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79–467CC 2002

WELFARE REFORM: A REVIEW OF ABSTINENCE

EDUCATION AND TRANSITIONAL MEDICAL ASSISTANCE

HEARING

BEFORE THE

SUBCOMMITTEE ON HEALTH

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES

ONE HUNDRED SEVENTH CONGRESS

SECOND SESSION

APRIL 23, 2002

Serial No. 107–104

Printed for the use of the Committee on Energy and Commerce

(

Available via the World Wide Web: http://www.access.gpo.gov/congress/house

COMMITTEE ON ENERGY AND COMMERCE

W.J. ‘‘BILLY’’ TAUZIN, Louisiana, Chairman 

MICHAEL BILIRAKIS, Florida 

JOE BARTON, Texas 

FRED UPTON, Michigan 

CLIFF STEARNS, Florida 

PAUL E. GILLMOR, Ohio 

JAMES C. GREENWOOD, Pennsylvania 

CHRISTOPHER COX, California 

NATHAN DEAL, Georgia 

RICHARD BURR, North Carolina 

ED WHITFIELD, Kentucky 

GREG GANSKE, Iowa 

CHARLIE NORWOOD, Georgia 

BARBARA CUBIN, Wyoming 

JOHN SHIMKUS, Illinois 

HEATHER WILSON, New Mexico 

JOHN B. SHADEGG, Arizona 

CHARLES ‘‘CHIP’’ PICKERING, Mississippi 

VITO FOSSELLA, New York 

ROY BLUNT, Missouri 

TOM DAVIS, Virginia 

ED BRYANT, Tennessee 

ROBERT L. EHRLICH, Jr., Maryland 

STEVE BUYER, Indiana 

GEORGE RADANOVICH, California 

CHARLES F. BASS, New Hampshire 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO, California 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

ERNIE FLETCHER, Kentucky

JOHN D. DINGELL, Michigan 

HENRY A. WAXMAN, California 

EDWARD J. MARKEY, Massachusetts 

RALPH M. HALL, Texas 

RICK BOUCHER, Virginia 

EDOLPHUS TOWNS, New York 

FRANK PALLONE, Jr., New Jersey 

SHERROD BROWN, Ohio 

BART GORDON, Tennessee 

PETER DEUTSCH, Florida 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

BART STUPAK, Michigan 

ELIOT L. ENGEL, New York 

TOM SAWYER, Ohio 

ALBERT R. WYNN, Maryland 

GENE GREEN, Texas 

KAREN MCCARTHY, Missouri 

TED STRICKLAND, Ohio 

DIANA DEGETTE, Colorado 

THOMAS M. BARRETT, Wisconsin 

BILL LUTHER, Minnesota 

LOIS CAPPS, California 

MICHAEL F. DOYLE, Pennsylvania 

CHRISTOPHER JOHN, Louisiana 

JANE HARMAN, California

DAVID V. MARVENTANO, Staff Director 

JAMES D. BARNETTE, General Counsel 

REID P.F. STUNTZ, Minority Staff Director and Chief Counsel

SUBCOMMITTEE ON HEALTH

MICHAEL BILIRAKIS, Florida, Chairman 

JOE BARTON, Texas 

FRED UPTON, Michigan 

JAMES C. GREENWOOD, Pennsylvania 

NATHAN DEAL, Georgia 

RICHARD BURR, North Carolina 

ED WHITFIELD, Kentucky 

GREG GANSKE, Iowa 

CHARLIE NORWOOD, Georgia 

Vice Chairman 

BARBARA CUBIN, Wyoming 

HEATHER WILSON, New Mexico 

JOHN B. SHADEGG, Arizona 

CHARLES ‘‘CHIP’’ PICKERING, Mississippi 

ED BRYANT, Tennessee 

ROBERT L. EHRLICH, Jr., Maryland 

STEVE BUYER, Indiana 

JOSEPH R. PITTS, Pennsylvania 

W.J. ‘‘BILLY’’ TAUZIN, Louisiana 

(Ex Officio)

SHERROD BROWN, Ohio 

HENRY A. WAXMAN, California 

TED STRICKLAND, Ohio 

THOMAS M. BARRETT, Wisconsin 

LOIS CAPPS, California 

RALPH M. HALL, Texas 

EDOLPHUS TOWNS, New York 

FRANK PALLONE, Jr., New Jersey 

PETER DEUTSCH, Florida 

ANNA G. ESHOO, California 

BART STUPAK, Michigan 

ELIOT L. ENGEL, New York 

ALBERT R. WYNN, Maryland 

GENE GREEN, Texas 

JOHN D. DINGELL, Michigan, 

(Ex Officio) 

(II) 

C O N T E N T S 

Page

Testimony of: 

Del Rosario, Jacqueline Jones, Executive Director, ReCapturing the Vision International ......................................................................................... 41

Kaplan, David W., Head of Adolescent Medicine, Professor of Pediatrics, 

University of Colorado School of Medicine ................................................. 53

Mann, Cindy, Senior Fellow, the Kaiser Commission on Medicaid and 

the Uninsured ............................................................................................... 57

McIlhaney, Joe S., Jr., the Medical Institute for Sexual Health .................. 47

Scanlon, William J., Director, Health Care Issues, U.S. General Accounting Office ........................................................................................................ 64

Material submitted for the record by: 

American Civil Liberties Union, prepared statement of ............................... 107

American Hospital Association, prepared statement of ................................ 109

Diggs, John R., prepared statement of ........................................................... 109

Golden, Alma L., prepared statement of ........................................................ 112

Richards, Cory L., Alan Guttmacher Institute, letter dated May 1, 2002 ... 114

(III) 

(1)

WELFARE REFORM: A REVIEW OF ABSTINENCE EDUCATION AND TRANSITIONAL 

MEDICAL ASSISTANCE 

TUESDAY, APRIL 23, 2002

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON HEALTH, 

COMMITTEE ON ENERGY AND COMMERCE, 

Washington, DC. 

The subcommittee met, pursuant to notice, at 3 p.m., in room 

2322, Rayburn House Office Building, Hon. Michael Bilirakis presiding. 

Members present: Representatives Bilirakis, Upton, Greenwood, 

Norwood, Buyer, Pitts, Tauzin (ex officio), Brown, Waxman, Strickland, Barrett, Hall, Stupak and Green. 

Also present: Representative Harman. 

Staff present: Erin Kuhls, majority counsel; Steven Tilton, health 

policy coordinator; Eugenie Edwards, legislative clerk; Amy Hall, 

minority professional staff member, John Ford, minority counsel; 

Bridgett Taylor, minority professional staff member; Karen Folk, 

minority professional staff member; and Jessica McNiece, staff assistant. 

