[Congressional Record Volume 144, Number 140 (Thursday, October 8, 1998)]
[House]
[Pages H10137-H10148]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATIONS ACT, 1999

  The CHAIRMAN. Pursuant to House Resolution 564 and rule XXIII, the 
Chair declares the House in the Committee of the Whole House on the 
State of the Union for the consideration of the bill, H.R. 4274.

                              {time}  1952


                     In The Committee Of The Whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the State of the Union for the consideration of the bill 
(H.R. 4274) making appropriations for the Departments of Labor, Health 
and Human Services, and Education, and related agencies, for the fiscal 
year ending September 30, 1999, and for other purposes, with Mr. 
Bereuter in the chair.
  The Clerk read the title of the bill.
  The CHAIRMAN. Pursuant to House Resolution 564, the bill is 
considered as having been read the first time.
  Pursuant to House Resolution 584, the gentleman from Illinois (Mr. 
Porter) and the gentleman from Wisconsin (Mr. Obey) each will control 
30 minutes.
  Mr. ENGEL. Mr. Chairman, today we take a vote on the future of our 
children. Day in and day out the Members of the 105th Congress come to 
the floor and express their concerns for ensuring opportunities for the 
next generation. H.R. 4274, ``the Labor-HHS-Education Appropriations 
bill,'' is one piece of legislation that goes to the heart of our 
collective concerns. However, despite our desire to assist our children 
we instead embark on a bill that politicizes their future. Instead of 
providing opportunities, this bill guts national education funding for 
short term political gain. This bill eliminates funding for technology 
in the classroom in low-income school districts, it eliminates funding 
for teacher training, and it even eliminates funding to ensure that our 
children can read before the end of the third grade.
  However, to just discuss the inadequacies of this bill on our 
elementary school aged children would not be a fair summarization of 
the destructive nature of this piece of legislation. This 
appropriations bill attempts at its very essence, to provide budget 
cuts off the backs of the poor, the immigrant and the laborer. H.R. 
4274 if passed would eliminate federal subsidized funding for 4.4 
million of the poorest households to pay for their heat during the 
winter months; this bill if passed would cut federal funding for 
bilingual education by $25 million which would reduce funding for 
adequate teacher training; this bill if passed would even cut OSHA 
workplace safety enforcement by $12 million which would result in 4,000 
fewer workplace safety inspections in 1999.
  The role of government is debated each day on the floor of this 
House, in our committee rooms, and in our districts but we all can 
agree that our mandate is to serve the people. It is paramount that as 
a national body we focus not on partisan political goals but rather on 
what is in the best interest of our constituents. Members would then 
understand that this appropriation bill is too unfair, too detrimental 
to our national educational policy and too damaging to the poor. I urge 
my colleagues on both sides of the aisle to join me in opposing H.R. 
4274 and vote no on this bill.
  Mr. PORTER. Mr. Chairman, Mr. Greenwood's amendment protects a good 
program, a program that Members should support.
  One of our priorities in this bill is public health programs that 
help expand access to care for the underserved. Title X--as George Bush 
and Richard Nixon recognized--is such a program.
  1. It supports a broad range of reproductive services to women--
including assistance for women who are having trouble conceiving 
children--as well as screening for breast and cervical cancer, sexually 
transmitted infections and hypertension. These are life saving, life 
giving, life enhancing services.
  2. In 1996, 4.3 million clients were served--83 percent with incomes 
below 150 percent of the federal poverty level. Everyone above the 
poverty line pays something for their care on a sliding scale. For many 
working poor, Title X provides their only access to the health care 
system.
  3. The law has always barred Title X from paying for any abortion 
under any circumstances. This is not an abortion issue.
  Title X is really an anti-abortion program: roughly half of all 
unintended pregnancies end in abortion. It is estimated that, in 1994, 
one million unintended pregnancies were averted as a result of services 
received at Title X projects. Title X prevents the unintended 
pregnancies that lead to abortions and that lead to low-birthweight 
babies.
  Title X improves maternal and child health, it lowers the incidence 
of unintended pregnancy and abortion and it lowers rates of STDs.
  It is a good program, it is a wise investment, and we should be very 
careful about adopting amendments that undermine the program's 
effectiveness.
  I urge all Members to support Mr. Greenwood's amendment and oppose 
Mr. Istook's substitute.
  Mr. STARK. Mr. Chairman, I oppose the Labor, Health and Human 
Services and Education Appropriations (Labor--HHS) Bill considered in 
the House today.


                   education suffers under this bill

  This bill would have devastating effects on students and our 
education system and I strongly urge my colleagues to reject this bill.
  My colleagues on the other side of the aisle have been busy with 
their education agenda this year. We've debated a Constitutional 
Amendment to allow for prayer in schools and we've tried to eliminate 
affirmative action programs for minority students. We've also tried to 
provide public dollars for private schools--not once, but twice, and to 
eliminate public dollars to be used for the purposes of educating our 
bilingual students. Lucky for our students, parents and teachers, 
Democrats have an education agenda, too.
  The Democratic plan will improve public education. We want to reduce 
the average class size in the early grades by helping local school 
districts hire 100,000 new qualified teachers. We want to provide 
federal tax credits to pay the interest on $22 billion in bonds for the 
modernization and construction of more than 5,000 schools. We want to 
make sure that schoolchildren have somewhere to go after school instead 
of hanging out on the streets. We are promoting after school learning 
opportunities for students. We support expanding resources for 
educational technology in order to ensure that every classroom and 
school library is connected to the Internet by 2001.
  The Democratic ideas will work; they will provide more opportunities 
for out kids. Nobody denies that public education is in bad shape. But 
the majority's solution is to cut funding and eliminate programs and to 
determine what choices are made available to school districts and 
teachers. This does not make good sense or good policy.
  This Education Appropriations bill fails to fund a single one of the 
Administration's initiatives to modernize schools and build new 
schools. it is no secret that schools are overcrowded. Schoolteachers 
in my district are conducting classes in portables, school lunchrooms 
and even in hallways. The majority, by not addressing this problem in 
their bill, are putting a bag over their head and hoping the problem 
goes away.
  This Education Appropriations bill does not fund the President's 
Literacy Initiatives and eliminates funding for the America Reads 
Challenge. Furthermore, the bill cuts funding for the Safe and Drug 
Free Schools initiative, and does not fund the President's plan to 
target funds to districts and schools with the largest drug and 
violence programs.
  This bill also incorporates the text of a bill that was defeated by 
the House earlier this year and with regard to bilingual education. 
This bill would limit the amount of bilingual education a student could 
receive to a maximum of two years. Reputable research proves that 
children take between four to seven years to master academic English 
necessary for higher education success. This bill provides no academic 
safety net for students who fail to master English in two years. It 
does not make sense to shove children arbitrarily from an environment 
where they are learning to one where they are predetemined to fail.
  The House has already soundly defeated this idea. Why does this bill 
pander to an extreme minority who has already lost this fight?
  This bill also prevents students from achieving success in the new 
millennium by cutting funds for GOALS 2000 by 50%. How does cutting 
funding for this program help students? I would ask the majority 
leadership to answer this question.
  This bill also prevents any funds from being spent to adopt a 
national testing standard for our kids. These tests have nothing to do 
with content and would test fourth graders for reading comprehensive 
and eighth graders for math ability. I support national testing 
standards. These voluntary tests will have no effect on home schooling 
or parochial education interests. Testing gives states, local 
communities and parents one more tool to measure how well their 
curriculum prepares students in basic reading and math skills. If we 
are to spend taxpayer money on public schools, we must know that we are 
getting measurable results.

  It is clear that my colleagues on the other side of the aisle do not 
think the same way about education as we do. Their attacks on our basic 
fundamental obligation to provide a

[[Page H10138]]

public education for every child in America will have a devastating 
effect on schoolchildren and our Country's future.
  A real stand for education is a vote against this terrible bill.

                     Cuts Hurt the Most Vulnerable

  H.R. 4274 is a confrontational bill--the product of a majority 
leadership decision to cave to demands from the right wing of its own 
conference. It does nothing to heal the economic and social divisions 
within our society. Instead it resembles a blueprint for the reelection 
of the House Republican leadership.
  H.R. 4274 is the direct result of the majority's decision to kill 
tobacco legislation. Instead of using tobacco company revenues to fund 
a set of fairly balanced domestic priorities, the majority has decided 
to offset their spending priorities by cutting the programs that 
benefit the most vulnerable members of our society.
  H.R. 4274 eliminates funding for LIHEAP. I oppose this provision. 
There is no programmatic or economic rationale to justify eliminating a 
program that helps 4.4 million low-income households pay their heating 
and cooling bills. About 1.5 million of these households have elderly 
members, 1.3 million have disabled members, and 2.1 million have 
children in poverty. Two-thirds of LIHEAP recipients earn less than 
$8,000 per year. Energy prices constitute a significant expense for 
poorer households whose incomes have not kept up with inflation.
  I also strongly oppose the bill's prohibitions on Title X funding. 
Title X family planning clinics offer a wide range of critical services 
including contraception, screening and treatment for sexually 
transmitted diseases, HIV screening, routine gynecological exams, and 
breast and cervical cancer screening. If minors are required to comply 
with parental consent or notification laws for contraceptive services, 
not only will they avoid seeking family planning services, they will 
avoid seeking any of the services at a Title X clinic. Without these 
services, the authors of this bill can soon take credit for an increase 
in abortions and sexually transmitted diseases. I oppose this bill for 
its blatant disregard for the reproductive health, safety, and 
constitutional rights of America's women.
  Supporters argue that H.R. 4274 eliminates excessive and burdensome 
federal regulation and provide enhanced discretion to state and local 
officials. Yet, the bill prohibits the use of Title X funds by any 
entity unless it certifies that it encourages family participation in 
the decision of minors to seek family planning services. It also 
prohibits a state or locality's contribution of Medicaid matching funds 
to pay for any abortion or to pay for health benefits coverage offered 
by a managed care provider that includes coverage of abortion.

