[House Report 112-63]
[From the U.S. Government Publishing Office]
112th Congress } { Report
1st Session } HOUSE OF REPRESENTATIVES { 112-63
=======================================================================
TO AMEND TITLE V OF THE SOCIAL SECURITY ACT TO CONVERT FUNDING FOR
PERSONAL RESPONSIBILITY EDUCATION PROGRAMS FROM DIRECT APPROPRIATIONS
TO AN AUTHORIZATION OF APPROPRIATIONS
_______
April 27, 2011.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Upton, from the Committee on Energy and Commerce,
submitted the following
R E P O R T
together with
DISSENTING VIEWS
[To accompany H.R. 1215]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 1215) to amend title V of the Social Security
Act to convert funding for personal responsibility education
programs from direct appropriations to an authorization of
appropriations, having considered the same, report favorably
thereon without amendment and recommend that the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 2
Committee Consideration.......................................... 3
Committee Votes.................................................. 3
Committee Oversight Findings..................................... 7
Statement of General Performance Goals and Objectives............ 7
New Budget Authority, Entitlement Authority, and Tax Expenditures 7
Earmark.......................................................... 7
Committee Cost Estimate.......................................... 7
Congressional Budget Office Estimate............................. 7
Federal Mandates Statement....................................... 10
Advisory Committee Statement..................................... 10
Applicability to Legislative Branch.............................. 10
Section-by-Section Analysis of the Legislation................... 10
Changes in Existing Law Made by the Bill, as Reported............ 10
Dissenting Views................................................. 12
Purpose and Summary
H.R. 1215, a bill to amend Title V of the Social Security
act to convert funding for personal responsibility education
program from direct appropriations to an authorization of
appropriations, was introduced on March 29, 2011, by Rep.
Robert Latta (R-OH), and referred to the Committee on Energy
and Commerce.
The purpose of H.R. 1215 is to reduce federal spending,
deficits, and debt by repealing mandatory programs with limited
Congressional oversight and ensure that Congress prioritize the
programs it funds by utilizing the traditional appropriations
process.
Background and Need for Legislation
Section 2953 of PPACA establishes state grants for personal
responsibility education programs to educate adolescents about
adulthood preparation, including education regarding financial
literacy, goal-setting, stress management, contraception use,
and development of healthy attitudes regarding body image.
Section 2953 appropriates $75 million for each of fiscal years
2010 through 2014. The legislation would convert the
appropriation into an authorization so Congress can determine
funding through the normal appropriations process. The
legislation would also rescind any unobligated funds.
This provision appears to duplicate existing government
programs, for example: the Effective Teaching and Learning for
a Well-Rounded Education program provides funding for financial
literacy education (the President's FY2012 Budget requests $246
million for the program); Title X funding provides dollars for
the Health Resources Services Administration to provide
information and screening for pregnancy and sexually
transmitted diseases (the President's Budget requests $327
million for Title X); and the Teenage Pregnancy Prevention
program at the Centers for Disease Control and Prevention
support teen prevention activities (the President's Budget
requests $22 million for FY2012).
The federal government is now borrowing 42 cents of every
dollar it spends. The current projected deficit for this fiscal
year is $1.6 trillion while national debt has exceeded $14
trillion. Regardless of whether Members support this grant
program, these funds should first be authorized then separately
appropriated. It is this system that allows Congress to
prioritize spending on those programs that most deserve funding
while ensuring that we control spending to reduce the budget
deficit. We can no longer afford to fund new programs without
eliminating other spending. Congress can then set fiscal
priorities by subsequently providing funding through the
appropriations process after weighing the relative value of
different programs.
Hearings
The Committee on Energy and Commerce held a hearing on
draft legislation that became H.R. 1215 on March 9, 2011. The
following witnesses testified at the hearing:
The Honorable Ernest J. Istook, The Heritage
Foundation
Dr. John Goodman, President and CEO,
National Center for Policy Analysis
The Honorable Joseph F. Vitale, New Jersey
State Senate
Committee Consideration
H.R. 1215 was introduced by Mr. Robert Latta on March 29,
2011, and was referred to the Committee on Energy and Commerce.