Mr. BILIRAKIS. I now call to order this hearing of the Health Subcommittee and would like to thank our witnesses for taking the 

time to appear before us today and I feel sure that your testimony 

will prove valuable as we consider reauthorizing our Nation’s welfare laws. 

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 reformed our Nation’s welfare laws to put an emphasis on work and end the seemingly endless cycle of dependence 

that was present under the old Aid to Families with Dependent 

Children program. 

The Health Subcommittee has jurisdiction over two areas of this 

landmark legislation which will be the focus of today’s hearing. The 

issues that we’re considering today are accurately captured, I feel, 

by the title of the 1996 law. Personal responsibility is encompassed 

by the funding provided to Title V of the Social Security Act related 

to abstinence only education. Title V allocated $50 million for fiscal 

years 1998 to 2002 for block grants to States for development of abstinence only education programs. To date, 49 of the 50 States have 

elected to participate in this program and I think this suggests that 

States have a high interest in abstinence only education programs. 

I’m very pleased that my own Satte of Florida has elected to participate in this program. In fact, today we will hear from JacVerDate 0ct 02 2002 09:18 Oct 05, 2002 Jkt 010199 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 W:\DISC\79467 79467
2

queline Del Rosario who will provide our subcommittee with valuable real world and I underline real world data on Florida’s experience. So often up here in Washington we don’t have the opportunity to hear from experts like Ms. Del Rosario who have real 

world exposure. Again, I welcome you particularly Ms. Del Rosario. 

I’m anxious to hear more about the near 100 percent success that 

your program has achieved with respect to limiting teen pregnancy 

rates. 

Transitional medical assistance is the second component, God 

knows, a very significant one the 1996 law that is under this subcommittee’s jurisdiction. As we all know, the costs of health insurance continue to rise. Many low income individuals who move from 

welfare to work often take low wage jobs that do not offer private 

health insurance coverage. Transitional medical assistance extends 

Medicaid coverage to these former welfare recipients for up to 1 

year after they leave the rolls. Obviously, the potential loss of one’s 

health insurance would be a significant disincentive to leaving welfare and entering the work force. Transitional medical assistance 

removes this barrier and ensures people do not have to sacrifice 

their health care in order to enter the work force. 

I would like to again thank our witnesses for appearing before 

us today and now I’m pleased to recognize the ranking member, 

Mr. Brown, for his opening statement. 

Mr. BROWN. Thank you, Mr. Chairman, I want to welcome our 

witnesses, thank you for joining us today. 

Although there’s no funding for the transitional medical assistance program in the Republican budget blueprint, reauthorization 

of this program isn’t or shouldn’t be a partisan issue. I appreciate 

your willingness, Mr. Chairman, and Chairman Tauzin’s willingness to focus on TMA this afternoon. 

The President’s budget includes funding for 1-year extension of 

TMA because to quote their budget document ‘‘this coverage helps 

ensure the work pays for families by preventing them from losing 

their health coverage when they start jobs.’’ Well put, but actually, 

the fundamental goal of welfare to work is not to increase the number of individuals who enter the workplace, it’s to increase the 

number of individuals who stay in the workplace. Employers who 

have hired welfare recipients have stated that access to help insurance is one of the five most important factors that keep those workers on the job. The TMA program makes sense. There are steps we 

can take to strengthen and improve the program that also makes 

sense. 

TANF has a 5-year authorization. TMA should be a 5-year authorization too. TMA is weighed down by some counter-productive 

regulatory requirements. I know how much my friends on the other 

side of the aisle hate government regulations. Here’s a golden opportunity to eliminate some of them. 

Let me give one example. Even though TMA recipients are eligible for 6 months regardless of income, these recipients must periodically go to the welfare office to report their income so individuals who are newly employed must take several days off from work 

to report information irrelevant, really irrelevant to their TMA eligibility or they will lose their TMA eligibility. We need to do someVerDate 0ct 02 2002 09:18 Oct 05, 2002 Jkt 010199 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 W:\DISC\79467 79467
3

thing about that and other needless hurdles that compromise the 

reach and the effectiveness of the program. 

There’s another logical step that we can take. We can restore 

Medicaid eligibility to legal immigrants, banning legal immigrant 

families, families that work here, pay taxes here just like all of us 

in this room, banning legal immigrant families from the Medicaid 

program is unfair, it’s arbitrary and it’s foolish. Reducing the number of uninsured is a bipartisan goal. You can search high and low 

and not find a more effective way to contravene that goal than by 

excluding legal immigrants from Medicaid. Immigrants are more 

than twice as likely to be uninsured as non-immigrants. Our colleagues, Mr. Waxman and Mr. Diaz-Balart, have introduced legislation, H.R. 1143 which would remove that Medicaid ban. If we 

took no other action this year to expand insurance coverage, we 

should at least retrace our footsteps and incorporate H.R. 1143 into 

this year’s TANF reauthorization. 

I want to turn to the other topic of this afternoon’s agenda, abstinence only education. The key word is ‘‘only.’’ I doubt there is any 

parent or policymaker who opposes featuring abstinence as a critically important component of sex education. We know for a fact 

that very few parents favor abstinence only education. A recent poll 

shows that 90 percent of parents with adolescents at home want 

their child’s sex education program to cover both abstinence and 

general information covering topics like birth control. Yet, if a 

State wants to use Federal tax dollars to provide sex education it 

must agree to use an abstinence only curriculum. There appears to 

be a major disconnect. And I have to say it’s ironic that we’re considering Medicaid and abstinence only education in the same hearing. The administration, the Republican majority are generally 

very supportive of State flexibility. That’s nowhere more apparent 

than in Medicaid. Look for the fine print in the Medicaid flexibility 

waivers. There really isn’t any. These waivers and the President’s 

Rx drug waivers are a hair’s breath away from the blank check. 

But when it comes to any issue like abstinence only education, it’s 

somehow Okay for this administration, it’s okay for the Federal 

Government to put a chokehold on the States. It’s a Federal State 

matching program with a curriculum wholly dictated by the Federal Government. So sometimes we want States’ rights, other times 

when it doesn’t serve our purpose, we don’t. 

To protect our kids and respect their parents’ wishes, States 

should be able to use this funding to promote abstinence in the context of real world choices and implications. 

Thank you, Mr. Chairman. 

Mr. BILIRAKIS. I thank the gentleman. Mr. Upton, for an opening 

statement. 

Mr. UPTON. Well, thank you, Mr. Chairman, for convening this 

hearing. As a lead sponsor of H.R. 4122, legislation reauthorizing 

these programs, I’m very pleased that we’re moving in a very timely manner to reauthorize these vital components of the 1996 Welfare Reform Bill. 