             This Bill Plays Politics With Organ Donations

  Every day 10 people die in this country waiting for an organ 
transplant. There is no disagreement about the problem--there aren't 
enough organs to meet the needs of patients.
  In March, the Department of Health and Human Services issued proposed 
regulations to equalize large discrepancies in waiting times for 
transplant patients around the country and help guide the transplant 
community to create a fairer transplant system.
  Now the House Labor-HHS bill includes two riders, which would 
prohibit the implementation of these regulations and prevent the HHS 
Secretary from working to increase the number of available organs.
  The first rider would prevent the Secretary from requiring hospitals 
to report patient deaths to regional Organ Procurement Organizations. 
This simple requirement is in effect in Maryland and Pennsylvania and 
both states report additional organ donations as a direct result. 
Preventing this regulation from going forward will make more patients 
die waiting for other organs. This is a matter of life and death and 
this rider should be removed from the bill.
  The second rider puts a moratorium on the Secretary's organ 
allocation plan to make the distribution of organs more fair for 
patients. The Secretary's organ allocation plan is urgently needed by 
patients across the country. Patients in the Bay Area wait an average 
of over 300 days for a transplant, while patients in Tennessee wait 21 
days. This isn't fair.
  The Secretary has proposed to let medical people make medical 
decisions about the best way to allocate the limited number of donated 
organs. The Appropriations Committee should allow these regulations to 
be implemented without further delay.
  This rider is being pushed by a group of Louisiana transplant 
surgeons who believe that organs should be hoarded for their own state 
use. Over 30% of Louisianans needing a transplant leave the state to 
find better care in other hospitals or because they have been turned 
down for transplants in Louisiana. The state has recently passed an 
``organ hoarding'' law to prevent organs that are made available for 
transplant in Louisiana from leaving the state. The state has also 
filed a lawsuit against the Secretary for issuing national regulations, 
despite the fact that the National Organ Transplant Act specifically 
requires that the Secretary do so.
  Fairness is half of this fight; Quality is the other part. There is a 
lot of money to be made in organ transplants. Too many centers have 
been opened to increase the prestige and the profits of a local 
hospital--and not because they do a good job. In fact, in general the 
lower volume small transplant centers have poorer outcomes than the 
high volume transplant centers. The fact is that having a transplant 
center has become the equivalent of health pork. Many of these centers 
are like the excess projects in the recently-passed highway bill: 
centers without a justification. But unlike highway pork, these centers 
sometimes end up killing patients because they do not do as good a job 
as the high volume centers. I really think it is immoral for centers 
that have a lower success rate than the high volume centers to be 
fighting the Department's regulation. Their actions are a disgrace to 
the Hippocratic Oath.
  The proliferation of poor quality transplant centers not only wastes 
lives, it wastes money. The United States has 289 hospitals doing 
tranplants--and that is an enormous commitment of capital. I have read 
that a hospital has to invest about $10 million to be able to do heart 
transplants.
  These proliferating costs are part of what drives health inflation in 
the United States and part of what places such huge budget pressures on 
Medicare. Concentrating transplants in fewer, high-quality, life-saving 
centers would allow us to save hundreds of millions of dollars in the 
years to come. The Department's regulation gives us the potential to 
focus on Centers of Excellence where we not only save lives, but can 
obtain economies of scale necessary to preserve the Medicare program.
  If my colleagues are serious about putting patients first, what is so 
onerous about a system that proposes to base transplant decisions on 
common medical criteria on a medical need list--not geography, not 
income, not even levels of insurance coverage--just pure professional 
medical opinion and medical need.
  This issue is about putting patients first--not putting transplant 
bureaucracies first. I can think of no better way to put patients first 
than to make the system fair for all. I urge my colleagues to support 
the Department's regulations and to vote against the Labor-HHS bill.

                  The Bill is Bad for Working Families

  This bill would have devastating effects on working families and I 
strongly urge my colleagues to reject this bill.
  America's working families deserve a break. After a few years of 
record profits for Wall Street and the Fortune 500 companies, it is 
time to help out the working men and women responsible for this 
productivity. Instead, some of my colleagues, in their quest to please 
corporate shareholders, have launched an assault upon the basic 
protections that working families count on and enjoy.
  I've heard from numerous young people in my district about the 
importance of the Summer Youth Employment Training Program (SYETP). 
They tell me that they have learned the value of a dollar and the 
importance of being accountable and responsible because of their summer 
jobs. I've heard from Mayors and School Districts about the need for 
this program. The Castro Valley Unified School District wrote to me to 
tell me that ``SYETP is one of those programs that addresses the needs 
of a segment of our student population and does so with a high degree 
of success.'' I've included this letter for the Congressional Record to 
accompany my statement.

  What has the Majority done in response to this support for the Summer 
Youth Employment Training Program? They have eliminated all of the 
funding for it.
  The Summer Youth Employment Training Program works. It give young 
people the tools, skills and experience they need to succeed in the 
workplace after they are finished with school. Eliminating this program 
is not an investment in our future.
  This Labor-HHS bill cuts funding for Job Training Partnership Act by 
$1.5 billion from the President's request. The bill also cuts School-
to-work programs by 62 percent from last year's appropriation. The 
message to young workers is clear: if you stuck in a low paying job or 
lack a graduate degree, the government will not help you obtain the 
skills you need to provide for your family. This is the wrong direction 
for our country to be going.
  One of the largest roles for government to protect working families 
is through the Occupational Safety and Health Administration (OSHA). 
OSHA offers guidelines for employers to provide employees with safe 
workplaces and enforces safety standards to ensure that the likelihood 
of injury or death on the job is reduced. OSHA is the safety cop on the 
beat for working families, and deserves our support.

[[Page H10139]]

  This Labor-HHS bill cuts OSHA funding by $18 million from the 
Administration's request. Furthermore, the bill includes provisions to 
require peer-review of the scientific data on which OSHA standards are 
based. The bill specifically permits a person with a financial interest 
in the outcome of the standard to set on the pear review panel. I 
question how many true labor protection standards will make it out of 
the regulatory process with employers and financial backers making the 
final decisions about what workers safety standards are really needed.
  The majority's labor record is clear. Working families should take a 
back seat to corporate interests and employer decisions. I don't share 
this view.
  I believe that working families deserve strong protections at the 
workplace, should be able to organize and advocate for their common 
interests and should not have to work in an environment of indentured 
servitude to guarantee a paycheck.
  If my colleagues were serious about help out working men and women, 
they would work to pass a real minimum wage increase and link it to a 
cost of living adjustment to provide a real working wage for working 
families. Making investments in people is the highest priority for me. 
Cutting funding out of programs to provide job skills and job security 
does not lead to an economically stable society.
  I urge my colleagues to vote for working families and for worker 
protections and to vote against this bill.
         Board of Education, Castro Valley Unified School District
                            Castro Valley, CA, September 14, 1998.
     Hon. Fortney ``Pete'' Stark,
     Fremont, CA.
       Dear Representative Stark: The purpose of this letter is to 
     urge you to support the continuation of the Summer Youth 
     Employment Training Program (SYETP). This program has been a 
     valuable one over the years over the Castro Valley Unified 
     School District as it has provided opportunities for students 
     from low income families to be successful in a work 
     experience environment.
       Our responsibility as educators is to provide programs and 
     strategies that are diverse in nature in order to address the 
     diversity within our student population. SYETP is one of 
     those programs that addresses the needs of a segment of our 
     student population and does so with a high degree of success.
       There is no doubt that the elimination of this program will 
     be a major loss for us in the district and the Regional 
     Occupational Program in general. Judging by the information 
     that I have received, the elimination of SYETP nationally 
     would result in approximately 400,000 young people not having 
     an opportunity for work and educational assistance in 1999. 
     This is staggering and unacceptable! We cannot afford to 
     ignore the needs of any of our students and specifically with 
     regard to SYETP, the needs of students who have potential to 
     be productive members of our society when they reach 
     adulthood.
       Thank you in advance for your support and assistance.
           Sincerely,
                                                   George Granger,
                                                        President.
  Ms. JACKSON-LEE of Texas. Mr. Chairman, thank you for the opportunity 
to speak on this bill tonight, and this amendment, the Istook/Barcia/
Manzullo Amendment to the Labor HHS bill. Mr. Chairman, for the first 
time EVER, the House Appropriations Committee voted to impose a 
restrictive provision in this bill which will require that minors 
require five business days' parental notice or parental consent before 
a minor can obtain contraceptive services at a Title X clinic.
  I have consistently opposed mandatory parental consent requirements 
for young people seeking family planning services, and I am not alone. 
The American Medical Association, the American Academy of Pediatrics, 
the American Academy of Physicians, and the American Medical Women's 
Association are just a number of the organizations that also oppose 
this restriction. The reason is because such restrictions are dangerous 
to our country's young people.
  There is no question that recent declines in the teen pregnancy and 
teen abortion rates have been attributed to increased use of birth 
control. The vast majority of young people who seek contraceptive and 
family planning services are already sexually active. In one recent 
study of over 1,200 teenagers in 31 family planning clinics, only 14 
percent of the teens came in for family planning services prior to 
initiating sexual activity. In fact, over \1/3\ of these teens (36 
percent) sought services ONLY because they suspected they were 
pregnant. This legislation will only make it worse. In general, teens 
are sexually active for 11.5 months prior to seeking clinic services! 
This provision will not persuade our young people to have sex, it will 
ensure that the rates of unintended pregnancies, abortion and STDs 
including HIV increase! Currently 78 percent of teen pregnancies are 
unintended, half of which end in abortion. Approximately 3 million 
teenagers acquire an STD each year! I am sure that no Member of 
Congress wants these numbers to increase, yet making it more difficult 
for teenagers to seek reproductive health services will do just this.

  Title X counselors are already required to encourage family 
participation for teen clients. However, Congress, despite, its wishes 
cannot mandate open family communication. Title X clinics encourage 
their teenage clients to discuss their needs with parents or family 
members they can trust. Confidential access to family planning is 
crucial in helping teenagers obtain timely medical advice and 
appropriate medical care.
  Our children are our most important resource. We must do whatever we 
can to make sure that our children remain safe and healthy. I am voting 
against this amendment because I want our children to have a childhood 
and to keep our teenagers from becoming parents.
  Mr. CASTLE. Mr. Speaker, as you know, Title X of the Public Health 
Service Act, the National Family Planning Program, sponsored by then-
Congressman George Bush, was enacted in 1970. It was signed into law by 
President Nixon. The program provides grants to public and private non-
profit agencies to support projects which provide a broad range of 
family planning and reproductive services, as well as screening for 
breast and cervical cancer, sexually-transmitted infections and high 
blood pressure. Title X also supports training providers, an 
information and education program, and a research program that focuses 
on family planning service delivery improvements. The Title X program 
has provided services to millions of American women, many of whom have 
no other access to health care services. By law, none of the funds 
provided may be used for abortions.
  Today, we are considering a bill that includes a provision requiring 
parental consent or advanced notification in order for a minor to 
receive contraceptive drugs or devices. Ideally, we would like all 
teens to abstain from pre-mature sexual relationships. Ideally, we 
would like to think that all teenagers have a wonderful relationship 
with a loving parent. Unfortunately, the reality is that for many, many 
teens neither is the case. There are young people who are scared to 
death of their parents. There are young people who do not have parents. 
And, the unfortunate reality is that there are young people who would 
rush out and have unprotected sex if they knew practicing safe sex 
would come at the price of having their parents find out. This is what 
the mandatory parental consent and advanced parental notification 
provision does.
  In many cases such a provision would actually increase the chances of 
teenagers engaging in unprotected, nondiscriminatory or unsafe sex, 
thereby increasing the rates of pregnancy, sexually-transmitted 
diseases, and abortions. 56% of women and 73% of men are sexually 
active before the age of 18. 86% of teenagers using or seeking Title X 
services for the first time were already sexually active for nearly a 
year. In addition, studies show that about 55% of adolescents already 
inform parents of their use of reproductive health services. For those 
who do not or cannot discuss family planning with their parents, 
mandatory parental consent and advanced parental notification are not 
likely to convince them otherwise. In fact, an overwhelming number of 
teens who do not involve their parents in such decisions reported that 
they would not seek clinic care if their parents had to be notified. 
Let me repeat--they would not seek clinic care. This means that they 
are left to make decisions on their own, and those decisions will most 
likely lead to unprotected sex, higher rates of pregnancy and higher 
rates of abortion.
  Let me give you an example. In my home state, as scary as this is, 
there are kids who have reported that they cannot tell their parents 
about the use of family planning services because they are afraid they 
will be hurt physically. We also had a case where parents of a 15 year 
old girl refused to bring her to get family planning services until she 
was 16 years old and had her drivers license. Well, she turned 16, she 
got her drivers license and she was already pregnant. If she had the 
services a year before, she wouldn't be in this predicament. Now, I'm 
not saying this is the norm. What I am saying is that we need to take 
situations like this into consideration before we start mandating 
policies as far reaching as this one. If parents and guardians are 
unable to help these teenagers, for whatever reason. I believe health 
professionals should help.
  I also want to note that the Greenwood/Castle amendment does not in 
anyway discourage parental involvement. It simply strikes the mandatory 
parental notification clause and inserts strong language requiring 
Title X providers to take a strong stand on abstinence, by expressly 
informing all minors that abstinence is the only certain way to avoid 
pregnancy, sexually transmitted diseases, and HIV. Our language ensures 
that all Title X counselors receive training on how to help minors 
abstain from sexual activity, avoid coercive relationships, and involve 
their parents in the decision to receive family planning services.
  We support family involvement, and if we believe that mandating 
parental consent or notification was in the best interest of teens, 
than we would support that as well. But, we do not. There are too many 
facts that demonstrate that mandating parental consent will hurt teens 
considerably more than it could ever help them.
  Congressmen Istook and Manzullo will offer a second degree amendment 
to our amendment inserting the parental consent or notification 
language back into the bill. I urge my colleagues to vote against their 
amendment and for the Greenwood/Castle amendment. Mandated parental 
consent or notification would scare teens into doing something