On March 31, 2011, the Subcommittee on Health met in open
markup session to consider H.R. 1215. Subsequently, the
Subcommittee ordered H.R. 1215 favorably reported by a recorded
vote of 15-11.
On April 5, 2011, the Energy and Commerce Committee met in
open markup session to consider H.R. 1215. Subsequently, the
Committee ordered H.R. 1215 favorably reported by a vote of 25-
17.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Committee Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the oversight findings and
recommendations of the Committee are reflected in the
descriptive portions of this report, including the finding that
reigning in mandatory spending is necessary to avoid a debt
crisis.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the performance goals and
objectives of the Committee are reflected in the descriptive
portions of this report, including the goal that reigning in
mandatory spending is necessary to avoid a debt crisis.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee finds that H.R.
1215 would result in no new or increased budget authority,
entitlement authority, or tax expenditures or revenues.
Earmark
In compliance with clause 9(e), 9(f), and 9(g) of rule XXI,
the Committee finds that H.R. 1215 contains no earmarks,
limited tax benefits, or limited tariff benefits.
Committee Cost Estimate
The Committee adopts as its own the cost estimate prepared
by the Director of the Congressional Budget Office pursuant to
section 402 of the Congressional Budget Act of 1974.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is a cost estimate
provided by the Congressional Budget Office pursuant to section
402 of the Congressional Budget Act of 1974:
H.R. 1215--A bill to amend title V of the Social Security Act to
convert funding for personal responsibility education programs
from direct appropriations to an authorization of
appropriations
Summary: H.R. 1215 would amend the personal responsibility
education programs created by the Patient Protection and
Affordable Care Act (PPACA) by eliminating direct
appropriations of $75 million each year between 2012 and 2014.
Additionally, the bill would authorize the appropriation of $75
million a year over that same period.
Pay-as-you-go procedures apply because enacting the
legislation would affect direct spending. CBO estimates that
enacting the bill would reduce direct spending by $225 million
over the 2012-2021 period. Enacting the bill would not affect
revenues.
CBO also estimates that implementing H.R. 1215 would
increase discretionary spending by about $200 million over the
2011-2016 period and $225 million over the 2012-2021 period,
assuming appropriation of the authorized amounts.
H.R. 1215 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
Estimated cost to the Federal government: The estimated
budgetary impact of H.R. 1215 is shown in the following table.
The costs of this legislation fall within budget function 500
(education, training, employment, and social services).
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------------------------------------------------------------
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2012-2016 2012-2021
--------------------------------------------------------------------------------------------------------------------------------------------------------
Budget Authority.................................. -75 -75 -75 0 0 0 0 0 0 0 -225 -225
Estimated Outlays................................. -15 -38 -56 -53 -38 -19 -8 0 0 0 -199 -225
Authorization Level............................... 75 75 75 0 0 0 0 0 0 0 225 225
Estimated Outlays................................. 15 38 56 53 38 19 8 0 0 0 199 225
--------------------------------------------------------------------------------------------------------------------------------------------------------
Note: Components may not add to totals because of rounding.
Basis of estimate: For the purpose of this estimate, CBO
assumes that the bill will be enacted near the end of fiscal
year 2011, and that the authorized amounts will be appropriated
for fiscal years 2012 through 2014.
H.R. 1215 would modify the personal responsibility
education programs, which were created in PPACA. Under current
law, those programs receive direct appropriations of $75
million each year from 2010 through 2014. Under H.R. 1215, the
direct appropriation of funds between 2012 and 2014 would be
eliminated, and any unobligated balances would be rescinded.
CBO estimates that enacting the bill would reduce direct
spending by $225 million over the 2012-2021 period. CBO expects
there would be no unobligated balances to rescind. However, if
unobligated balances existed on the date of enactment, the
direct spending savings would be greater.
H.R. 1215 also would authorize the appropriation of $75
million per year for personal responsibility education programs
for each year from 2012 through 2014. As a result, CBO
estimates that implementing the bill would have a discretionary
cost of $225 million over the 2012-2021 period, assuming
appropriation of the authorized amounts.
Pay-as-you-go considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget reporting and enforcement
procedures for legislation affecting direct spending or
revenues. The net changes in outlays that are subject to those
pay-as-you-go procedures are shown in the following table.
CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 1215 AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON ENERGY AND COMMERCE ON APRIL 5, 2011
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-------------------------------------------------------------------------------------------------------------
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2011-2016 2011-2021
--------------------------------------------------------------------------------------------------------------------------------------------------------
NET DECREASE (-) IN THE DEFICIT
Statutory Pay-As-You-Go Impact............ 0 -15 -38 -56 -53 -38 -19 -8 0 0 0 -199 -225
--------------------------------------------------------------------------------------------------------------------------------------------------------
Note: Components may not add to totals because of rounding.
Intergovernmental and private-sector impact: H.R. 1215
contains no intergovernmental or private-sector mandates as
defined in UMRA. By reclassifying funding for the personal
responsibility program, the bill would likely decrease the
amount of funds that state, local, and tribal government
receive to implement the program.
Estimate prepared by: Federal Costs: Jonathan Morancy;
Impact on State, Local, and Tribal Governments: Lisa Ramirez-
Branum; Impact on the Private Sector: Sarah Axeen.
Estimate approved by: Holly Harvey, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 1. Converting Funding for Personal Responsibility Education
Programs from Direct Appropriations to an Authorization of
Appropriations
The legislation would amend Section 513(f) of the Social
Security Act to convert the direct appropriations for personal
responsibility education programs to an authorization of
appropriations for these activities. The legislation would
rescind the unobligated balances from the amounts already
provided.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
SOCIAL SECURITY ACT
* * * * * * *
TITLE V--MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT
* * * * * * *
SEC. 513. PERSONAL RESPONSIBILITY EDUCATION.
(a) Allotments to States.--
(1) Amount.--
(A) In general.--For the purpose described in
subsection (b), subject to the succeeding
provisions of this section, for each of fiscal
years 2010 through 2014, the Secretary shall
allot to each State an amount equal to the
product of--
(i) the [amount] amounts appropriated
under subsection (f) for the fiscal
year and available for allotments to
States after the application of
subsection (c); and
* * * * * * *
[(B) Minimum allotment.--
[(i) In general.--Each State
allotment under this paragraph for a
fiscal year shall be at least $250,000.
[(ii) Pro rata adjustments.--The
Secretary shall adjust on a pro rata
basis the amount of the State
allotments determined under this
paragraph for a fiscal year to the
extent necessary to comply with clause
(i).]
[(C)] (B) Application required to access
allotments.--
(i) * * *
* * * * * * *
(c) Reservations of Funds.--
(1) Grants to implement innovative strategies.--From
the [amount] amounts appropriated under subsection (f)
for the fiscal year, the Secretary shall reserve
$10,000,000 of such amount for purposes of awarding
grants to entities to implement innovative youth
pregnancy prevention strategies and target services to
high-risk, vulnerable, and culturally under-represented
youth populations, including youth in foster care,
homeless youth, youth with HIV/AIDS, pregnant women who
are under 21 years of age and their partners, mothers
who are under 21 years of age and their partners, and
youth residing in areas with high birth rates for
youth. An entity awarded a grant under this paragraph
shall agree to participate in a rigorous Federal
evaluation of the activities carried out with grant
funds.
(2) Other reservations.--From the [amount] amounts
appropriated under subsection (f) for the fiscal year
that remains after the application of paragraph (1),
the Secretary shall reserve the following amounts:
(A) * * *
* * * * * * *
(f) [Appropriation] Authorization of Appropriations.--For the
purpose of carrying out this section, there is [appropriated,
out of any money in the Treasury not otherwise appropriated,]
authorized to be appropriated $75,000,000 for each of fiscal
years [2010] 2012 through 2014. [Amounts appropriated under
this subsection shall remain available until expended.]
* * * * * * *
DISSENTING VIEWS
We, the undersigned members of the Committee on Energy and
Commerce, oppose the passage of H.R. 1215, a bill to convert
the Personal Responsibility Education Program (established in
the Patient Protection and Affordable Care Act) from a program
of mandatory spending to a program of discretionary spending.
Accordingly, we submit the following comments to express our
concerns about this very misguided, deeply divisive, and
unabashedly hypocritical legislation.