Anyone who doesn’t think abstinence education works has only 

to examine the Michigan record. Begun in 1993, Michigan’s Abstinence Program, MAP, is an innovative approach implemented 

through the community empowerment model. Community coaliVerDate 0ct 02 2002 09:18 Oct 05, 2002 Jkt 010199 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 W:\DISC\79467 79467
4

tions plan, implement, evaluate, revise, and monitor the program. 

It works. For the last 3 years in a row, Michigan has received a 

bonus award from the Department of HHS given each year to up 

to five States which experience the largest decrease in their ratio 

of out-of-wedlock to total births, while also experiencing a reduction 

in their abortion rate. 

Too many of our children’s dreams have been cut short by bad 

decisions that dramatically alter the course of their lives. Abstinence education programs give our young both the inspiration and 

education that they need to make good, healthful decision. Our 

young people look to us for clear messages and for help in setting 

high standards for themselves. Abstinence education programs will 

give them that help, that is for sure. 

It is also vital that we reauthorize the TMA, Transition Medical 

Assistance Program. One of the greatest disincentives to leaving 

the welfare rolls and entering the workforce is the loss of Medicaid 

coverage, particularly for children. It is important that we ensure 

that former welfare recipients and their families do not abruptly 

lose their coverage. This legislation, H.R. 4122, extends that vital 

program for another year. We look forward to today’s hearing and 

we look forward to working with the chairman and I yield back the 

balance of my time. 

[The prepared statement of Hon. Fred Upton follows:]

PREPARED STATEMENT OF HON. FRED UPTON, A REPRESENTATIVE IN CONGRESS FROM

THE STATE OF MICHIGAN

Mr. Chairman, thank you for convening today’s hearing to review the Abstinence 

Education and Transitional Medical Assistance programs. As the lead sponsor of 

H.R. 4122, legislation reauthorizing these programs, I am very pleased that we are 

moving in a timely manner to reauthorize these vital components of the 1996 welfare reform bill. 

Anyone who doesn’t think abstinence education works has only to examine the 

Michigan record. Begun in 1993, Michigan’s Abstinence Partnership (MAP) program 

is an innovative approach implemented through the community empowerment 

model. Community coalitions plan, implement, evaluate, revise and monitor the program. Parent education is provided to encourage effective communication with youth 

about the importance and benefits of choosing abstinence. For the last three years 

in a row, Michigan has received a bonus award from the Department of Health and 

Human Services given each year to up to five states which experience the largest 

decrease in their ratio of out-of-wedlock to total births, while also experiencing a reduction in their abortion rate. 

And Michigan is far from alone in embracing abstinence education as an effective 

means of reducing teen pregnancies and out-of-wedlock births and of protecting our 

young people from the scourge of sexually transmitted diseases. State participation 

in the Title V abstinence education program is voluntary, and for every four dollars 

in federal funding states receive, they must put in three dollars in non-federal funding. Yet interest in this program is high. Today, 49 out of the 50 states are participating in the program, and over one-third of all school districts in the nation now 

choose to teach abstinence education in their classrooms. As part of their abstinence 

education programs, states and local grantees have launched media campaigns to 

influence attitudes and behavior, developed abstinence curricula, revamped sexual 

education classes, started mentoring programs, and implemented many other creative and effective approaches to encourage abstinence. 

It is important to note that reauthorizing the Title V Abstinence Education program will in no way affect federal support for other teen pregnancy prevention/sexual education programs. There are at least 25 federal programs providing funding 

for contraceptive/sex education, while there are only 3 abstinence-focused programs. 

Contrary to claims that you may have heard about restrictions on what may be discussed in abstinence education programs, nothing in the federal law or guidelines 

to the states prohibits the discussion of any subject. And contrary to the claim that 

there is no scientific evidence that abstinence programs work, there are in fact ten 

5

scientific evaluations available showing that abstinence education is effective in reducing early sexual activity. 

Since the 1996 enactment of welfare reform including abstinence education, teen 

pregnancy and birthrates have been falling. That is good news, but we need to continue and build on this success. Out-of-wedlock births are often disastrous for mothers, children, and society as a whole. Children born out of wedlock are far more likely to be poor, suffer ill health, drop out of school, and in the case of boys, are twice 

as likely to commit a crime leading to incarceration by the time they reach their 

early thirties. 

Sexually transmitted diseases (STDs) have reached epidemic proportions in our 

country, placing the health and lives of sexually active young people in serious peril. 

In the 1960s, one in 47 sexually active teenagers was infected with an STD. Today, 

one in four is infected. Young people need to know that having sexual relations puts 

them at risk not only for HIV/AIDS, but also herpes, which is incurable and may 

infect babies during birth resulting in severe damage or death. Teens need to know 

that they are at risk for Human Papillomavirus (HPV), which is the leading viral 

STD and which causes nearly all cases of cervical cancer. And they need to know 

that scientific research shows that condom use offers relatively little protection from 

herpes and no protection from HPV. Abstinence education programs provide this information. 

Too many of our children’s dreams have been cut short by poor decisions that dramatically alter the course of their lives. Abstinence education programs give our 

young people both the inspiration and education they need to make good, healthful 

decisions. Our young people look to us for clear messages and for help in setting 

high standards for themselves. Abstinence education programs will give them that 

help. 

It is also vital that we reauthorize Transitional Medical Assistance. One of the 

greatest disincentives to leaving the welfare rolls and entering the workforce is the 

loss of Medicaid coverage, particularly for children. It is important we ensure that 

former welfare recipients and their families do not abruptly lose their coverage. H.R. 

4122 extends this vital program for one year. 

I look forward to today’s hearing and to moving to a full Committee markup on 

these two important parts of welfare reform.

Mr. BILIRAKIS. The Chair thanks the gentleman. Mr. Waxman, 

for an opening statement. 

Mr. WAXMAN. I think Mr. Hall is here before me. 

Mr. BILIRAKIS. Were you here when the gavel went down? 

Mr. WAXMAN. No, I wasn’t. 

Mr. BILIRAKIS. Mr. Hall for an opening statement. 

Mr. HALL. Mr. Waxman got up here before I did, by many years. 

Mr. WAXMAN. You’re a fine, young man. 

Mr. HALL. And I’d be glad to follow Mr. Waxman any time. 

Mr. Chairman, I want to thank you for bringing this before the 

subcommittee, these bills, abstinence education and transitional 

Medicaid assistance, both of which, I think, are critically important 

to providing critical health care need for the most vulnerable of our 

country. 

I’m pleased to be the Democratic co-sponsor of both reauthorizations and I hope there will be bipartisan support for their passage. 

The abstinence education bill is simply reauthorization of Title V 

funding to promote adolescent health, prevent teen pregnancy and 

reduce sexually transmitted diseases by stressing abstinence. 