[[Page H10140]]

stupid--like having unprotected sex in secret rather than having their 
parents find out that they wanted to be safe and responsible.
  Mr. PAUL. Mr. Chairman, I am sorry that under the rule my amendment 
to the Labor-HHS-Education Appropriations bill is not permitted. This 
simple amendment forbids the Department of Health and Human Services 
from spending any funds to implement those sections of the Health 
Insurance Portability and Accountability Act of 1996 authorizing the 
establishment of a ``standard unique health care identifier'' for all 
Americans. This identifier would then be used to create a national 
database containing the medical history of all Americans. Establishment 
of such an identifier would allow federal bureaucrats to track every 
citizen's medical history from cradle to grave. Furthermore, it is 
possible that every medical professional, hospital, and Health 
Maintenance Organization (HMO) in the country would be able to access 
an individual citizen's record simply by entering the patient's 
identifier into the national database.
  My amendment was drafted to ensure that the administration cannot 
take any steps toward developing or implementing a medical ID. This 
approach is necessary because if the administration is allowed to work 
on developing a medical ID it is likely to attempt to implement the ID 
on at least a ``trial'' basis. I would remind my colleagues of our 
experience with national testing. In 1997 Congress forbade the 
Department of Education from implementing a national test, however it 
allowed work toward developing national tests. The administration has 
used this ``development loophole'' to defy congressional intent by 
taking steps toward implementation of a national test. It seems clear 
that only a complete ban forbidding any work on health identifiers will 
stop all work toward implementation.
  Allowing the federal government to establish a National Health ID not 
only threatens privacy but also will undermine effective health care. 
As an OB/GYN with more than 30 years experience in private practice, I 
know better than most the importance of preserving the sanctity of the 
physician-patient relationship. Oftentimes, effective treatment depends 
on a patient's ability to place absolute trust in his or her doctor. 
What will happen to that trust when patients know that any and all 
information given their doctor will be placed in a data base accessible 
by anyone who knows the patient's ``unique personal identifier?''
  I ask my colleagues, how comfortable would you be confiding any 
emotional problem, or even an embarrassing physical problem like 
impotence, to your doctor if you knew that this information could be 
easily accessed by friend, foe, possible employers, coworkers, HMOs, 
and government agents?
  Mr. Chairman, the Clinton administration has even come out in favor 
of allowing law enforcement officials access to health care 
information, in complete disregard of the fifth amendment. It is 
bitterly ironic that the same administration that has proven so 
inventive at protecting its privacy has so little respect for 
physician-patient confidentiality.
  My amendment forbids the federal government from creating federal IDs 
for doctors and employers as well as for individuals. Contrary to the 
claims of some, federal-ID numbers for doctors and employers threaten 
American liberty every bit as much as individual medical IDs.
  The National Provider ID will force physicians who use technologies 
such as e-mail in their practices to record all health care 
transactions with the government. This will allow the government to 
track and monitor the treatment of all patients under that doctor's 
care. Government agents may pull up the medical records of a patient 
with no more justification than a suspicion the provider is involved in 
fraudulent activity unrelated to that patient's care!
  The National Standard Employer Identifier will require employers to 
record employees' private health transactions in a database. This will 
allow coworkers, hackers, government agents and other unscrupulous 
persons to access the health transactions of every employee in a 
company simply by typing the company's identifier into their PC!
  Many of my colleagues admit that the American people have good reason 
to fear a government-mandated health ID card, but they will claim such 
problems can be ``fixed'' by additional legislation restricting the use 
of the identifier and forbidding all but certain designated persons to 
access those records.
  This argument has two flaws. First of all, history has shown that 
attempts to protect the privacy of information collected by, or at the 
command, of the government are ineffective at protecting citizens from 
the prying eyes of government officials. I ask my colleagues to think 
of the numerous cases of IRS abuses that were brought to our attention 
in the past few months, the history of abuse of FBI files, and the case 
of a Medicaid clerk in Maryland who accessed a computerized database 
and sold patient names to an HMO. These are just some of many examples 
that show that the only effective way to protect privacy is to forbid 
the government from assigning a unique number to any citizen.
  Even the process by which the National Identifier is being developed 
shows disdain for the rights of the American people. The National 
Committee on Vital and Health Statistics, which is developing the 
national identifier, attempted to keep important documents hidden from 
the public in violation of federal law. In fact, one of the members of 
the NCVHS panel working on the medical ID chastised his colleagues for 
developing the medical ID ``in an aura of secrecy.''
  Last September, NCVHS proposed guidelines for the development of the 
medical ID. Those guidelines required that all pre-decisional documents 
``should be kept in strict confidence and not be shared or discussed,'' 
This is a direct violation of the Federal Advisory Committee Act, which 
requires all working documents to be made public. Although NCVHS, 
succumbing to public pressure and possible legal action against it, 
recently indicated it will make its pre-decisional documents available 
in compliance with federal law, I hope my colleagues on the Rules 
Committee agree that the NCVHS attempt to evade the will of Congress 
and keep its work secret does not bode well for any future attempts to 
protect the medical ID from abuse by government officials.
  The most important reason, legislation ``protecting'' the unique 
health identifier is insufficient is that the federal government lacks 
any constitutional authority to force citizens to adopt a universal 
health identifier, regardless of any attached ``privacy protections.'' 
Any federal action that oversteps constitutional limitations violates 
liberty for it ratifies the principle that the federal government, not 
the Constitution, is the ultimate arbitrator of its own jurisdiction 
over the people. The only effective protection of the rights of 
citizens is for Congress and the American people to follow Thomas 
Jefferson's advice and ``bind (the federal government) down with the 
chains of the Constitution.''
  For those who claim that this amendment would interfere with the 
plans to ``simplify'' and ``streamline'' the health care system, under 
the Constitution, the rights of people should never take a backseat to 
the convenience of the government or politically powerful industries 
like HMOs.
  Mr. Chairman, all I ask is that Congress by given the change to 
correct the mistake made in 1996 when they authorized the National 
Health ID as part of the Kennedy-Kasebaum bill. The federal government 
has no authority to endanger the privacy of personal medical 
information by forcing all citizens to adopt a uniform health 
identifier for use in a national data base. A uniform health ID 
endangers the constitutional liberties, threatens the doctor-patient 
relationships, and could allow federal officials access to deeply 
personal medical information. There can be no justification for risking 
the rights of private citizens. I therefore urge the Rules Committee to 
take the first step toward protecting Americans from a medical ID by 
ruling my amendment to the Labor-HHS-Education Appropriations bill in 
order.
  Mrs. CLAYTON. The Labor-HHS-Education Appropriations Bill is one 
about priorities. Cutting successful and extremely important education 
and labor programs is not a priority for me.
  Mr. Chairman, I am very disturbed about the number of programs that 
have been left out of this bill.
  Strong employment and training programs for youth and adults would 
help mitigate problems arising from people who do not have the skills 
or the intent to be good employees. Yet, this Labor HHS and Education 
Appropriations bill decimates funding for these very programs. This 
bill eliminates funding for effective programs such as School-to-Work, 
Summer Jobs, and Job Corps.
  By eliminating the Summer Jobs program, the bill denies jobs to a 
half-million of our most disadvantaged youth. Without these funds, \3/
4\ of the young people currently participating in this program would be 
without a job next year. Are these not the same youth who concern us 
because of their potential for gang affiliation, violence and crime?
  The bill, in its original form, eliminated the Low-Income Home Energy 
Assistance Program (LIHEAP)--a program that helps 4.4 million low-
income households pay their heating and cooling bills. However, the 
manager's amendment may appropriate money for LIHEAP, but it will only 
be a fraction of the 1.1 billion appropriated in advance last year for 
use in FY 1999. 1.5 million of the 4.4 million households have elderly 
members. 1.3 million have disabled members. And 2.1 million have 
children in poverty. Who, out of the 4.4 million households, will 
receive the benefit of this insufficient amount of money?
  This bill also cuts funding for the Goals 2000 education reform 
program by 50% below current levels. And, it cuts OSHA workplace safety 
enforcement by 9% below the administration's request. It's ironic. How 
can you eliminate so many programs and claim to improve

[[Page H10141]]

and support opportunities for employment, and the good health and 
education of the people of our country?
  We must restore these programs and remain committed to initiatives 
that allow the disadvantaged to survive. We must remain devoted to 
programs that educate our youth and dedicated to providing our youth 
with opportunities that prepare them for the world of work.
  Mr. Speaker, this is a bill about priorities. This is a bill about 
values. It is not my priority to eliminate necessary programs. And it 
definitely is not a priority for the disadvantaged individuals in our 
society.
  However, it is my priority to ensure that our youth and those who are 
disadvantaged are treated fairly and are given the opportunity to be 
productive citizens. So I ask you . . . honestly is this your priority? 
If it is, then vote no to the Labor-HHS-Education Appropriations Bill.
  Mr. PORTER. Mr. Chairman, I rise in opposition to the Istook 
substitute.
  The Istook amendment is unwise and should be opposed.
  A. First, because it overturns the considered judgment of many 
states.
  1. Virtually all states have laws providing for some degree of 
confidentiality in the provision of such services to minors.
  2. In Illinois, statute provides that physicians may give birth 
control services and information to minors under a number of 
circumstances--including when the minor is already married, is already 
a parent, or when failure to do so would create a serious health 
hazard.
  3. This amendment would overturn the considered judgment of the state 
of Illinois in enacting these provisions--and you might find that it 
poses similar problems in your state. And I do not recommend abrogating 
a law that empowers physicians to act to address serious health 
hazards.
  4. In fact, there are presently twenty-three states that explicitly 
ensure minors' access to confidential family planning services. The 
amendment directly contravenes these state's judgments.
  5. If we are going to set up this Congress as a super State 
Legislature, it seems to me that, at a bare minimum, we should look at 
these state laws carefully and incorporate the learning of the states 
on this subject?
  B. Second, the Istook amendment is premised on the false logic that, 
if minors had to tell their parents they were getting contraceptive 
services, they would abstain from sexual activity. That sounds good, 
but unfortunately its wrong.
  1. The truth is that most minors who go to Title X projects have 
already been sexually active for about a year. They go to a Title X 
project when they fear they have contracted a disease, become pregnant, 
or they decide they need contraceptives.
  2. When they enter the door, they receive counseling by professionals 
who attempt to ascertain the nature of the relationship, including 
potential sexual abuse, encourage the minor to consider abstinence and 
to involve their parents in their decision making, and educate them on 
how to resist coercive sexual activity.
  3. If these minors who are already sexually active know that they 
will not be able to receive contraceptives, they will not go to the 
project. They will not receive abstinence counseling or other 
protective assistance. They will continue to have sex, contract STDs, 
become pregnant and, statistics tell us, over half will have abortions.

