99–006 

112TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 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 


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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 


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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. 


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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. 


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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. 


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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. 


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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 

* * * * * * * 


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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 øamount¿ amounts appropriated under subsection (f) for the fiscal year and available for allotments to States after the application of subsection (c); 

and 

* * * * * * * 

ø(B) MINIMUM ALLOTMENT.— ø(i) IN GENERAL.—Each State allotment under this 

paragraph for a fiscal year shall be at least $250,000. 

ø(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).¿ 

ø(C)¿ (B) APPLICATION REQUIRED TO ACCESS ALLOT- MENTS.— 

(i) * * * 

* * * * * * * 

(c) RESERVATIONS OF FUNDS.— 

(1) GRANTS TO IMPLEMENT INNOVATIVE STRATEGIES.—From 

the øamount¿ 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 underrepresented 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 øamount¿ 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) øAPPROPRIATION¿ AUTHORIZATION OF APPROPRIATIONS.—For 

the purpose of carrying out this section, there is øappropriated, out 

of any money in the Treasury not otherwise appropriated,¿ authorized to be appropriated $75,000,000 for each of fiscal years ø2010¿ 

2012 through 2014. øAmounts appropriated under this subsection 

shall remain available until expended.¿ 

* * * * * * * 


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1Guttmacher 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). 3 Id. 

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). 6Guttmacher 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). 7Guttmacher 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). 8Guttmacher 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). 

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

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

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 ageappropriate, medically accurate instruction and information on all 

matters related to sex remains high.7

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 


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9SIECUS, 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. 11 Id. 12The ACA is comprised of two public laws, P.L. 111–148 and P.L. 111–152. 13 ACA Section 2953. 14SIECUS, 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). 

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

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

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. 

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

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 fedVerDate Mar 15 2010 06:35 Apr 28, 2011 Jkt 099006 PO 00000 Frm 00013 Fmt 6604 Sfmt 6604 E:\HR\OC\HR063.XXX HR063

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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? 16Social Security Act Section 510. 17Social 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.) 19SIECUS, 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). 20Guttmacher 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. 23For examples of various federal programs that are supported through mandatory spending, 

see Committee on Energy and Commerce, Democratic Staff, The Pitts Proposal to Block Mandaeral programs,15 PREP stands alone as the first and only federal 

program with dedicated funding to address this concern. 

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

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. 

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


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tory 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). 26See 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). 27This 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.)) 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)). 29See, 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.) 

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

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. 

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 


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30See 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. 

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. 

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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