Teaching our children to abstain from sexual activity is one absolute way to prevent pregnancy. Of course, there are others. Unfortunately, some people feel that this legislation threatens family 

planning and contraceptive programs. Although I might be willing 

to threaten family planning and contraceptive programs, this bill 

doesn’t do it. 

These Title V funds do not impact other family planning programs and are not mutually exclusive of other sex education methVerDate 0ct 02 2002 09:18 Oct 05, 2002 Jkt 010199 PO 00000 Frm 00009 Fmt 6633 Sfmt 6602 W:\DISC\79467 79467
6

ods. Funding abstinence education simply expands the options our 

communities will have at their disposal to help reduce teenage 

pregnancy. We’re all in agreement that teenage out-of-wedlock 

pregnancies is a problem that we have to address. Why then do we 

want to prevent our communities from gaining access to this important tool? 

Mr. Chairman, a vote against providing a meager $50 million for 

abstinence education isn’t bolstering family planing and contraceptive sex education methods. It’s a vote against a complementary 

tool in protecting our teens. 

The other piece of legislation I’ve co-sponsored is the reauthorization of transitional Medicaid assistance. This program extends 

Medicaid benefits for 1 year to those people who are succeeding in 

removing themselves from the welfare roles. Many poor and near 

poor families cannot afford their own health insurance, even if they 

are working, yet they may not qualify for Medicaid in some States. 

By bridging this gap, this helps families to stay off of welfare. I 

hope both my Democratic and Republican colleagues will join me 

in supporting these two important critical reauthorizations. Both 

have proven effective in the past and I believe it could be a devastating shock to our community should these programs disappear. 

I yield back my time. 

Mr. BILIRAKIS. Thank you. Dr. Norwood, for an opening statement. 

Mr. NORWOOD. Thank you, Mr. Chairman. I’m anxious to hear 

from our witnesses and with that I would ask permission to put my 

statement in the record and thank you for having the hearing. 

Mr. BILIRAKIS. Without objection, the opening statement of all 

members of the subcommittee will be made a part of the record. 

Let’s see, Mr. Waxman, for an opening statement. 

Mr. WAXMAN. Thank you very much, Mr. Chairman. Unfortunately, this committee has chosen to limit this hearing today to 

only some of the areas in this committee’s jurisdiction which are 

part of welfare reform. We’re looking at transitional Medicaid assistance for people leaving the welfare rolls for work and we’re 

looking at the abstinence education program established in the 

Welfare Reform Law of 1996. But the Majority is studiously ignoring the ban on Medicaid coverage for legal immigrant children and 

pregnant women that resulted from the anti-immigrant provisions 

that were forced through this Congress in 1996, under the guise of 

reforming the welfare system. That policy was wrong then and it’s 

wrong now. Banning coverage of legal, immigrant children and 

pregnant women for 5 years after entering the country and continuing to attribute the sponsor’s income to the near permanent 

barrier occurs is worse than simply short-sighted health policy. It 

is a perverse and insidious discrimination against legal immigrants 

who work and pay taxes. It risks long-term health effects on children born without prenatal care. It undermines efforts for broad 

participation of children in the Medicaid and the SCHIP programs. 

And we’re not just ignoring the topic in today’s hearing, the limited, narrowly drawn mark-up vehicle the committee will consider 

tomorrow is obviously designed to block members from having any 

opportunity to redress this wrong. Some might even conclude that 

this is clearly an effort to protect members from voting on this 

7

issue. Better to discriminate in the dark than vote directly on this 

mean-spirited policy. 

I conclude that this is an intentional action in response to the 

wishes of this administration. It leaves legal immigrant children 

and pregnant women without health care and it leaves States holding the bag. If they want to provide coverage, as many do, they 

have no Federal matching assistance. It is ironic indeed that this 

administration which seems willing to waive just about any requirement of Medicaid law has refused to use its waiver authority 

to allow States to cover legal immigrant women and children and 

now has also blocked consideration of legislation to remedy this. 

This decision denies our colleague representative, Lincoln DiazBalart, the lead sponsor of H.R. 1143, the Legal Immigrant Children’s Improvement Act and the 118 bipartisan co-sponsors who 

have joined us on the bill the opportunity to vote on remedying this 

policy. This is the right time to end that discrimination and this 

is the right mark-up to take action on that legislation. It is doubly 

ironic that instead, we’re focusing on continuing a program of abstinence education that has very little to do with good health policy, 

but a lot to do with the political agenda. 

Let’s be clear. No one is against abstinence. No one is dismissing 

the advantages of abstinence, particularly to young people who are 

not yet mature enough to make important life choices. No one is 

against educating young people about the advantages of abstinence, but it is a ridiculous policy to pretend that people, including 

young people, will not be sexually active whatever we may tell 

them. They need to know how to protect themselves from unwanted pregnancies and from transmission of sexually transmitted 

diseases and HIV. This knowledge can literally be the difference 

between life and death. 

A program that purports to be about public health, but which 

does not allow open and complete communication on all the ways 

of avoiding unwanted pregnancies and transmission of sexually 

transmitted diseases and HIV is not just a poor program, but a 

harmful program. A gag rule on information is no way to solve a 

serious public health problem and I’m pleased that our colleague, 

Congresswoman Harman, will be offering some amendments on 

this subject. I hope we can get bipartisan support. 

In closing, let me note that the Transitional Medical Assistance 

Program which is also being considered today is a vital part of any 

successful effort to move people off welfare and into the work force. 

I believe this program has broad support on both sides of the aisle. 

In view of that, it is particularly regrettable that the legislation before the committee tomorrow is limited to a 1-year extension of 

Transitional Medical Assistance. Obviously, it takes much more—

it would make much more sense to reauthorize this program for 

the full period of reauthorizatoin of TANF. I hope my colleagues on 

the committee would recognize the clear advantage of that and 

will——

Mr. BILIRAKIS. The gentleman’s time has expired. 

Mr. WAXMAN. Just to complete the sentence. That presents itself 

on the floor or in conference to achieve that result. 

Mr. BILIRAKIS. The Chair recognizes the chairman of the full 

committee, Mr. Tauzin, for an opening statement. 

8

Chairman TAUZIN. Thank you, Mr. Chairman. I want to thank 

you for holding this very important hearing. Reauthorization of the 

landmark 1996 Welfare Reform Law is an important priority for 

Congress this year. In the next few weeks, in fact, we will be undertaking this very worthy task and the hearing and the testimony 

that this panel will provide today will help us in that effort. I want 

to thank you for coming and sharing with us today. 