  4. And minors from dysfunctional families who may suffer abuse at 
home and be surrounded by drug and alcohol abuse and crime may have 
many valid reasons for wishing to not involve their parents. 
Categorically mandating that involvement, in the absence of a court 
order is neither wise nor realistic.
  5. This is why so many states expressly protect confidential services 
for minors.
  6. And this is why medical organizations--the provider organizations 
that know the realities better than anyone in this room--support 
confidential services.
  a. As the American Medical Association has told us, AMA policy 
opposes mandatory parental notification when prescription 
contraceptives are provided to minors through federally funded programs 
since it creates a breach of confidentiality in the physician-patient 
relationship.
  b. The American Public Health Association and American Nurses 
Association are similarly opposed.
  We should heed this judgment and support the substitute.
  Mr. CLAY. Mr. Chairman, I rise in opposition to the H.R. 4274, the 
Labor/HHS Appropriations bill, because through it the House Republicans 
propose to make drastic cuts in many programs that are vitally 
important to all Americans, but especially to those most in need whose 
very survival and growth depends upon the assistance they receive from 
their government. Fortunately, however, this destructive bill is going 
nowhere and every Member of this body knows it for the sham that it is. 
The Republican leadership recognizes they don't have the votes to pass 
it and are negotiating to include another version of this measure in 
the Omnibus spending bill.
  The funding levels in the bill, as reported, fall $2 billion short of 
what democrats believe is needed to improve our schools and prepare our 
children for the 21st Century. There are no funds for America Reads, 
which helps endure that all children can read well when they complete 
the third grade. There are no funds to help communities hire 100,000 
new teachers and reduce class size so that students can have a better 
chance to learn. There are no funds to help communities modernize and 
build schools that provide safe and appropriate learning environments. 
Clearly, there is nothing in this bill that reflects any investment in 
the future of public education. In fact, this bill grossly underfunds 
existing and proven educational programs upon which we have long 
relied.
  Later today, this body will consider a bipartisan conference report 
reauthorizing the Head Start program, yet this appropriations bill 
would provide $160 million less than what the President has requested 
to run Head Start next year. A second bipartisan conference report to 
be taken up today extending child nutrition programs, would authorize 
new funds for meal supplements to induce greater participation in 
after-school programs. This appropriations bill, however, would provide 
$140 million less than what the President requested to operate these 
very same after-school programs. I can't imagine how any Member who 
would vote today to reauthorize our Head Start and nutrition programs 
could, in good conscience, support these devastating cuts.
  Regrettably, Mr. Speaker, the cuts don't stop here, there are many 
many more. For example, funding for Title I, bilingual education, Safe 
and Drug Free Schools, Work-Study, and School to Work are all cut. 
Without the assistance there programs, provide, thousands of 
disadvantaged students will be deprived of both the educational and 
career opportunities they need to succeed in life.
  Our nation's labor force also suffers under this appropriations bill. 
It cuts funding for critical worker protection programs run by the 
Occupational Safety and Health Administration, and the Mine Safety and 
Health Administration. Several regulatory riders are attached that 
compromise these agencies' effectiveness. In addition, the bill 
undermines efforts to help our youth enter the workforce by completely 
defunding the Summer Jobs Program and the President's Youth Opportunity 
Areas Initiative.
  Finally, Mr. Chairman, this bill eliminates funding for the Low 
Income Energy Assistance Program which provides heating and cooling 
assistance for over 5.5 million low and fixed-income households. With 
winter approaching, many of those who have relied on this program may 
soon be forced to choose between heating their homes and feeding their 
families. That should be totally unacceptable in a nation as prosperous 
as ours. But rather than meet this urgent need, Republicans would 
rather squander available dollars on tax cuts for the wealthy.
  Mr. Chairman, this is a bad bill that hurts students, working 
families, and our most neediest families. I strongly urge Members to 
oppose it.
  Thank you Mr. Chairman.
  The Chair recognizes the gentleman from Illinois (Mr. Porter).

  Mr. PORTER. Mr. Chairman, I yield back the balance of my time.
  Mr. OBEY. Mr. Chairman, because I think this is a colossal waste of 
time, I, too, yield back the balance of my time.
  The CHAIRMAN. All time for general debate has expired.
  Pursuant to the House Resolution 564, the bill shall be considered 
for amendment under the 5-minute rule.
  Pursuant to that resolution, Amendment No. 1 printed in House Report 
105-762 may be offered only at the appropriate point in the reading of 
the bill. Pursuant to House Resolution 584, Amendments No. 2 and 3 
shall be in order before the consideration of any other amendment.
  The Amendments No. 2 and 3 printed in the report may be offered only 
by a Member designated in the report, shall be considered read, shall 
be debatable for the time specified in the order of the House today, 
equally divided and controlled by the gentleman from Pennsylvania (Mr. 
Greenwood) for 8 minutes, the gentleman from Oklahoma (Mr. Coburn) for 
8 minutes, the gentleman from Oklahoma (Mr. Istook) for 8 minutes, and 
the gentleman from Ohio (Mr. Stokes) for 8 minutes, shall not be 
subject to amendment except as specified in the report, and shall not 
be subject to a demand for division of the question.
  The Clerk will read.

[[Page H10142]]

  The Clerk read as follows:

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled, That the 
     following sums are appropriated, out of any money in the 
     Treasury not otherwise appropriated, for the Departments of 
     Labor, Health and Human Services, and Education, and related 
     agencies for the fiscal year ending September 30, 1999, and 
     for other purposes, namely:


                Amendment No. 2 Offered By Mr. Greenwood

  Mr. GREENWOOD. Mr. Chairman, I offer an amendment.
  (The portion of the bill to which the amendment relates is as 
follows:)

       Sec. 220. (a) Notwithstanding any other provision of law, 
     no provider of services under title X of the Public Health 
     Service Act shall be exempt from any State law requiring 
     notification or the reporting of child abuse, child 
     molestation, sexual abuse, rape, or incest.
       (b) None of the funds appropriated in this or any other Act 
     for any fiscal year for carrying out title X of the Public 
     Health Service Act may be made available to any family 
     planning project under section 1001 of such title if any 
     provider of services in the project knowingly provides 
     contraceptive drugs or devices to a minor, unless--
       (1) the minor is emancipated under applicable State law;
       (2) the minor has the written consent of a custodial parent 
     or custodial legal guardian to receive the drugs or devices;
       (3) a court of competent jurisdiction has directed that the 
     minor may receive the drugs or devices; or
       (4) such provider of services has given actual written 
     notice to a custodial parent or custodial legal guardian of 
     the minor, notifying the parent or legal guardian of the 
     intent to provide the drugs or devices, at least five 
     business days before providing the drugs or devices.
       (c) Each provider of services under title X of the Public 
     Health Service Act shall each year certify to the Secretary 
     of Health and Human Services compliance with this section. 
     Such Secretary shall prescribe such regulations as may be 
     necessary to effectuate this section.
       This title may be cited as the ``Department of Health and 
     Human Services Appropriations Act, 1999''.

  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 2 printed in the House Report Number 105-762 
     offered by Mr. Greenwood:
       Page 52, strike line 8 and all that follows through page 
     53, line 8, and insert the following:
       (b)(1) The Secretary of Health and Human Services (in this 
     section referred to as the ``Secretary'') shall require that 
     each family planning project under section 1001 of title X of 
     the Public Health Service Act--
       (A) expressly inform all minors who seek the services of 
     the project that abstinence is the only certain way to avoid 
     pregnancy, sexually transmitted diseases, and infection with 
     the human immunodeficiency virus; and
       (B) ensure that all individuals who provide counseling 
     services to minors through the project are trained to provide 
     to minors counseling that encourages the minors--
       (i) to abstain from sexual activity;
       (ii) to avoid being coerced into engaging in sexual 
     activities; and
       (iii) to involve their parents in the decision to seek 
     family planning services.
       (2) The Secretary, acting through the Deputy Assistant 
     Secretary for Population Affairs, shall carry out the 
     following with respect to family planning projects referred 
     to in paragraph (1):
       (A) The Secretary shall develop and disseminate to the 
     projects protocols for providing the counseling described in 
     paragraph (1)(B), including protocols for training 
     individuals to provide the counseling.
       (B) The Secretary shall ensure that such protocols include 
     protocols specific to younger adolescents.
       (C) In developing protocols under subparagraphs (A) and 
     (B), the Secretary shall consider the results of research 
     under title XX of the Public Health Service Act.
                               __________
                               

3. A Substitute Amendment Offered by Representative Istook of Oklahoma 
 or His Designee to the Amendment Numbered 2 Offered by Representative 
               Greenwood of Pennsylvania or His Designee

       Strike section 220 (page 52, line 3, and all that follows 
     through page 53, line 8) and insert the following:
       Sec. 220. (a) Notwithstanding any other provision of law, 
     no provider of services under title X of the Public Health 
     Service Act shall be exempt from any State law requiring 
     notification or the reporting of child abuse, child 
     molestation, sexual abuse, rape, or incest.
       (b) None of the funds appropriated in this or any other Act 
     for any fiscal year for carrying out title X of the Public 
     Health Service Act may be made available to any family 
     planning project under section 1001 of such title if any 
     provider of services in the project knowingly provides 
     contraceptive drugs or devices to a minor, unless--
       (1) such provider of services has given actual written 
     notice to a custodial parent or custodial legal guardian of 
     the minor, notifying the parent or legal guardian of the 
     intent to provide the drugs or devices, at least five 
     business days before providing the drugs or devices; or
       (2) the minor has the written consent of a custodial parent 
     or custodial legal guardian to receive the drugs or devices; 
     or
       (3) the minor is emancipated under applicable State law; or
       (4) a court of competent jurisdiction has directed that the 
     minor may receive the drugs or devices.
       (c)(1) The Secretary of Health and Human Services (in this 
     section referred to as the ``Secretary'') shall require that 
     each family planning project under section 1001 of title X of 
     the Public Health Service Act--
       (A) expressly inform all minors who seek the services of 
     the project that abstinence is the only certain way to avoid 
     pregnancy, sexually transmitted diseases, and infection with 
     the human immunodeficiency virus; and
       (B) ensure that all individuals who provide counseling 
     services to minors through the project are trained to provide 
     to minors counseling that encourages the minors--
       (i) to abstain from sexual activity;
       (ii) to avoid being coerced into engaging in sexual 
     activities; and
       (iii) to involve their parents in the decision to seek 
     family planning services.
       (2) The Secretary, acting through the Deputy Assistant 
     Secretary for Population Affairs, shall carry out the 
     following with respect to family planning projects referred 
     to in paragraph (1):
       (A) The Secretary shall develop and disseminate to the 
     projects protocols for providing the counseling described in 
     paragraph (1)(B), including protocols for training 
     individuals to provide the counseling.
       (B) The Secretary shall ensure that such protocols include 
     protocols specific to younger adolescents.
       (C) In developing protocols under subparagraphs (A) and 
     (B), the Secretary shall consider the results of research 
     under title XX of the Public Health Service Act.

  The CHAIRMAN. Pursuant to the order of the House today, the gentleman 
from Pennsylvania (Mr. Greenwood) and a Member opposed, the gentleman 
from Oklahoma (Mr. Coburn) each will control 8 minutes.