Introduction and Background
Each year, some 750,000 American teenagers aged 15 to 19
become pregnant.\1\ For those who carry to term, two-thirds of
births to women younger than age 18 and more than half of those
among women aged 18 and 19 are unintended.\2\
---------------------------------------------------------------------------
\1\Guttmacher Institute, In Brief: Facts on American Teens' Sexual
and Reproductive Health, p. 2 (Jan. 2011) (online at http://
www.guttmacher.org/pubs/FB-ATSRH.pdf).
\2\Centers for Disease Control and Prevention, U.S. Department of
Health and Human Services, About Teen Pregnancy: Teen Pregnancy in the
United States (online at http://www.cdc.gov/TeenPregnancy/
AboutTeenPreg.htm#a) (accessed Apr. 22, 2011).
---------------------------------------------------------------------------
In 2009, approximately 410,000 infants were born to women
aged 15 to 19--a live birth rate of 39.1 per 1,000 women in
this age group. Coupled with the 2008 rate, this figure
reflects the resumption of the long-term downward trend of the
U.S. teen birth rate. This number had fallen significantly over
the period 1991 through 2005, but briefly increased during 2006
and 2007.\3\
---------------------------------------------------------------------------
\3\Id.
---------------------------------------------------------------------------
Despite these improvements, the U.S. teen pregnancy and
birth rates are substantially higher than those of other
western industrialized countries, as are the nation's rates for
sexually transmitted diseases (STDs).\4\ Of the approximately
19 million new STDs diagnosed each year, almost half are among
youth aged 15 to 24.\5\ And in 2008, young people aged 13 to 24
accounted for 17% of all those diagnosed in the U.S. with H1V/
AIDS.\6\ Clearly, the need for age- appropriate, medically
accurate instruction and information on all matters related to
sex remains high.\7\
---------------------------------------------------------------------------
\4\Id.
\5\Centers for Disease Control and Prevention, U.S. Department of
Health and Human Services, Healthy Youth! Health Topics: Sexual Risk
Behaviors (online at http://www.cdc.gov/healthyyouth/sexualbehaviors/
index.htm) (accessed Apr. 22, 2011).
\6\Guttmacher Institute, In Brief: Facts on American Teens' Sexual
and Reproductive Health, p. 2 (Jan. 2011) (online at http://
www.guttmacher.org/pubs/FB-ATSRH.pdt).
\7\Guttmacher Institute, In Brief: Facts on American Teens' Sources
of Information About Sex, pp. 1-2 (Feb. 2011) (online at http://
www.guttmacher.org/pubs/FB-Teen-Sex-Ed.pdt).
---------------------------------------------------------------------------
Experts credit the majority of the decline in teen
pregnancy rates--86%--to teens' increasingly consistent use of
contraceptives; the remaining 14% is due to the higher
percentage of teenagers electing to delay sexual activity.\8\
This, in turn, can be significantly attributed to young
people's participation in comprehensive sexuality education
programs which provide ``age-appropriate, medically accurate
information on a broad set of topics related to sexuality
including human development, relationships, decision making,
abstinence, contraception, and disease prevention.''\9\ Indeed,
these programs have been found to be effective in delaying the
onset of sexual intercourse, reducing the number of sexual
partners, and increasing contraception and condom use among
teens.\10\
---------------------------------------------------------------------------
\8\Guttmacher Institute, In Brief: Facts on American Teens Sexual
and Reproductive Health, p. 2 (Jan. 2011) (online at http://
www.guttmacher.org/pubs/FB-ATSRH.pdf).
\9\SIECUS, Fact Sheet: What the Research Says . . . Comprehensive
Sex Education (updated Oct. 2009) (online at http://www.siecus.org/
index.cfm?fuseaction=Page.ViewPage&PagelD=1193).
\10\Id.
---------------------------------------------------------------------------
Because of its consistently strong track record,
comprehensive sexuality education enjoys the support of
numerous leading medical professional groups, including the
American College of Obstetricians and Gynecologists, the
Society of Adolescent Health, the American Academy of
Pediatrics, the American Medical Association, and the American
Nurses Association, as well as the Institute of Medicine.
Public support for these programs is also robust.\11\
---------------------------------------------------------------------------
\11\Id.