We’re focusing on two welfare reform issues within the committee’s jurisdiction—abstinence only education and transitional medical assistance. I understand there are differences of opinion regarding one of these issues, which I expect will produce a healthy 

bit of debate today. Back in 1996, Congress passed, and President 

Clinton signed into law, welfare reform legislation. This law included a permanent appropriation of $50 million over 5 years for 

abstinence only education. Almost every State has participated in 

this State block grant program voluntarily. To do so, they have to 

match every $4 Federal with $3 of their own, which suggests a very 

high State interest in using abstinence only education as one way 

to address teen pregnancy. We’ve seen an incredible reduction in 

the rates of teen pregnancy in this country and, more importantly, 

a huge reduction in the number of children living under poverty. 

Obviously, the program is working and we need to continue it. 

In fact, to address the States’ high teen birthrates and sexually 

transmitted disease rates, my own State of Louisiana has applied 

for and received funding for abstinence only education under Title 

V. The goals of the Louisiana program are laudable, to reduce teen 

pregnancy and STD rates by delaying the onset of sexual activity, 

to decrease risk behaviors and to educate young people concerning 

the importance of obtaining self-sufficiency and marriage before engaging in sexual activity. 

Louisiana has a coordinated state-wide evaluation plan in place 

to measure the effect of the program in meeting these goals. This 

important program reaches kids through 10 community based 

projects that are designed to promote sexual abstinence among adolescents ages 13 through 19. The program also uses public and private schools to get the abstinence message to teens and pre-teens 

through clubs established in 30 high schools in various school districts across the State, and in seventh grade health classes in various junior high schools in our State. 

I look forward to the testimony of Ms. Del Rosario who will speak 

firsthand about her experience spreading the message of abstinence 

to at risk teens through her program entitled Recapturing the Vision. Her program strengthens students, providing them with accurate information to promote healthy sexual decisions and behaviors 

so that these students can build a much brighter future for themselves. I want to thank you for traveling from Florida to be with 

us today. 

We will also hear today testimony from Dr. Joe McIlhaney, who 

after nearly 30 years of practice as a gynecologist is dedicating 

himself to addressing two medical problems affecting our Nation’s 

youth, out-of-wedlock pregnancy and sexually transmitted disease 

issue. 

9

I would also like to thank and welcome Dr. Kaplan, a professor 

from the University of Colorado, School of Medicine, who has a different perspective through his work as a pediatrician. 

This hearing will also focus on an important work support for 

former welfare recipients, Transitional Medical Assistance. This 

benefit ensures that former welfare recipients have health care coverage after entering the work force. It is due to expire this year. 

We all recognize that this assistance provides a valuable incentive 

for people to move off of welfare. In fact, the President said, if you 

want to value and measure compassion in the welfare area, it’s not 

on how much we spend on welfare, how many people are on welfare, but how many people we rescue from that system and actually 

introduce to the world of self-respect and decency, to a world where 

they’re not dependent upon someone else, but they have their own 

independent life. That is indeed the goal of this hearing today. 

Cindy Mann from the Kaiser Commission on Medicaid and the 

Uninsured and Bill Scanlon from the General Accounting Office are 

here today to highlight the benefits of Transitional Medical Assistance and we look forward to hearing from them. 

Ms. Bilirakis, let me thank you again for holding this important 

hearing and I yield back the balance of my time. 

Mr. BILIRAKIS. I thank the chairman. Mr. Stupak for an opening 

statement. 

Mr. STUPAK. I’ll pass, Mr. Chairman. 

Mr. BILIRAKIS. Dr. Norwood? 

Mr. NORWOOD. I’ve already passed. 

Mr. BILIRAKIS. You’ve already passed, haven’t you. Mr. Pitts. 

Mr. PITTS Thank you, Mr. Chairman, for holding this important 

hearing today. In the 1996 Welfare Reform Law, Congress provided 

$50 million each year for fiscal year 1998 to 2002 for abstinence 

only education to help our Nation’s young people avoid unplanned 

pregnancies, sexually transmitted diseases and the emotional consequence of sex outside of marriage. I am pleased that the legislation before us today will reauthorize this program for the next 5 

years at $50 million a year. 

Mr. Chairman, as we address this issue, we must be aware of the 

consequences of early sexual activity, the undesirable contents of 

conventional safe sex educational programs and the findings concerning the effectiveness of genuine abstinence programs. Abstinence education is essential to reducing out-of-wedlock childbearing, preventing sexually transmitted diseases and improving 

emotional and physical well-being among our Nation’s youth. True 

abstinence education programs help young people to develop an understanding of commitment, fidelity and intimacy that will serve 

them well as the foundations of healthy marital life in the future. 

Abstinence education programs have repeatedly been shown to be 

effective in reducing sexual activity among their participants. In 

my State of Pennsylvania, abstinence education and related services is a $3.8 million initiative. The Pennsylvania program incorporates local communities in crafting and implementing the abstinence services. It emphasizes the role of parents and guardians in 

teaching the skills to empower youth to abstain from sexual activities as well as ask the role of health care providers in providing 

counseling and guidance to teens and their parents. 

10

Pennsylvania also has a strong media component to their abstinence education program in which a television, radio or movie theater campaign encourages parents to talk to their kids about sexual 

matters. I’m also pleased to report that the Pennsylvania Department of Health is able to use some TANF funds to create an abstinence curriculum targeting Latino youth. While preliminary reports sound promising, I’m looking forward to seeing the final evaluation of the entire project in Pennsylvania when the grant ends 

in September 2002. 

Mr. Chairman, as we review this issue, I think we need to realize 

that sexually transmitted diseases including incurable viral infections have reached epidemic proportions. Annually, 3 million teenagers contract STDs. STDs afflict roughly 1 in 4 teens who are sexually active. Second, early sexual activity has multiple negative 

consequences for young people. Research shows that young people 

who become sexually active are not only vulnerable to STDs, but 

also likely to experience emotional and psychological injuries, subsequent marital difficulties and involvement in other high risk behaviors. Third, conventional safe sex programs, sometimes erroneously called abstinence plus programs, place little or no emphasis on encourage young people to abstain from early sexual activity. 

Instead, such programs strongly promote condom use and implicitly 

condone sexual activity among teens. This is not true abstinence 

education. And finally, despite claims to the contrary, there are scientific evaluations showing that real abstinence programs can be 

highly effective in reducing early sexual activity and I would like 

to ask unanimous consent to submit for the record a summary of 

these evaluations. 

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Mr. BILIRAKIS. Without objection. 

Mr. PITTS Abstinence education has proven effective in reducing 

the rate of sexual activity among teens. As Members of the House, 

we have a duty to ensure that we are not sending mixed messages 

to our youth. I look forward to hearing from the witnesses today 

on abstinence only education and would encourage my colleagues 

to reaffirm our commitment to abstinence only education, support 

the reauthorization, Title V, abstinence block grants in the interest 

of protecting and preserving the health of our Nation’s children. I 

yield back the balance of my time. 