Amendment No. 3 Offered By Mr. Istook As A Substitute For The Amendment 
                        Offered By Mr. Greenwood

  Mr. ISTOOK. Mr. Chairman, I offer an amendment as a substitute for 
the amendment.
  The CHAIRMAN. The Clerk will designate the amendment offered as a 
substitute for the amendment.
  The text of the amendment offered as a substitute for the amendment 
is as follows:

       Amendment No. 3 printed in House Report 105-762 offered by 
     Mr. Istook as a substitute for the Amendment No. 2 offered by 
     Mr. Greenwood:
       Strike section 220 (page 52, line 3, and all that follows 
     through page 53, line 8) and insert the following:
       Sec. 220. (a) Notwithstanding any other provision of law, 
     no provider of services under title X of the Public Health 
     Service Act shall be exempt from any State law requiring 
     notification or the reporting of child abuse, child 
     molestation, sexual abuse, rape, or incest.
       (b) None of the funds appropriated in this or any other Act 
     for any fiscal year for carrying out title X of the Public 
     Health Service Act may be made available to any family 
     planning project under section 1001 of such title if any 
     provider of services in the project knowingly provides 
     contraceptive drugs or devices to a minor, unless--
       (1) such provider of services has given actual written 
     notice to a custodial parent or custodial legal guardian of 
     the minor, notifying the parent or legal guardian of the 
     intent to provide the drugs or devices, at least five 
     business days before providing the drugs or devices; or
       (2) the minor has the written consent of a custodial parent 
     or custodial legal guardian to receive the drugs or devices; 
     or
       (3) the minor is emancipated under applicable State law; or
       (4) a court of competent jurisdiction has directed that the 
     minor may receive the drugs or devices.
       (c)(1) The Secretary of Health and Human Services (in this 
     section referred to as the ``Secretary'') shall require that 
     each family planning project under section 1001 of title X of 
     the Public Health Service Act--
       (A) expressly inform all minors who seek the services of 
     the project that abstinence is the only certain way to avoid 
     pregnancy, sexually transmitted diseases, and infection with 
     the human immunodeficiency virus; and
       (B) ensure that all individuals who provide counseling 
     services to minors through the project are trained to provide 
     to minors counseling that encourages the minors--
       (i) to abstain from sexual activity;
       (ii) to avoid being coerced into engaging in sexual 
     activities; and
       (iii) to involve their parents in the decision to seek 
     family planning services.
       (2) The Secretary, acting through the Deputy Assistant 
     Secretary for Population Affairs, shall carry out the 
     following with respect to family planning projects referred 
     to in paragraph (1):
       (A) The Secretary shall develop and disseminate to the 
     projects protocols for providing the counseling described in 
     paragraph

[[Page H10143]]

     (1)(B), including protocols for training individuals to 
     provide the counseling.
       (B) The Secretary shall ensure that such protocols include 
     protocols specific to younger adolescents.
       (C) In developing protocols under subparagraphs (A) and 
     (B), the Secretary shall consider the results of research 
     under title XX of the Public Health Service Act.
       (d) Each provider of services under section 1001 of title X 
     of the Public Health Service Act shall each year certify to 
     the Secretary of Health and Human Services compliance with 
     this section. Such Secretary shall prescribe such regulations 
     as may be necessary to effectuate this section.

  The CHAIRMAN. Pursuant to the order of the House today, the gentleman 
from Oklahoma (Mr. Istook) and a Member opposed, the gentleman from 
Ohio (Mr. Stokes) each will control 8 minutes.
  The Chair recognizes the gentleman from Pennsylvania (Mr. Greenwood).
  Mr. GREENWOOD. Mr. Chairman, I yield myself 2 minutes.
  Mr. Chairman, this is a virtual reality debate as we know. This bill 
is not going to go anywhere. This is a debate that should have occurred 
months ago, and the opponents of free debate on the floor held us up 
for months, but now we will have the debate. I think we can and should 
do it in a civilized way.
  This is the issue. The gentleman from Oklahoma (Mr. Istook) in the 
Committee on Appropriations inserted language into the title 10 
program, the program that provides family planning services to 
Americans, to lower income Americans, so that they can avoid pregnancy 
and provide services so that they can avoid sexually transmitted 
diseases.
  The language of the gentleman from Oklahoma (Mr. Istook) says that, 
when a minor, a 17-year-old teenager who has been sexually active for a 
long time, as is usually the case, comes into a clinic. The clinic 
counselor must send a letter to the parents and the child. The minor 
cannot receive services for 5 additional days.
  I understand the gentleman's intent. I am a parent. But it is wrong-
headed. The result of that language, the result of that policy is that 
if young people do not go into centers and clinics, they do not get the 
services they need, they become pregnant, and they get diseases.
  Our language makes it clear that every family counselor, every family 
planning counselor has to encourage family involvement in the decision 
of minors to seek family planning services and provide counseling to 
minors on how to resist coercive sexual relations.
  It requires them to expressly inform all minors that abstinence is 
the only certain way to avoid pregnancy, sexually transmitted diseases, 
including HIV.
  It requires further that every counselor have state of the art 
training to encourage, to learn how, and teach kids to involve their 
parents with these decisions and to abstain from sexual activity.
  I urge a ``no'' vote on the Istook amendment and a ``yes'' vote on 
the underlying Greenwood amendment.
  Mr. ISTOOK. Mr. Chairman, I yield myself 1 minute and 15 seconds.
  Mr. Chairman, the Committee on Appropriations has sought to reform a 
Federal program that has not been revised or reviewed by the Congress 
in a great number of years, that being Federal Family Planning.
  It is not a matter of 17 years olds, it is a matter of children of 
any age whatsoever, Mr. Chairman. It is not a matter of just low income 
persons because the effect of not having parental notice is to say that 
any child is considered to be a child of poverty and, therefore, at 
taxpayers' expense, can receive, among other things, taxpayer financed 
contraceptives, condoms, birth control pills, IUDs, diaphragms, with 
neither the knowledge or consent of their parents.
  Now, Mr. Chairman, if the government were enabling children to be 
involved with drugs or alcohol or were aware that they were involved, 
parents would be notified. There is no other circumstance like this 
where parents are cut out.
  The issue is to vote that parents have a right to know, to be 
involved with the morals and the life and the activities of their 
children. That is simply why we encourage a vote for the Istook 
substitute to provide for parental notice, which is sadly lacking 
today.

                              {time}  1900

  Mr. GREENWOOD. Mr. Chairman, I yield 4 minutes to the gentleman from 
Ohio (Mr. Stokes) for purposes of control.
  The CHAIRMAN. Without objection, the gentleman from Ohio (Mr. Stokes) 
will control 4 minutes.
  There was no objection.
  Mr. STOKES. Mr. Chairman, I thank the gentleman for yielding to me. 
Mr. Chairman, I yield the 4 minutes to the distinguished gentlewoman 
from New York (Mrs. Lowey).
  Mrs. LOWEY. Mr. Chairman, I thank my distinguished good friend and 
ranking minority member, the gentleman from Ohio, (Mr. Stokes).
  My colleagues, the Istook provision represents the latest attack by 
family planning opponents against our Nation's flagship program. Three 
years ago, family planning opponents tried to zero out funds for the 
Title X program. They failed. Two years ago, family planning opponents 
led by the gentleman from Oklahoma (Mr. Istook) offered a parental 
consent amendment, and it failed. Last year the gentleman from Oklahoma 
(Mr. Istook) offered language nearly identical to that which he is 
offering today. That amendment also failed.
  These attacks on the Title X program have failed because a majority 
of Members in this body, pro-life and pro-choice, understand that 
denying teens access to family planning does not promote abstinence. I 
only wish it were that simple.
  Contrary to what we will hear today, the Istook language does not 
promote family values or protect the authority of parents over their 
teenagers. As a mother of 3 and a grandmother of 2, I can vouch for 
that. And instead, cutting off family planning services to teens simply 
increases STDs and HIV infections, unintended pregnancies and 
abortions.
  The Istook provision would deny contraception to minors unless they 
have the consent of their parents or waited 5 days after their parents 
were notified before obtaining contraception. Some of my colleagues are 
making a distinction between notification and consent, but who is 
kidding who? The 5-day waiting period before contraception can be 
obtained is no different than parental consent. The AMA, the American 
Academy of Pediatricians, Child Welfare League, Public Health 
Association, Social Workers and Nurses Association all oppose the 
mandatory parental notification restrictions in the Istook amendment.
  Of course, we would prefer that all teens consult with their parents 
about important life decisions such as using contraception. We would 
prefer that teens abstain from having sex altogether. But 
unfortunately, we know that teens will not change their behavior just 
because Congress passes a law. Instead, teens will forego contraception 
rather than facing their parents.
  In fact, studies show that over 80 percent of teens seeking family 
planning services have already been sexually active for nearly a year. 
By denying contraceptive services to tens of thousands of teens, the 
Istook language will simply result in higher rates of STDs, more 
unintended pregnancies and more abortions. If teens are required to 
obtain parental consent for contraceptive services, they will also 
avoid STD and HIV screening and routine gynecological exams.
  Our Nation already leads the western world in teen pregnancies. 
Millions of teens have some kind of STD, and the incident of AIDS among 
teens is, frankly, alarming.
  Mr. Chairman, we need to address these problems, but not by making 
Title X services more difficult to obtain. My colleagues, we have a 
teen pregnancy crisis in the country, and the Istook provision, in my 
judgment, will only make it worse. By contrast, the Greenwood-Castle 
substitute before us today promotes sensible policies for teens. It 
promotes the values we all share: abstinence for teens and parental 
involvement. However, it does not threaten the health of teens by 
withdrawing contraceptive services from our most vulnerable teens who 
simply have nowhere else to turn.
  Please, I say to my colleagues, think carefully. Let us protect the 
health and well-being of our teenagers, reduce the teen pregnancies 
which lead to abortion, support the Greenwood-Castle substitute, and 
oppose the Istook second degree amendment.

[[Page H10144]]