---------------------------------------------------------------------------
It was against this backdrop that Congress established the
Personal Responsibility Education Program (PREP) as part of the
Patient Protection and Affordable Care Act (ACA), enacted in
2010.\12\ The purpose of the program is to provide young people
with the age-appropriate and medically accurate information to
help them reduce their risk of unintended pregnancy, HIV/AIDS,
and other STDs.
---------------------------------------------------------------------------
\12\The ACA is comprised of two public laws, P.L. 111-148 and P.L.
111-152.
---------------------------------------------------------------------------
PREP is principally comprised of two parts: (1) grants to
states; and (2) grants for innovative youth pregnancy
prevention strategies.\13\ Programs supported by PREP must
provide evidence-based information on both abstinence and
contraception as well as materials on a number of adulthood
preparation topics (e.g., healthy relationships, education and
career success). Funds are also specifically reserved for
research, training, and technical assistance. All grant
recipients must agree to participate in a rigorous federal
evaluation. As of October 2010, 43 states and the District of
Columbia have applied for PREP funding, including all but two
states (Texas and Virginia) represented by members of the
Committee.\14\
---------------------------------------------------------------------------
\13\ACA Section 2953.
\14\SIECUS, Fact Sheet: State by State Decisions: The Personal
Responsibility Education Program and Title V Abstinence-Only Program
(updated Oct. 2010) (online at http://wwvv.siecus.org/
index.cfm?fuseaction=Page.ViewPage&PageID=1272).
---------------------------------------------------------------------------
Support for PREP--$75 million in each of FY 2010 through FY
2014--is provided on the basis of mandatory spending. H.R. 1215
seeks to convert this funding stream into a program of
discretionary spending, subjecting PREP to the annual and
unpredictable appropriations process.
A Bold and New Approach to Sexuality Education
As discussed above, PREP was established in specific
response to both the need for comprehensive sexuality education
for teenagers and the demonstrated success of comprehensive
sexuality education in reducing sex-related risk behaviors
among this population. Despite Republican claims that it is
duplicative of other ongoing federal programs,\15\ PREP stands
alone as the first and only federal program with dedicated
funding to address this concern.
---------------------------------------------------------------------------
\15\Among the existing programs Republicans cite in this report
about the duplicative nature of PREP is Title X (of the Public Health
Service Act), the federal family planning program. This is not only
puzzling given the stated purpose of the two programs, but also
completely contradictory to the position Republicans have taken with
regard to continued support for Title X. In H.R. 1, Full-Year
Continuing Appropriations Act, 2011, for example, Repulicans proposed
to eliminate all funding for Title X program. How can Republicans
legitimately argue that PREP duplicates a program that they want to
eliminate altogether?
---------------------------------------------------------------------------
But PREP's creation also stands as an outright rejection of
the policy behind the Title V abstinence-only-until-married
program\16\ that has received $1.5 billion in mandatory funding
since its inception in 1996. In contrast to PREP--which
requires evidence-based instruction in both abstinence and
contraception--this program restricts sexuality education to
include only and exclusively ``abstinence from sexual activity
outside marriage.''\17\ No standard of evidence-based or
medical accuracy exists in the authorizing statute.\18\ And in
contrast to PREP as well, a significant number of states are
not interested in participating in the abstinence-only program.
Today, in fact, only 30 states have abstinence-only grants and
many states have never even applied for support.\19\
---------------------------------------------------------------------------
\16\Social Security Act Section 510.
\17\Social Security Act Section 510(b)(2).
\18\Committee counsel confirmed this understanding of the law
during the Committee mark up of H.R. 1215. (See House Committee on
Energy and Commerce, Business Meeting to Mark Up H.R. 1213 et al.,
112th Cong., p. 317 (Apr. 5, 2011) (transcript of the proceeding.)
\19\SIECUS, Fact Sheet: State by State Decisions: The Personal
Responsibility Education Program and Title V Abstinence-Only Program
(updated Oct. 2010) (online at http://www.siecus.org/
index.cfm?fuseaction=Page.ViewPage&PageID=1272).
---------------------------------------------------------------------------
Numerous studies have found the Title V program--and others
like it--to be ineffective in stopping or even delaying sexual
initiation among teens,\20\ the program's principle goal.