Mr. BILIRAKIS. I thank you, Mr. Pitts. Ms. Harman, for an opening statement? 

Ms. HARMAN. Well, thank you, Mr. Chairman. I didn’t expect to 

offer one, so I’ll wait until the questioning period. Thank you very 

much. 

Mr. BILIRAKIS. Thank you very much. Mr. Greenwood, for an 

opening statement. 

Mr. GREENWOOD. Thank you, Mr. Chairman. I’ll be very brief. I 

have two daughters, 15 and 161⁄2. I am more interested in abstinence than I’ve ever been interested in it in my life right now. 

And I believe that any sex education that doesn’t talk about abstinence is poor sex education indeed. If you don’t talk about the 

fact that abstinence is the only way to be certain to avoid pregnancy and sexually transmitted diseases, you do a disservice to 

children. Certainly, if you implicitly or otherwise promote sexual 

activity among teenagers, I think you do a disservice to children. 

My concern is I think you do a disservice to children when that’s 

all that you tell them. That’s certainly not all that my wife and tell 

our daughters because we want our daughters to understand how 

their bodies work. We want them to understand how male bodies 

work. We want them to understand how they work together and 

then we want them to understand why it is in their interest to abstain from sex until they’re in a committed and hopefully married 

relationship. But I am so interested in abstinence that I think we 

ought to spend Federal dollars to teach abstinence, but since we 

don’t spend any Federal dollars to teach sex education in the 

schools at all, I think we need to teach both. And I think it’s a no 

brainer. And I don’t know what we’re fighting about. But I look forward to fighting about it. 

Mr. BILIRAKIS. I believe that completes the opening statements 

of all the people who are present. That being the case, we’ll go 

right into the Panel. 

First, I would ask unanimous consent that a letter which has 

been shared with the minority, dated April 23 from Secretary 

Thompson to Chairman Tauzin regarding this issue and the fact 

that the administration supports a 5-year reauthorization of the 

abstinence program and also is a strong supporter of the 1-year reauthorization of Transitional Medical Assistance, I ask unanimous 

consent that it be admitted into the record. 

There’s a letter here from Mr. Rick Pollack, Executive Vice President of the American Hospital Association, dated April 19th, advancing health in America, dated April 19th. I ask unanimous consent that be made part of the record. 

41

We’ll go into our Panel then. Ms. Jacqueline Del Rosario resides 

in Miami, Florida. Dr. Joe S. McIlhaney, The Medical Institute for 

Sexual Health, Austin, Texas. Dr. David W. Kaplan is head of the 

Adolescent Medicine and Professor of Pediatrics, University of Colorado School of Medicine. Dr. Cindy Mann, a Senior Fellow with 

the Kaiser Commission on Medicaid and the Uninsured. And Dr. 

William J. Scanlon, Director of Health Care Issues with General 

Accounting Office. We’ve had the honor and pleasure of having Mr. 

Scanlon here many times. It’s awfully nice to see you, sir and we 

will start off with Ms. Del Rosario. We set the clock at 5 minutes. 

If you haven’t quite completed your statement, I certainly won’t cut 

you off. Please proceed. 

STATEMENTS OF JACQUELINE JONES DEL ROSARIO, EXECUTIVE DIRECTOR, RECAPTURING THE VISION INTERNATIONAL; JOE S. McILHANEY, JR., THE MEDICAL INSTITUTE FOR SEXUAL HEALTH; DAVID W. KAPLAN, HEAD OF ADOLESCENT MEDICINE, PROFESSOR OF PEDIATRICS, UNIVERSITY OF COLORADO SCHOOL OF MEDICINE; CINDY MANN, 

SENIOR FELLOW, THE KAISER COMMISSION ON MEDICAID 

AND THE UNINSURED; AND WILLIAM J. SCANLON, DIRECTOR, HEALTH CARE ISSUES, U.S. GENERAL ACCOUNTING OFFICE 

Ms. ROSARIO. Thank you. Thank you for inviting me to share 

today. I believe that I will bring a very unique perspective on the 

issue of abstinence education. As I began to do my research for my 

presentation I was very surprised to find that there’s just tons of 

documentation of studies and evaluations that have been conducted. There are many that say that abstinence only education is 

successful. There are others that say it is not. It just depends on 

what side of the field that you’re standing on. 

I was much more of a skeptic when I entered the field. When I 

worked with teens at the middle and high school levels what I 

found was that they have very, very different views of sex. It was 

not because of a revolution, but they were very base in action. 

Wanting to have sex, my challenge was telling kids well, you want 

to postpone that, you don’t want to get pregnant. You want to preserve your education? Why? Because it’s going to give you a better 

life. Well, no, my mom had me at 17. My grandmother had her at 

18. Or that they have a boyfriend that they want to give a baby 

to. I mean these are the issues that I don’t think that condom distribution really is going to be able to impact. 

One day I was delivering a lesson with the students discussing 

various issues and I was asking what do some of these statements, 

what message do they send to you? One was sex outside of marriage, the other was condom distribution or contraceptions in 

schools. Unanimously, kids that had just earlier stated I’m not considering being abstinent, others saying that they were, unanimously all of them stated that I believe that this message tells 

them that adults are saying that they’re not going to be able to abstain from sex, you’re going to do it and it’s okay as long as you 

protect yourself. 

I quickly became a very ardent believer in the abstinence message. This is because I find that kids do want a very clear and conVerDate 0ct 02 2002 09:18 Oct 05, 2002 Jkt 010199 PO 00000 Frm 00045 Fmt 6633 Sfmt 6602 W:\DISC\79467 79467
42

cise message and I was surprised to find that many want to take 

the high road. I think that as roads we have to encourage them to 

raise a standard, but more than that, I believe that the abstinence 

funding allows us to really build human character. 

For the first time, we’re really able to use these dollars to build 

the individual that’s going to continue to keep our Nation strong. 

And I think that we’re talking about the subculture that’s developing in the United States of America. Kids have mixed values. 

They’re very confused. And I think that we have to begin to be surrogates to help to strengthen the families, to keep kids dreaming 

about their futures and believing in life as a possibility. And that’s 

what I found to be the purpose of abstinence education. 

As I said before my research, I found that there were studies 

that proved that abstinence was successful, others that said that 

it was not. I have looked at several issues concerning this, however. 