  Mr. ISTOOK. Mr. Chairman, we have 3 cosponsors of the amendment: 
myself, the gentleman from Michigan (Mr. Barcia), and the gentleman 
from Illinois (Mr. Manzullo).
  Mr. Chairman, I yield 2 minutes to the gentleman from Illinois (Mr. 
Manzullo).
  Mr. MANZULLO. Mr. Chairman, the reason for the Istook-Barcia-Manzullo 
amendment is simple. In McHenry County, Illinois, which I represent, a 
37-year-old teacher was raping a 13-year-old student of his over and 
over and over again. He took her to the Title X-funded McHenry Tri-
County Health Clinic. She was injected on 3 different occasions with 
Depo-Provera, which is a harsh chemical. In fact, the chemical of 
choice for chemical castration by convicts.
  Her parents had no idea that she was getting these shots. In America 
today, children as young as 12 years old are being injected, implanted, 
and given prescriptive medication without their parents even knowing.
  Our bill does something very simple. It adopts the language of the 
gentleman from Oklahoma (Mr. Istook) that Title X health care providers 
are required to counsel all minors regarding abstinence. It adopts the 
gentlewoman from New York (Mrs. Lowey's) problem with this bill that 
says that children are getting STDs because our bill still allows them 
to get STDs. In fact, the clinic is still open. Kids can get all the 
information they want.
  What we are simply saying here is this: Allow the parents in this 
Nation to be put in charge of the sexuality of their children. It is 
just that simple. We talk about 17 year olds, the gentleman from 
Pennsylvania (Mr. Greenwood) talks about. I wonder at what age he would 
allow young women to get these injections. In Winnebago County, we 
understand it is 12 years old. Winnebago County, Illinois.
  So vote for the Istook-Barcia amendment that does 3 things. Parents 
are given actual notice that their children are about to receive 
prescriptive drugs. It provides for judicial bypass. The amendment does 
not require parental notification for a minor to receive information, 
counseling and treatment of STDs. A very modest request.
  JAMA, Journal of American Medical Association, in a study done in 
September of 1997 would agree with this position.
  Mr. GREENWOOD. Mr. Chairman, I yield myself 15 seconds.
  In response to the previous speaker, one cannot conduct this debate 
by using the most exaggerated, extreme cases. In the real world, it is 
16- and 17-year-old kids who have no parent at home to talk to, who 
will have no counseling unless the Greenwood amendment is adopted.
  Mr. Chairman, I yield 1 minute to the gentleman from Delaware (Mr. 
Castle).
  Mr. CASTLE. Mr. Chairman, I rise in support of the Greenwood 
amendment and in opposition to the Istook amendment.
  I would like to explain to everybody, this is not pro-life and pro-
choice. We need to understand what is going on. Mr. Chairman, 55 
percent of all teenagers consult with their parents before they do 
anything. Eighty-six percent of the teenagers that go into these 
clinics looking for contraceptive devices or other help are already 
sexually active.
  In a perfect world we would have no sexual activity among teenagers, 
but we do. And when they come in there, they are looking for help, and 
the help they are getting hopefully will help them prevent STD or 
pregnancy and abortion. It is my personal view that if we are able to 
give them the help, even though we may not prefer that they be involved 
with a sexual activity, but if we give them that help that they are 
going to in that way be able to prevent getting sexual diseases, 
prevent pregnancy, and therefore, prevent the abortion.
  I love the idea of mandatory parental notification. That is the 
difference between our bills, because everything else is provided for 
in the Greenwood-Castle bill, except for the mandatory parental 
notification, but if we do that, we are not going to have these kids go 
in and get the help they need. Please support the Greenwood bill.
  Mr. ISTOOK. Mr. Chairman, I yield myself 15 seconds.
  Mr. Chairman, I think it is crucial to understand that we are not 
talking about the past when a child goes into a Title X clinic, we are 
talking about the future. We are talking about enabling the future 
conduct with a program that spends $200 million of taxpayers' money a 
year and gives these to 1\1/2\ million teenagers without the knowledge 
of their parents.
  Mr. COBURN. Mr. Chairman, I yield 1 minute and 15 seconds to the 
gentlewoman from Idaho (Mrs. Chenoweth).
  Mrs. CHENOWETH. Mr. Chairman, I thank the gentleman for yielding me 
this time.
  I just simply wanted to say that I rise in great support of the 
Istook amendment.
  Mr. Chairman, the tendency in these days is to interfere with that 
very precious relationship between parents and children, and yes, 
children are going to do what young people do. But nevertheless, the 
parents are still primarily responsible for their children, and we as 
lawmakers must do all that we can to make sure that relationship stays 
strong and the parents remain responsible.
  In a recent Gallup poll of over 500 teenagers between the ages of 15 
and 17, fully 66 percent of those polled said that they believed that 
parental consent, which is a stronger standard than we are asking for 
in the Istook amendment, parental consent should be required. This is 
what teenagers said.
  Also, in another recent poll it also said that 47 percent of all 
unintended pregnancies in the U.S. occur when women are on 
contraceptives. We need more than just contraceptives. We need good 
parental relationships, and we need to encourage that.
  Mr. GREENWOOD. Mr. Chairman, I yield myself 15 seconds.
  Mr. Chairman, the gentlewoman who just spoke said that we need more 
than contraceptives. That is why the Greenwood language is so focused 
on abstinence, abstinence counseling. That is why we are so focused on 
getting the families in. The problem is that not every kid has the 
right parent to do that.
  Mr. Chairman, I yield 2 minutes to the gentlewoman from Maryland 
(Mrs. Morella).
  Mrs. MORELLA. Mr. Chairman, I rise in very strong support of the 
Greenwood-Castle amendment and in opposition to the Istook amendment.
  This current language in the bill requiring parental consent or 
notification would really do great harm to our efforts to lower the 
number of unintended pregnancies and abortions, and to our efforts to 
reduce the incidence of sexually transmitted diseases, including HIV 
and AIDS.
  On the face of it it sounds very reasonable, but it really ignores 
the realities of the young people who seek care at these clinics. The 
vast majority of them are already sexually active, have been for almost 
a year or more, and many of them seek these services because they are 
afraid they may be pregnant or they have a sexually transmitted 
disease.
  Mr. Chairman, if teens are required to obtain parental consent for 
any of the Title X services, many of them will avoid the program 
entirely. It is important to remember that some contraceptives provide 
protection from STDs. And the opportunity to provide accurate, 
potentially life-saving education on the transmission of HIV and other 
STDs could also be lost if teens avoid these services because of 
parental consent requirements.
  I think the Greenwood-Castle amendment offers all kinds of counseling 
that would be necessary.
  I just want to point out the medical community is overwhelmingly 
opposed to parental consent notification requirements for minors, and I 
hope that this Congress will support the Greenwood-Castle amendment and 
oppose the Istook amendment.
  The CHAIRMAN. The Chair will seek a clarification of the gentleman 
from Pennsylvania. Did the gentleman yield 4 of his 8 minutes to the 
gentleman from Ohio (Mr. Stokes)?
  Mr. GREENWOOD. Mr. Chairman, I believe I yielded 4 minutes, and I 
would be delighted to yield another 4 minutes.
  The CHAIRMAN. The gentleman has exhausted the balance of his time 
through yielding it to the gentlewoman from New York (Mrs. Lowey).
  Mr. GREENWOOD. Mr. Chairman, is it the case then that the time is not 
entirely fungible, but that there will be

[[Page H10145]]

another 8 minutes yielded on the Greenwood underlying amendment? Is 
that correct?
  The CHAIRMAN. The time was allocated at the outset for both 
propositions.
  Mr. ISTOOK. Mr. Chairman, if I may inquire as to the time remaining 
and the different allocations.
  The CHAIRMAN. The Chair asks indulgence for 1 minute. The Chair 
understands the time as fungible.
  Under the unanimous consent, each of the following Members were 
recognized for 8 minutes:
  The gentleman from Oklahoma (Mr. Istook); the gentleman from Oklahoma 
(Mr. Coburn); the gentleman from Ohio (Mr. Stokes); the gentleman from 
Pennsylvania (Mr. Greenwood), and that is on both amendments, in 
combination, total time.
  So the gentleman from Pennsylvania (Mr. Greenwood), perhaps under a 
misunderstanding, has yielded 4 of his 8 minutes to the gentleman from 
Ohio (Mr. Stokes), who used that time. The gentleman from Ohio (Mr. 
Stokes) may, in turn, choose to yield 4 minutes of his time back to the 
gentleman from Pennsylvania.
  Mr. STOKES. Mr. Chairman, I am pleased to yield 4 minutes to the 
gentleman from Pennsylvania (Mr. Greenwood)

                              {time}  1915

  The CHAIRMAN. The gentleman from Ohio (Mr. Stokes) yields to the 
gentleman from Pennsylvania (Mr. Greenwood) for his management of 4 
minutes of time.
  Mr. COBURN. Mr. Chairman, I yield 1 minute to the gentleman from 
Michigan (Mr. Barcia).
  Mr. BARCIA. Mr. Chairman, I rise in support of the Istook amendment 
to allow parental notification of minors seeking contraceptives in 
Title X clinics.
  In a recent Gallop survey of 500 teens age 13 through 17, 66 percent 
indicated that they believed that parental consent should be required 
before minors received birth control, and believed in fact that 
parental support and involvement would be beneficial to them.
  I would like to also point out, current law requires minors to 
receive parental consent to have their ears pierced, or even, in cases 
of an allergy sufferer, to receive an allergy shot. Yet these children 
can gain access to hormones or other contraceptive drugs that can in 
fact pose a serious danger to the health of that child. In effect, this 
issue begs the question of what role should parents have in helping to 
determine their children's health care needs.
  I want to say that while I respectfully disagree with my 
distinguished colleagues, I commend them for their concern and their 
focus on abstinence, also, as a key method of preventing unwanted 
pregnancies.
  The CHAIRMAN. The Chair will advise the four Members controlling 
time, for purposes of the debate that the decision is that the 
gentleman from Oklahoma (Mr. Istook) as a member of the committee will 
have the right to close, and the gentleman from Ohio (Mr. Stokes) as a 
member of the committee will be next to last in closing.
  In order to balance the other two, the gentleman from Oklahoma (Mr. 
Coburn) and the gentleman from Pennsylvania (Mr. Greenwood), it is in 
the Chair's discretion to decide. In order to alternate pro and con on 
this issue overall, the gentleman from Pennsylvania (Mr. Greenwood) 
will go first in the final use of time, the gentleman from Oklahoma 
(Mr. Coburn) will go second, the gentleman from Ohio (Mr. Stokes) 
third, and the gentleman from Oklahoma (Mr. Istook) fourth.
  Mr. COBURN. Mr. Chairman, I yield 2 minutes to the gentleman from 
Florida (Mr. Weldon).
  Mr. WELDON of Florida. Mr. Chairman, I thank the gentleman for 
yielding time to me.
  Mr. Chairman, I rise in strong support of the Istook-Barcia-Manzullo 
amendment. I encourage all of my colleagues to vote for it, and vote 
against the Greenwood amendment.
  As many know, I practiced medicine prior to coming to the Congress, 
including working in emergency rooms. When I work in the emergency 
room, one of the things we always fear is the possibility that a minor 
child can come in with a serious illness and the parents will not be 
with them, and we will not be able to get parental consent.
  The reason why that is a very, very serious concern is if we stitch 
up a wound or give a drug and that child has a reaction to that drug, 
we can actually be prosecuted for assault. Indeed, a minor child cannot 
get an aspirin from a school nurse, nor, as was stated previously on 
the other side of the aisle, their ears pierced without parental 
consent in the United States. But there is one place in the United 
States today where a minor child can get medical care without parental 
consent, and that is in the Title X family planning clinics.
  It has been proposed or expounded that these clinics are somehow 
cutting down on the incidence of AIDS, unwanted pregnancies, or HIV. I 
would assert that all the research data indicates that since this 
program began that the incidence of all of those things has gotten 
consistently worse, not better.
  Indeed, I would assert that this policy established by this Congress 
has been a tremendous assault on the integrity of the family, and has 
played a role in the explosion of sexual activity.
  In closing, I would just like to say one additional thing. The data 
that has actually come out of the Alan Gutmacher Institute indicates 
that up to as many as 50 percent of these kids under the age of 18 are 
having sexual relations with a man over the age of 18, and in the vast 
majority of the States that is statutory rape. Indeed, in the case 
cited by the gentleman from Illinois (Mr. Manzullo), it involved a 
teacher of 37 years having relations with a 13-year-old child.
  So I would encourage all of my colleagues to vote with the gentleman 
from Oklahoma (Mr. Istook) on his amendment. It is the right thing to 
do for the family, it is morally right, and the arguments being put 
forward by the opponents of the gentleman from Oklahoma (Mr. Istook) 
are incorrect.
  Mr. GREENWOOD. Mr. Chairman, I yield 2 minutes to the gentlewoman 
from Connecticut (Mrs. Johnson).
  Mrs. JOHNSON of Connecticut. Mr. Chairman, in the real world it is 
not hard for kids to get condoms. We may not like it, but it is true. 
Would Members not rather that they got the advice that came from 
someone who said to them, you ought to talk to your mom and dad about 
that; that it was someone skilled enough that they would know how to 
tell that kid how to talk to their mom and dad? A lot of kids do not 
talk to their mom and dad about this stuff because they actually do not 
know how to approach it.
  They would sit them down and say, look, this is how you do it, then 
back them up, and say, come back to me and talk to me about it. A lot 
of kids need to be coached to talk to their parents, because their 
parents do not talk to them. Their parents do not talk to them, not 
just about sex, but also not about school, not about friendships, not 
about intimacy, not about love.
  If Members want to mandate, mandate that everyone has to get anything 
they want to use from a Title X clinic or any health clinic that meets 
these standards. Then every kid, including the kid that the gentleman 
from Illinois (Mr. Manzullo) was so concerned about, she would have 
come someplace that was skilled in explaining to her, you do not have 
to participate in coercive sexual relationships.
  My point is that we do not tell kids this is coercive sex, we do not 
tell them they do not have to do this. We do not get them someplace 
where there are skilled people who can help them build their 
relationships with their family, help them resist the kind of pressures 
that are on them, help them understand that abstinence is the only real 
protection. Furthermore, it gives them a chance to develop their 
personal power as a young woman.
  If Members want to mandate, mandate that they get whatever it is that 
they want to get from skilled counselors, from a facility that can give 
them the advice and guidance they need to go to the right people, their 
families. Remember, States are a lot closer to these problems. 
Connecticut has a very good law. I ask Members, please do not override 
our good law with their mandate.
  Mr. COBURN. Mr. Chairman, I yield 15 seconds to the gentleman from 
Illinois (Mr. Manzullo).
  Mr. MANZULLO. Mr. Chairman, in the case in Illinois, under Illinois 
law,

