributed to dramatic declines in maternal and infant mortality. Widespread use of contraceptives has been the driving force in reducing unintended pregnancies and sexually transmitted infections, and reducing the need for abortion in this nation. Contraceptive use also saves public health dollars. For every dollar spent to provide services in publicly funded family planning clinics, $4.02 in Medicaid expenses are saved because unintended births are averted. (7)Reducing unintended pregnancy improves maternal health and is an important strategy in efforts to reduce maternal mortality. Women experiencing unintended pregnancy are at greater risk for physical abuse. (8)A child born from an unintended pregnancy is at greater risk than a child born from an intended pregnancy 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 allows couples to achieve economic stability by facilitating greater educational achievement and participation in the workforce. (10)Contraceptives are effective in preventing unintended pregnancy when used consistently and correctly. Without contraception, a sexually active woman has an 85 percent chance of becoming pregnant within a year. (11)Approximately 50 percent of unintended pregnancies occur among women who do not use contraception. (12)Many poor and low-income women cannot afford to purchase contraceptive services and supplies on their own. The number of women needing subsidized services has increased by more than 1,000,000 (seven percent) since 2000. A poor woman in the United States is now nearly four times as likely as a more affluent woman to have an unplanned pregnancy. Between 1994 and 2001, unintended pregnancy among low-income women increased by 29 percent, while unintended pregnancy decreased by 20 percent among women with higher incomes. (13)Public health programs, such as the Medicaid program and family planning programs under title X of the Public Health Service Act, provide high-quality family planning services and other preventive health care to underinsured or uninsured individuals who may otherwise lack access to health care. (14)Medicaid has become an essential source of support for the provision of subsidized family planning services and supplies. It is the single largest source of public funds supporting these services. In 2001, the program provided six in ten of all public dollars spent on family planning services. In 2006, 12 percent of women of reproductive age (7,300,000 women between the ages of 15 and 44) looked to Medicaid for their care and 37 percent of poor women of reproductive age rely upon Medicaid. (15)Approximately 1,400,000 unintended pregnancies and 600,000 abortions are averted each year because of services provided in publicly funded clinics. In 2006, title X service providers performed more than 2,400,000 Pap tests, 2,400,000 breast exams, and 5,800,000 tests for STIs, including 652,426 HIV tests and 2,300,000 Chlamydia tests. One in four women who obtain reproductive health services from a medical provider does so at a publicly funded clinic. (16)The stagnant funding for public family planning programs in combination with the increasing demand for subsidized services; the rising costs of contraceptive services and supplies, and the high cost of improved screening and treatment for cervical cancer and sexually transmitted infections has diminished the ability of clinics receiving funds under title X of the Public Health Services Act to adequately serve all those in need. At present, clinics are able to reach just 41 percent of the women needing subsidized services. Had title X funding kept up with inflation since FY 1980, it would now be funded at $759,000,000, instead of its fiscal year 2007 funding level of $283,000,000. Taking inflation into account, funding for title X in constant dollars is 63 percent lower today than it was in FY 1980. (17)While the Medicaid program remains the largest source of subsidized family planning services, States are facing significant budgetary pressures to cut their Medicaid programs, putting many women at risk of losing coverage for family planning services. (18)In addition, eligibility under the Medicaid program in many States is severely restricted, which leaves family planning services financially out of reach for many poor women. Many States have demonstrated tremendous success with Medicaid family planning waivers that allow States 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 coverage of family planning programs through Medicaid. (19)As of December 2008, 27 States offered expanded family planning benefits as a result of Medicaid family planning waivers. The cost-effectiveness of these waivers was affirmed by a recent evaluation funded by the Centers for Medicare & Medicaid Services. This evaluation of six waivers found that all family planning programs under such waivers resulted in significant savings to both the Federal and State governments. Moreover, the researchers found measurable reductions in unintended pregnancy. (20)Although employer-sponsored health plans have improved coverage of contraceptive services and supplies, largely in response to State contraceptive coverage laws, there is still significant room for improvement. The ongoing lack of coverage in health insurance plans, particularly in self-insured and individual plans, continues to place effective forms of contraception beyond the financial reach of many women. (21)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. (22)Approved for use by the Food and Drug Administration, emergency contraception is a safe and effective way to prevent unintended pregnancy after unprotected sex. Research confirms that easier access to emergency contraceptives does not increase sexual risk-taking or sexually transmitted diseases. (23)The available evidence shows that many women do not know about emergency contraception, do not know where to get it, or are unable to access it. Overcoming these obstacles could help ensure that more women use emergency contraception consistently and correctly. (24)A November 2006 study of declining pregnancy rates among teens concluded that the reduction in teen pregnancy between 1995 and 2002 is primarily the result of increased use of contraceptives. As such, it is critically important that teens receive accurate, unbiased information about contraception. (25)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. (26)Teens who receive comprehensive sexuality education that includes discussion of contraception as well as abstinence are more likely than those who receive abstinence-only messages to delay sex, to have fewer partners, and to use contraceptives when they do become sexually active. (27)Government-funded abstinence-only-until-marriage programs are precluded from discussing contraception except to talk about failure rates. An October 2006 report by the Government Accountability Office found that the Department of Health and Human Services does not review the materials of recipients of grants administered by such Department for scientific accuracy and requires grantees to review their own materials for scientific accuracy. The GAO also reported on the Department’s total lack of appropriate and customary measurements to determine if funded programs are effective. In addition, a separate letter from the Government Accountability Office found that the Department of Health and Human Services is in violation of Federal law by failing to enforce a requirement under the Public Health Service Act that federally funded grantees working to address the prevention of sexually transmitted diseases, including abstinence-only-until-marriage programs, must provide medically accurate information about the effectiveness of condoms. (28)Recent scientific reports by the Institute of Medicine, the American Medical Association, and the Office on National AIDS Policy stress the need for sexuality education that includes messages about abstinence and provides young people with information about contraception for the prevention of teen pregnancy, HIV/AIDS, and other sexually transmitted diseases. (29)A 2006 statement from the American Public Health Association (referred to in this section as APHA) states that APHA recognizes the importance of abstinence education, but only as part of a comprehensive sexuality education program … APHA calls for repealing current Federal funding for abstinence-only programs and replacing it with funding for a new Federal program to promote comprehensive sexuality education, combining information about abstinence with age-appropriate sexuality education.. (30)Comprehensive sexuality education programs respect the diversity of values and beliefs represented in the community and will complement and augment the sexuality education children receive from their families. (31)Over 60 percent of the 56,300 annual new cases of HIV infections in the United States occur in youth ages 13 through 24. African-American and Latino youth have been disproportionately affected by the HIV/AIDS epidemic. In 2005, Blacks and Latinos accounted for 84 percent of all new HIV infections among 13- to 19-year-olds and 76 percent of HIV infections among 20- to 24-year-olds in the United States even though, Black and Latinos represent only about 32 percent of people in these ages. Teens in the United States contract an estimated 9,000,000 sexually transmitted infections each year. By age 24, at least one in four sexually active people between the ages of 15 and 24 will have contracted a sexually transmitted infection. (32)Approximately 50 young people a day, an average of 2 young people every hour of every day, are infected with HIV in the United States.