In our state, sex education is taught in the schools. Currently, 9 

out of 10 schools out of the 2 million nationwide do teach a comprehensive sex education course. In addition to that Title X funding 

has not been decreased to make room for abstinence education. The 

funding in our State level is $15.2 million, $8 million of that is 

given at the State level for Title V abstinence education; 4 of that 

$8 million is a match from the State. 

Despite these things happening, I think that we’re able to see 

that there has not been a significant change in the trends of sexual 

behaviors, nor has there been a decline really in pregnancy rates 

over the 30 years that Title X funding has been given. I think that 

we’ve seen a decrease over the past 10 years and many will say, 

according to the argument that abstinence education profoundly 

has impacted that. Others might say that it has not. 

But I would ask you to consider today the plight of America’s 

youth. As I look at some of the attitudes that I’m witnessing in the 

classrooms, I’m concerned. I’m concerned because it’s not about 

Johnny loving Sally any more. It’s about the subculture. It’s about 

a lifestyle and we need programs that are going to enable us to 

teach to the whole person, not to the behavior, bandaid approach 

that we’re going to apply a condom or use a contraceptive over the 

genitalia, but what’s going to protect the dignity. I’m interested in 

building the fiber of our Nation one individual at a time and I 

think that abstinence education allows us to do that with the 

young people of this Nation. And I think to circumvent that would 

be to abate progress. 

Recapturing the Vision has been in existence for 8 years. We’ve 

enjoyed funding that was not under Title V, but we’ve also had 

funding under Title V education dollars and our program to date 

has a success rate of 99.9 percent. Let me give you a picture of the 

type of citizens that we work with. Basically, 65 percent of those 

that we serve are on public assistance. They are intergenerational 

kids outside of wedlock. In other words, they are the offspring of 

the offspring of the offspring of a teen parent. 

They are receiving sex education, but they have a mindset that 

does not even make them sometimes want to avoid pregnancy. 

What I found in my dealing with this population is that they’re 

wanting us to believe in them and they’re wanting us to furnish 

them with the skills to support the high road. I think that many 

43

kids are taking the high road. Of the 52 high school age students 

that are sexually active, remember that there’s 48 percent that are 

not. But even of those 52 percent that are, I think that we can still 

let them know that they need to take the high road. Abstinence 

education teaches to the psychological situations and circumstances 

to early sexual involvement outside of marriage. 

It gives them the skills that they need to be able to support this 

decision to remain abstinent. I’m talking about character development. I’m talking about conflict resolution skills, negotiation skills, 

refusal skills. I’m talking about the understanding and building of 

value for marriage and family. It’s that simple. 

This is America today. Some of the subcultures that we’re seeing 

now are transcending the ’hood. They’re moving into suburbia and 

I think that they’re getting so many messages about condoms and 

safe sex and all of those things, abstinence represents one voice in 

a crowd of many. Last week I was watching MTV. They were talking about safe sex and condoms. Abstinence represents a very 

small voice. It’s one voice that cannot be snuffed out. It’s a voice, 

I believe that’s going to do more than just prevent teen pregnancies, but it’s going to be able to build strong citizens for our Nation. 

Thank you. 

[The prepared statement of Jacqueline Jones Del Rosario follows:]

PREPARED STATEMENT OF JACQUELINE DEL ROSARIO

Introduction 

I am Jacqueline Jones Del Rosario, Executive Director of ReCapturing the Vision 

International, a non-profit organization working in the field of abstinence-only education since 1994. I would like to share my unique experience in the area of abstinence and Title V Funding. 

I initiated abstinence-only education purely as a skeptic. I believed that teens 

from strong families or those with strong religious convictions could perhaps be 

taught to delay sex until marriage because I believed that our message merely reinforced the same message these children received from strong home environments. 

I did not believe, however, that the masses of at-risk teens from impoverished backgrounds could adhere to the abstinence message. After all, many of them could not 

understand why they should avoid getting pregnant before graduating. 

In the beginning years of ReCapturing the Vision, I was teaching a group of thirty 

students at Madison Middle School. This school is located in a dilapidated area of 

Miami-Dade County. Over 80% of the students enrolled received free or reduced 

priced lunches each day. This school had been rated a ‘‘D’’ school under the criteria 

established by Governor Jeb Bush. 

In the lesson that I was delivering that day, we reviewed pages from the Capturing the Vision textbook. The students were asked to explain what messages do 

the following actions send: lying, sex outside of marriage and the distribution of 

birth control in school. I received an awakening when the students unanimously responded that the message they gathered from the distribution of condoms was that 

adults expected them to have sex, but only asked them to use protection. In the student’s minds, this action represented consent, as long as protection was used. 

The answer from this population was riveting. I had heard it said that abstinence 

with contraceptives was a ‘‘mixed message’’ but I never believed it to be true. Kids 

need a concise and clear message. To hear it from the students caused me to believe 

that we must be the voice that tells them that we expect them to abstain and we 

believe they can do it. 

Sex Education is Being Taught in 91% of Schools 

According to a recent Kaiser Family Foundation Study, nine out of ten (89%) of 

the nation’s nearly 20 million public secondary schools teach sex education (Kaiser 

Family Foundation, Sex Education in America: A Series of National Surveys of Students, Parents, Teachers, and Principals. September 2000). This holds true in 

44

Miami-Dade and Broward counties where the students receive sex education involving information on contraceptives and STD’s including HIV. However, at the onset 

of our program, less than 10% of those who received this education knew what abstinence meant. 

Through this, ReCapturing the Vision has realized that sex for today’s generation 

is different from when our parents dealt with it during their adolescence. No longer 

is sex an expression of love; it has evolved as a social trend, and because of this, 

ReCapturing the Vision has become that one voice that encourages kids that they 

do not need to have sex, nor do they have to. ReCapturing the Vision teaches the 

consequences of sexual involvement and educates students on STD’s, but most of all; 

we build personal value and foster the vested interest that kids need take into their 

futures. 

In 1999, a nationwide study of principals discovered that 58% describe their 

school’s sex education curriculum as comprehensive, teaching that ‘‘young people 

should wait to have sex but if they do not, they should use birth control and practice 

safer sex.’’ On the contrary, only 34% say that they offer abstinence-only education 

teaching ‘‘young people should only have sex when they are married’’ (Kaiser Family 

Foundation, Sex Education in America: A Series of National Surveys of Students, 

Parents, Teachers, and Principals. September 2000). 

According to the 2000 Federal School Health Education Profiles study, the median 

percentage of schools offering required health education courses to students in 

grades 6 through 12 was 91%. Among these schools, a large percentage said that 

they tried to increase knowledge of HIV (96%) and teenage pregnancy prevention 

(84%) (Centers for Disease Control and Prevention, Guidelines for Effective School 

Health Education to Prevent the Spread of AIDS, MMWR 37 (S-2): 1-14, January 

29, 1988). 