[[Page H10146]]

the 13-year-old did receive abstinence counseling.
  Mr. COBURN. Mr. Chairman, I am happy to yield 45 seconds to the 
gentlewoman from North Carolina (Mrs. Myrick).
  Mrs. MYRICK. Mr. Chairman, the Istook amendment does protect our 
children, and it does provide counseling for children during the time 
that they are going through emotional problems in their lives. But it 
does protect a parent's right to know. It simply requires that a parent 
be notified before their child is given contraception. As parents, we 
do want to know that. We want to know if they smoke, drink, or do 
drugs. I do not really see why this is any different.
  One thing we have not talked about is that all birth control is not 
safe, because it has been documented that birth control can be very 
damaging to young girls going through puberty. It can cause blood 
clotting, bone deterioration, blindness, among a long list of possible 
side effects, and even death in girls with heart conditions. It has 
been a cause of brainstem stroke in teenagers. So I urge Members to 
support the Istook amendment.
  Mr. STOKES. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman 
from Texas (Ms. Sheila Jackson-Lee).
  (Ms. JACKSON-LEE of Texas asked and was given permission to revise 
and extend her remarks.)
  Ms. JACKSON-LEE of Texas. Mr. Chairman, I thank the gentleman from 
Ohio for yielding time to me.
  Mr. Chairman, this is a difficult time. Let me share a fact in our 
community. A young woman living with a stepfather and her mother, a 
young woman having her future before her, her stepfather sexually 
abused her. There obviously was not enough communication in that home. 
The child wound up pregnant.
  I support the Greenwood-Castle substitute, for any other approach to 
that would go against what 23 States have done. This now will require 
Title X counselors to expressly inform all minors that abstinence is 
the only certain way to avoid pregnancy, sexually transmitted 
infections, and HIV, but it adds counseling to this process. It makes 
clear that Title X providers must abide by State laws in the reporting 
of contribution, child molestation, sexual abuse, rape, and incest.
  Now we are talking more to these young women who may come for these 
kinds of prescriptions, but then also share and burden those who are 
counseling them, what is going on in their home, and maybe this tragedy 
in Houston would not have occurred.
  The Greenwood-Castle substitute ensures that all Title X counselors 
receive state-of-the-art training on how to help minors abstain from 
sexual activity, avoid coercive sexual relationships, and involve their 
parents in the decision to receive family planning.
  Mr. Chairman, if the Istook amendment is passed, we will see more of 
those victims, impregnated young girls, losing the future of their 
lives. I would ask that we vote for the Greenwood-Castle substitute 
only.
  Mr. COBURN. Mr. Chairman, I yield 2 minutes to the gentleman from 
Pennsylvania (Mr. Pitts).
  Mr. PITTS. Mr. Chairman, I rise in strong support of the Istook-
Barcia-Manzullo parental notification amendment. Parents should have 
the right to know what the Federal Government is doing to their 
children. It absolutely amazes me that the opponents of this provision 
do not have a problem with having to write a note for their daughters 
to receive an aspirin at school or permission to have their ears 
pierced. Yet, when it comes to young girls being given serious birth 
control prescription by strangers, opponents do not believe that 
parents should even be told, that they even have the right to know.
  President Clinton has said, parents quite simply have a right to 
know. Unfortunately, he was not referring to parents having the right 
to know about their children being given DepoProvera, he was referring 
to the importance of parents knowing which companies are most 
responsible for the problem of teen smoking.
  If parents quite simply have the right to know about teen smoking, 
then surely they have the right to know if their minor daughter is 
receiving potentially dangerous contraceptive prescriptions. The Istook 
amendment is the only amendment that requires parental notification for 
prescription contraceptives. The Greenwood amendment would gut this 
provision.
  I urge Members to vote for the Istook-Barcia-Manzullo amendment, to 
give parents the right to protect their minor daughters.
  Mr. STOKES. Mr. Chairman, I yield 1 minute to the gentlewoman from 
New York (Mrs. Maloney).
  Mrs. MALONEY of New York. Mr. Chairman, in my State alone over 
300,000 women and teens rely on Title X for their only reproductive 
health care. Studies show that 80 percent of teens who currently seek 
family planning advice at clinics would stop going if they had to tell 
their parents. The Istook language will cause many teens to delay or, 
even worse, avoid seeking essential health care services, placing their 
health at risk.
  How can we claim to be protecting the health of our young women if we 
pass legislation that damages their health by restricting access to the 
care they need? I agree that ideally teens should be encouraged to talk 
to their parents about their health care decisions, but we do not live 
in an ideal world, and millions of teens do not live in ideal families.

                              {time}  1930

  The Greenwood-Castle substitute is the correct approach. It provides 
teens with the message that abstinence is the only way to avoid 
pregnancy, STDs and HIV infection without restricting their access to 
needed health care.
  Mr. COBURN. Mr. Chairman, I reserve the balance of my time.
  The CHAIRMAN. The Chair would inquire of the gentleman from Oklahoma 
(Mr. Coburn) how many speakers he has remaining for his 1\1/2\ minutes.
  Mr. COBURN. Just one, Mr. Chairman.
  The CHAIRMAN. And how many speakers does the gentleman from 
Pennsylvania (Mr. Greenwood) have remaining for his 2 minutes?
  Mr. GREENWOOD. One, Mr. Chairman.
  The CHAIRMAN. The gentleman from Ohio (Mr. Stokes) has 30 seconds 
remaining. In that case, I think it would be appropriate that all the 
rest of the time be used for closing statements.
  So then it is appropriate under the previous direction of the Chair 
that the gentleman from Pennsylvania (Mr. Greenwood) is recognized to 
close with 2 minutes.
  Mr. GREENWOOD. Mr. Chairman, I yield myself the balance of my time.
  Mr. Chairman, this is one of those debates where real good friends 
look at each other and say, ``How can you think this way? How can we 
come to such different conclusions?"
  Mr. Chairman, these are my two pretty little girls and I love them 
and I want to make sure that nothing ever happens to them. And they are 
so lucky. They are so lucky because their mother and I talk to them, 
and we are going to talk to them about their health and their sexuality 
and their personalities and the strength of their character. And when 
they come to this decision, they will have us.
  But walk out the door of this building. Walk out the door of this 
building and tell me how many minutes it takes to find the first 
teenage girl whose parents could care less about her; if they knew 
where she was, if she knew where they were. Tell us what value it is 
that we are accomplishing when we send a letter into that home, we send 
a letter into that home from an agency.
  Do my colleagues know what happens? The girl says, Do not send that 
letter there. I do not want this service, if that is what it means. And 
so where does she live? She lives in a world in which she has 
predators. She could be 15 or 16, and there are guys in those 
neighborhoods all over America, all kinds of neighborhoods, preying on 
her, putting her at risk of pregnancy, putting her at risk of abortion, 
putting her at risk of HIV.
  She has got nobody. She does not have a parent. She does not have, if 
the Istook language prevails, a counselor. She has got nobody to teach 
her what is right. And if we want these values taught to these poor 
kids, just like we want them taught to our kids, vote for the Greenwood 
amendment and please vote ``no'' on the Istook amendment.
  Mr. COBURN. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman 
from Oklahoma (Mr. Istook).

[[Page H10147]]

