[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\
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    \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.))
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    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.
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    \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.)
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    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.
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    \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.
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    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.

                                  
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