Indeed, a 10-year government-sponsored study of the program
found that it had no beneficial impact on young people's sexual
behavior.\21\ Based on results such as these, the program's
authority was not renewed when it expired in June 2009. It was
reauthorized for an additional five years as part of the ACA--
once again with mandatory spending\22\--as part of a larger
political compromise regarding the health reform law.
---------------------------------------------------------------------------
\20\Guttmacher Institute, In Brief: Facts on American Teens'
Sources of Information About Sex, p. 3 (Feb. 2011) (online at http://
www.guttmacher.org/pubs/FB-Teen-Sex-Ed.pdf); SIECUS, Fact Sheet: End
Funding for the Failed Title V Abstinence-Only-Until-Marriage Program;
Support Comprehensive Sex Education (online at http://www.siecus.org/
index.cfm?fuseaction=Page.ViewPage&PageID=1272).
\21\Christopher Trenholm, et al., Impacts of Four Title V, Section
510 Abstinence Education Programs: Final Report, Mathematica Policy
Research (Apr. 2007) (online at http://www.mathematica-mpr.com/
publications/pdfs/impactabstinence.pdf).
\22\ACA Section 2954.
---------------------------------------------------------------------------
Mandatory Spending
Republicans chief objection to PREP lies not in their
concern with potential duplication of program efforts. Rather,
their opposition centers on PREP's being supported through
mandatory spending. Given the program's purpose, the impressive
track record for comprehensive sexuality education--as well as
the poor results that have come from the abstinence-only-until-
marriage program--and Republican concern about the nation's
teen pregnancy rate, it comes as a great disappointment that
they have taken this position.
This is especially true since Republican and Democratic
members of Congress frequently make choices--often very
difficult choices--about which programs should benefit from
mandatory spending.\23\ In fact, Republicans made such a choice
in rejecting an amendment offered during the full Committee
mark up to terminate mandatory spending for the Title V
abstinence-only-until-married program, choosing instead to
maintain mandatory spending for a program that has been shown
not to work while ending mandatory spending for a program that
has proven it clearly does.\24\ They also rejected an amendment
to treat both programs the same in terms of their funding
mechanism.\25\ Moreover, Republicans had no answer when asked
how they could justify these positions given their staunch
objection to mandatory funding as a matter of principal\26\--
opposing mandatory spending not necessarily because of the
substance of a program, but because of the stated belief that
mandatory spending usurps Congress's prerogative to fund or not
to fund health programs.\27\
---------------------------------------------------------------------------
\23\For examples of various federal programs that are supported
through mandatory spending, see Committee on Energy and Commerce,
Democratic Staff, The Pitts Proposal to Block Mandatory Funding in the
Affordable Care Act (Mar. 9, 2011) (online at http://democrats
.enerzycommerce.house.gov/sites/default/files/image uploads/
Fact%20Sheet_03.09.11.pdf).
\24\Amendment offered By Rep. Baldwin (see House Committee on
Energy and Commerce, Business Meeting to Mark Up H.R. 1213 et al.,
112th Cong., pp. 320-341 (Apr. 5, 2011) (transcript of the proceeding).
\25\Amendment offered by Rep. DeGette (see House Committee on
Energy and Commerce, Business Meeting to Mark Up H.R. 1213 et al.,
112th Cong., pp. 341-356 (Apr. 5, 2011) (transcript of the proceeding).
\26\See House Committee on Energy and Commerce, Business Meeting to
Mark Up H.R. 1213 et al., 112th Cong., pp. 325-326; 329-332 (Apr. 5,
2011) (transcript of the proceeding).
\27\This argument is at the center of Republican support for this
and other public health initiatives the Committee has considered during
this session of Congress. (See dissenting views filed for the Committee
reports on H.R. 1214, a bill to repeal mandatory funding for school-
based health center construction; H.R. 1216, a bill to covert funding
for graduate medical education in qualified teaching health centers
from direct appropriations to an authorization of appropriations; and
H.R. 1217, a bill to repeal the Prevention and Public Health Fund (H.
Rept. 112-57, pp. 9-15.))