  Mr. ISTOOK. Mr. Chairman, this program provides birth control pills 
and other contraceptives to kids. Not just those who are 17, but it 
freely gives them to those who are 15, to those who are 13, to those 
who are 12, to those who are 11, to those who are 11, 10, with no 
limit, totally ignoring the State laws on the books about age of 
consent.
  Without the language, the Istook language in the bill, we do not even 
have a requirement to turn in people who are taking advantage of kids, 
and then taking them to these clinics for birth control, who are 
breaking the law that is designed to protect minors and our kids.
  The issue is should $200 million a year of taxpayers' money go to 
provide contraceptives to 1.5 million kids each year without their 
parents knowing it? This is not emergency care. We do not say they have 
to have notice if they need treatment, if they have already contracted 
some disease. It is only if they are giving out contraceptives for 
future sexual activity.
  And birth control pills, yes, they have side effects. They have 
interactions. Parents need to know about their children's health, as 
well as about their children's morals, if they are going to be involved 
in being able to give parental guidance.
  The Istook language has counseling on abstinence. It has a 
requirement that State laws are to be followed in reporting sexual 
predators. For goodness sakes, Mr. Chairman, let the parents know.
  Mr. STOKES. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman 
from Texas (Mr. Edwards) for the purpose of closing.
  Mr. EDWARDS. Mr. Chairman, this debate is certainly not about 
statutory rape, nor is it about taking aspirin. What this debate is 
about is the real world consequences of the Istook amendment, 
regardless of the intentions.
  I often hear my Republican friends and colleagues talking about 
taking responsibility for one's actions. They are right, and I agree. 
And what taking responsibility means on the Istook amendment is that 
the supporters of this amendment must honestly face the real world 
consequences of the actions of this amendment and the result of this 
amendment, if it were to pass into law.
  According to the expert opinion of the American Medical Association, 
the American College of Obstetricians and Gynecologists, and even the 
American Family Physicians, is that this type of amendment could cause 
several things to happen. First, more unplanned pregnancies. Because of 
that, more abortions.
  It could also cause in the real world a lot of young teenagers to 
have serious health problems that otherwise could have been prevented, 
including lifelong infertility for young women who would love to some 
day have a family of their own, like many of us are blessed to have our 
own family.
  I do not question the intentions of the gentleman from Oklahoma (Mr. 
Istook) or his supporters but I do ask them to face not the ideal world 
in which we would like to live but the real world and the real world 
consequences that we actually do live in.
  I will finish. To suggest that there is anything in the Greenwood 
language that would come between families and teenagers and parents is 
absolutely simply not true.
  Mr. ISTOOK. Mr. Chairman, I yield the balance of the time to the 
gentleman from Oklahoma (Mr. Coburn), a family doctor who practices in 
this area, to close the debate.
  The CHAIRMAN. The gentleman from Oklahoma (Mr. Coburn) is yielded the 
remaining 4 minutes.
  Mr. COBURN. Mr. Chairman, first of all, let me thank the gentleman 
from Illinois (Mr. Porter) for the way he worked with us this year. He 
has my utmost respect. I also want to say that the gentleman from 
Pennsylvania (Mr. Greenwood) and I have become good friends through 
this because we have both learned something from one another.
  I do not doubt anybody's motives here, but I definitely doubt the 
gentleman's knowledge of the facts. I am in the real world every day 
dealing with teenagers who are pregnant and have a sexually transmitted 
disease. Do you know what? Two-thirds of them have already been to the 
Title X clinic. We enabled them to fail.
  At the time we have this debate today, 32,000 Americans will get a 
new sexually transmitted disease, and of that, 17,000 have already been 
to a Title X clinic.
  So the question is, what are the real facts? I agree, if we put in 
the Istook language, some additional young women will get pregnant; 
some will get a sexually transmitted disease. But what about all those 
children now who are going to a Title X clinic or using birth control 
pills and do not use them right because it is not talked to by their 
parents? They do not even brush their teeth at night, let alone 
remember to take a pill.
  Here is the science on oral contraceptives. This is married couples 
taking the pill, here is what we can expect: 12 to 16 percent of them 
get pregnant in the first year. Why would we think a 12 or a 16 or 18 
year old would not? That does not have anything to do with sexually 
transmitted diseases, of which human papilloma virus is growing like 
gangbusters, and herpes, now 40 percent of our population has herpes.
  Oral contraceptives do not protect; a condom does not protect. What 
are we going to give our children for the two greatest sexually 
transmitted diseases that we have today? The only thing that we can 
give them is the knowledge of involving their parents back with them in 
this decision.
  I agree, there will be young women who will choose not to go but 
there will be hundreds of thousands of young women who do have an 
opportunity to have a relationship with their parents renewed and 
discuss this issue. If they choose to continue to take oral 
contraceptives, they will have a parent there saying be sure and take 
your pill; be sure and do not be indiscriminate; let us teach you how 
to do it.
  The idea of the gentleman from Pennsylvania (Mr. Greenwood) on 
counseling, I agree.
  Title X, for those under 18 years of age, in my opinion, is one of 
the biggest causes of failure of our children. It is not a help. The 
facts do not show that it is a help. We like to say it is a help 
because of all of the problems we see.
  I give teenage girls oral contraceptives. I practice in this area. 
But before they walk out of my office, after I have tried to talk them 
out of it, I make sure they know everything about it, everything about 
it. The real world is, is there are some wonderful Planned Parenthood 
clinics that do a good job but the real world on Title X clinics is 
they do not. They hand them a book of pills and a piece of paper and 
say, go. They never say the first thing about they are not going to be 
protected against a sexually transmitted disease.
  Finally, my colleagues need to know about the NIH study. Ninety 
thousand teenagers, 1993, we sponsored the study, here is what it says: 
The number one way to keep teenagers from getting pregnant or getting a 
sexually transmitted disease is to connect the parent to the teenager. 
It is called parental connectedness.
  Why would we not want to have a government policy that follows the 
largest study ever done in our country on this issue?
  It is an easy, simple thing. We all want the same thing. We do not 
want our kids to get pregnant. We do not want them to get a sexually 
transmitted disease. The difference is, there is a base of knowledge 
and if we will really look at it we will all go to the same point. We 
are not 100 percent right or 100 percent wrong.
  The CHAIRMAN. The question is on the amendment offered by the 
gentleman from Oklahoma (Mr. Istook), as a substitute for the amendment 
offered by the gentleman from Pennsylvania (Mr. Greenwood).
  The question was taken; and the Chairman announced that the ayes 
appeared to have it.


                             Recorded Vote

  Mr. STOKES. Mr. Chairman, I demand a recorded vote.
  A recorded vote was ordered.
  The CHAIRMAN. Pursuant to clause 2(c) of rule XXIII, the Chair 
announces that he may reduce to not less than 5 minutes any recorded 
vote on the underlying Greenwood amendment.
  The vote was taken by electronic device, and there were--ayes 224, 
noes 200, not voting 10, as follows:

[[Page H10148]]

                             [Roll No. 504]

                               AYES--224

     Aderholt
     Archer
     Armey
     Bachus
     Baker
     Ballenger
     Barcia
     Barr
     Barrett (NE)
     Bartlett
     Barton
     Bateman
     Bereuter
     Bilirakis
     Bishop
     Bliley
     Blunt
     Boehner
     Bonilla
     Bono
     Brady (TX)
     Bryant
     Bunning
     Burr
     Burton
     Callahan
     Calvert
     Camp
     Canady
     Cannon
     Chabot
     Chambliss
     Chenoweth
     Christensen
     Coble
     Coburn
     Collins
     Combest
     Cooksey
     Costello
     Cox
     Cramer
     Crane
     Crapo
     Cubin
     Cunningham
     Danner
     Deal
     DeLay
     Diaz-Balart
     Dickey
     Doolittle
     Doyle
     Dreier
     Duncan
     Dunn
     Ehlers
     Emerson
     English
     Ensign
     Everett
     Ewing
     Forbes
     Fossella
     Fowler
     Fox
     Gallegly
     Gekas
     Gibbons
     Gillmor
     Goode
     Goodlatte
     Goodling
     Gordon
     Goss
     Graham
     Granger
     Gutknecht
     Hall (OH)
     Hall (TX)
     Hamilton
     Hansen
     Hastert
     Hastings (WA)
     Hayworth
     Hefley
     Herger
     Hill
     Hilleary
     Hoekstra
     Holden
     Hostettler
     Hulshof
     Hunter
     Hutchinson
     Hyde
     Inglis
     Istook
     Jenkins
     John
     Johnson, Sam
     Jones
     Kanjorski
     Kasich
     Kildee
     Kim
     King (NY)
     Kingston
     Knollenberg
     LaFalce
     LaHood
     Largent
     Latham
     Lewis (CA)
     Lewis (KY)
     Linder
     Lipinski
     Livingston
     LoBiondo
     Lucas
     Manzullo
     Mascara
     McCollum
     McCrery
     McHugh
     McIntosh
     McIntyre
     McKeon
     Metcalf
     Mica
     Miller (FL)
     Mollohan
     Moran (KS)
     Murtha
     Myrick
     Nethercutt
     Neumann
     Ney
     Northup
     Norwood
     Nussle
     Ortiz
     Oxley
     Packard
     Pappas
     Parker
     Paul
     Paxon
     Pease
     Peterson (MN)
     Petri
     Pickering
     Pitts
     Pombo
     Portman
     Quinn
     Radanovich
     Rahall
     Redmond
     Regula
     Riggs
     Riley
     Roemer
     Rogan
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Roukema
     Royce
     Ryun
     Salmon
     Sandlin
     Sanford
     Saxton
     Scarborough
     Schaefer, Dan
     Schaffer, Bob
     Sensenbrenner
     Sessions
     Shadegg
     Shaw
     Shimkus
     Shuster
     Skeen
     Skelton
     Smith (MI)
     Smith (NJ)
     Smith (OR)
     Smith (TX)
     Smith, Linda
     Snowbarger
     Solomon
     Souder
     Spence
     Stearns
     Stenholm
     Stump
     Stupak
     Sununu
     Talent
     Tanner
     Tauzin
     Taylor (MS)
     Taylor (NC)
     Thornberry
     Thune
     Tiahrt
     Traficant
     Turner
     Visclosky
     Walsh
     Wamp
     Watkins
     Watts (OK)
     Weldon (FL)
     Weldon (PA)
     Weller
     White
     Whitfield
     Wicker
     Wilson
     Wolf
     Young (AK)
     Young (FL)

                               NOES--200

     Abercrombie
     Ackerman
     Allen
     Andrews
     Baesler
     Baldacci
     Barrett (WI)
     Bass
     Becerra
     Bentsen
     Berman
     Berry
     Bilbray
     Blagojevich
     Blumenauer
     Boehlert
     Bonior
     Borski
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Brown (CA)
     Brown (FL)
     Brown (OH)
     Campbell
     Capps
     Cardin
     Carson
     Castle
     Clay
     Clayton
     Clement
     Clyburn
     Condit
     Conyers
     Cook
     Coyne
     Cummings
     Davis (FL)
     Davis (IL)
     Davis (VA)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Deutsch
     Dicks
     Dingell
     Dixon
     Doggett
     Dooley
     Edwards
     Ehrlich
     Engel
     Eshoo
     Etheridge
     Evans
     Farr
     Fattah
     Fawell
     Filner
     Foley
     Ford
     Frank (MA)
     Franks (NJ)
     Frelinghuysen
     Frost
     Furse
     Ganske
     Gejdenson
     Gephardt
     Gilchrest
     Gilman
     Gonzalez
     Green
     Greenwood
     Gutierrez
     Harman
     Hastings (FL)
     Hefner
     Hilliard
     Hinchey
     Hinojosa
     Hobson
     Hooley
     Horn
     Houghton
     Hoyer
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Johnson (CT)
     Johnson (WI)
     Johnson, E. B.
     Kaptur
     Kelly
     Kennedy (MA)
     Kennedy (RI)
     Kilpatrick
     Kind (WI)
     Kleczka
     Klink
     Klug
     Kolbe
     Kucinich
     Lampson
     Lantos
     LaTourette
     Lazio
     Leach
     Lee
     Levin
     Lewis (GA)
     Lofgren
     Lowey
     Luther
     Maloney (CT)
     Maloney (NY)
     Manton
     Markey
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McDermott
     McGovern
     McHale
     McInnis
     McKinney
     McNulty
     Meehan
     Meek (FL)
     Meeks (NY)
     Menendez
     Millender-McDonald
     Miller (CA)
     Minge
     Mink
     Moran (VA)
     Morella
     Nadler
     Neal
     Oberstar
     Obey
     Olver
     Owens
     Pallone
     Pascrell
     Pastor
     Payne
     Pelosi
     Pickett
     Pomeroy
     Porter
     Price (NC)
     Ramstad
     Rangel
     Reyes
     Rivers
     Rodriguez
     Rothman
     Roybal-Allard
     Rush
     Sabo
     Sanchez
     Sanders
     Sawyer
     Schumer
     Scott
     Serrano
     Shays
     Sherman
     Sisisky
     Skaggs
     Slaughter
     Smith, Adam
     Snyder
     Spratt
     Stabenow
     Stark
     Stokes
     Strickland
     Tauscher
     Thomas
     Thompson
     Thurman
     Tierney
     Torres
     Towns
     Upton
     Velazquez
     Vento
     Waters
     Watt (NC)
     Waxman
     Wexler
     Weygand
     Wise
     Woolsey
     Wynn

                             NOT VOTING--10

     Buyer
     Fazio
     Kennelly
     Martinez
     McDade
     Moakley
     Peterson (PA)
     Poshard
     Pryce (OH)
     Yates

                              {time}  2001

  Ms. HOOLEY of Oregon changed her vote from ``aye" to ``no.''
  Mr. STUPAK and Mr. NEY changed their vote from ``no'' to ``aye.''
  So the amendment offered as a substitute for the amendment was agreed 
to.
  The result of the vote was announced as above recorded.
  The CHAIRMAN. The question is on the amendment offered by the 
gentleman from Pennsylvania (Mr. Greenwood), as amended.
  The amendment, as amended, was agreed to.
  Mr. PORTER. Mr. Chairman, I move that the Committee do now rise.
  The motion was agreed to.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Shimkus) having assumed the chair, Mr. Bereuter, Chairman of the 
Committee of the Whole House on the State of the Union, reported that 
that Committee, having had under consideration the bill (H.R. 4274) 
making appropriations for the Departments of Labor, Health and Human 
Services, and Education, and related agencies, for the fiscal year 
ending September 30, 1999, and for other purposes, had come to no 
resolution thereon.

                          ____________________