---------------------------------------------------------------------------
Republicans cannot have it both ways--they must either vote
consistently and every time to end mandatory spending for
federal programs or they must acknowledge that in some
instances, it is, in fact, appropriate and necessary. Based
upon a strong record of need and accomplishment, in 2010,
Congress created PREP with mandatory spending. We believe that
decision was fully considered and well grounded and should
remain in place.
An Anti-Health Reform and Anti-Women Ideological Agenda
In our view, the Republicans' opposition to PREP as it is
currently structured is without merit. Instead, and first and
foremost, we believe H.R. 1215 represents the Republicans' new
strategy to disrupt, dismantle, and ultimately destroy the
ACA--even those programs that are justified, in or out of the
health reform law. What they have not been able to achieve
whole cloth,\28\ Republicans are now attempting to do piece by
piece.\29\ H.R. 1215 puts PREP in the frontline of this ongoing
assault.
---------------------------------------------------------------------------
\28\Although the House of Representatives has passed legislation to
repeal the ACA, that legislation will not become law since the Senate
has defeated the proposal. (H.R. 2, Repealing the Job-Killing Health
Care Law Act, passed the House of Representatives in January 2011
(Congressional Record, H322-323 (Jan. 11, 2011)). The Senate defeated a
similar proposal a month later. (Congressional Record S475 (Feb. 2,
2011)).
\29\See, e.g., comments made by Rep. Shimkus during the full
Committee mark up of H.R. 1215 that underscore this point. (``I would
think that this is just the first of many bites at the apple on the
healthcare law where we will continue to look at provisions. . . .'')
(House Committee on Energy and Commerce, Business Meeting to Mark Up
H.R. 1213 et al., 112th Cong., p. 332 (Apr. 5, 2011) (transcript of the
proceeding.)
---------------------------------------------------------------------------
But beyond its role in the endeavor to kill the health
reform law, H.R. 1215 is a component of a sustained attack on
women's health and women's reproductive rights. Pure and
simple, H.R. 1215 is just one of many legislative proposals
Republicans are pressing to enact in this Congress that would
curtail, restrict or eliminate altogether women's access to
medically appropriate (and legal) reproductive health
services.\30\ In this instance, enactment of H.R. 1215 would
undermine ongoing work by public health and other professionals
to provide basic and medically accurate information about
reproductive health to teenagers.
---------------------------------------------------------------------------
\30\See H.R. 1, Full-Year Continuing Appropriations Act, 2011
(regarding the Title X program); Amendment No. 11 to H.R. 1, Full-Year
Continuing Appropriations Act, 2011 (Congressional Record, H776 (Feb.
14, 2011)) (regarding Planned Parenthood); Amendment No. 182 to H.R. 1,
Full-Year Continuing Appropriations Act, 2011 (Congressional Record,
H786 (Feb. 14, 2011)) (regarding the papillomavirus vaccine); H.R. 3,
No Taxpayer Funding for Abortion Act; H.R. 217, Title X Abortion
Provider Prohibition Act; H.R. 358, Protect Life Act; and H. Con. Res.
36 (to correct the enrollment of H.R. 1473, Department of Defense and
Full-Year Continuing Appropriations Act of 2011) (regarding Planned
Parenthood) for additional examples of legislative efforts to curtail
women's access to reproductive health services.
---------------------------------------------------------------------------
The Republican argument that H.R. 1215 reflects a stand
against mandatory spending does not hold up in light of the
Republican record of supporting mandatory spending for programs
they like. It is therefore difficult to see H.R. 1215 as
anything other than an effort to move forward an ideological
agenda that ignores both science and reality and promotes
programs that do not work.
Such positions--on PREP, on health reform, and on women's
reproductive health--should not prevail because they do not
make for good health policy. With respect to PREP and our
opposition to H.R. 1215, we believe the views expressed here
make that case clear.
Henry A. Waxman.
Doris O. Matsui.
Mike Doyle.
Anthony Weiner.
Charles A. Gonzalez.
Eliot L. Engel.
John D. Dingell.
Diana DeGette.
Tammy Baldwin.
G.K. Butterfield.
Frank Pallone, Jr.
Anna G. Eshoo.
Donna M. Christensen.
Edolphus Towns.
Lois Capps.
Edward J. Markey.
Jay Inslee.
Jan Schakowsky.
Bobby L. Rush.
Gene Green.