If the pregnancy rate for Dade County were calculated for 445 students, RTV 

would expect 8.12 births to girls under the age of 19, despite the fact that children 

receive at least one sexual education course between grades 6 and 12. ReCapturing 

the Vision has served over 5,500 at-risk teens over the past eight years and only 

one participant has become pregnant during that time period. It is clear that abstinence-only education can make in impact in our city. 

As a program currently being evaluated under Title V by Mathematica Policy Research and locally at the state level, we are certain that the findings of these evaluations will only support what we have found to be true through internal evaluation. We have found that abstinence education is effective, not only in the lives of 

mainstream youth, but for at-risk teens as well. 

Title X Funding Has Not Produced Results 

The 1970’s produced an increase in the birthrate of unmarried adolescents by 

23.8%. The 1980s, increased to 52.3%. In the 1990’s however, the birth rate to unmarried adolescents increased only by 4.5%. 

The Title X funding expansion initiated the safe sex movement in the 1970s, and 

was followed by an increased growth rate in abortions, births to unmarried teens 

and premarital sex by teenagers. In the 80’s Title X funding was decreased, and following that cut was a reduction in the growth rates of abortion and unwed births. 

Title X dollars proved that contraception distribution and the ‘‘safe sex’’ message 

was not effective, but was creating an environment to breed an increase in teen sexual activity. 

In the 1990s privately funded abstinence programs worked to change the tide, 

while Title X continued to teach the safe sex message. The 1990s showed a dramatic 

decrease in the growth trend of birth rates to unwed teens, increasing only by 4.5%. 

It would be illogical to attribute such an improvement to the Title X initiative, when 

the previous 20 years have proven that Title X programs have consistently produced 

opposite results. 

The rise in abstinence programs in the 1990s has produced this change in trends. 

The growing abstinence-only message coincides with the improvement in the data 

reflecting adolescent sexual behavior. Abstinence programs are extremely effective. 

In 1982 through 1987, an abstinence program implemented in Denmark, SC reduced 

teen pregnancy by 59%. In the 1990s, the implementation of an abstinence-only curriculum in Washington, D.C. reported a pregnancy rate of 1.1%. ReCapturing the 

Vision in Miami-Dade and Broward Counties in Florida show a 1.1% teen pregnancy 

rate in eight years of service provision to the public. 

It is likely that the increase in the abstinence message is directly responsible for 

the improvement in the positive trend in adolescent sexual behavior recorded in recent years. It is safe to assess that these improvements would have been much 

greater if the allocated Title X dollars during the 1990s had been devoted to abstinence only education. 

45

Evaluating Strong, Not Weak, Abstinence Programs 

I have noted that there exists a definite conflict in most of the studies being conducted on abstinence-only education. Most do not measure up to the abstinence definition. That is to say, most of the programs being evaluated do not teach the eight 

points outlined in the Title V Social Security Act. This issue has been brought to 

the forefront of the current evaluation being conducted by Mathematica Policy Research. Those in the field have voiced their concerns that the programs being evaluated should be strong and solid programs, fulfilling congressional guidelines for abstinence education. There is a great variation among current programs being evaluated at the state levels. Some programs consist of five or more presentations. Their 

focus is to merely teach teens to say no to sex before marriage. These programs are 

not comprehensive and they do not contain the elements of most successful abstinence programs. According to A National Strategy to Prevent Teen Pregnancy, Annual Report 1998-99, U.S. Department of Health and Human Services, 1999, the following are five ‘‘Key Principles’’ that should be featured in successful abstinence 

programs:

1. Parental and Adult Involvement. Parents and other adult mentors must play key 

roles in encouraging young adults to avoid early pregnancy and stay in school. 

2. Abstinence. Abstinence and personal responsibility must be the primary message 

of prevention programs. 

3. Clear Strategies for the Future. Young people must be given clear connections and 

pathways to college or jobs that give them hope and a reason to stay in school 

and avoid pregnancy. 

4. Community Involvement. Public and private sector partners throughout the surrounding areas—including parents, schools, business, media, health and human 

service providers, and religious organizations—must work together to develop 

comprehensive strategies. 

5. Sustained Commitment. Real success requires a sustained commitment to the 

young person over a long period of time. 

If we are to examine the issue to arrive at the truth, again I must restate, strong 

and solid programming must be the basis of all evaluations. 

ReCapturing the Vision, An Abstinence Program for Youth 

ReCapturing the Vision does not just teach teens to say no to sex, but we also 

build their values and cause them to embrace the future. RTV embodies all five of 

these elements. As a result, ‘‘no’’ becomes a natural response. Building peer groups 

and educating parents on how to communicate with their teens on sexual issues has 

also made a great impact. Many parents have initially stated that they don’t tell 

their kids to abstain. Rather, they state in a greater frequency that protection is 

imperative. Improving teen/parent communication has strengthened the clear message that teens are receiving about sex and parental expectations. 

RTV is a holistic, multi-tier program providing abstinence strategies through a 

three-tier service delivery: school, home and the community. In the context of the 

school, RTV addresses the whole participant, building self-esteem, developing character, and providing information and skills to make positive choices. The program 

is delivered as an elective course during the regular school day. Students receive 

daily instruction throughout the entire school year. Our goal is to address the root 

issues of youth behaviors versus attempting to protect them from those risky behaviors. 

In the context of the home, RTV integrates the parent and family into the scope 

of service. Trained social workers make monthly home visits and conduct casework 

including counseling, referral services and parent training. Family mentoring 

spawns from this tier of service and involves families of the highest need in intensive three-day excursions that take place outside of their current environment. Families are immersed in bonding type activities and receive training to build the family 

structure and unity. 

The community brings the third and final level of intervention through after 

school programs delivered through partnerships with local churches and community 

based organizations that are in the feeder patterns of the schools that we serve; 

thereby offering students positive activities and opportunities for remediation during critical after school hours. 

Large-scale community events take the abstinence message community wide as 

significant community entities are educated on the importance of abstinence and the 

role they can play in the fight. These events include conferences, concerts, rallies 

and training workshops. 

46

RTV Success Rates 

Through RTV’s philosophy of addressing the whole child, versus merely teaching 

them to say no, consistent data clearly documents the inroads that we have made 

in changing teen attitudes and behaviors:

• 100% of students enrolled demonstrate increased self-esteem as assessed by an attitudinal survey. • 89% of students improved behavior as evidenced by a decrease in outdoor suspensions and 80% in indoor suspensions. • RTV has a 99.99% success rate in preventing teenage pregnancies among students 

actively involved in the program for one year. • 60% of students improved attendance • 75% improved academic performance as indicated by an increase in grade point 

averages. 

The Economic Implications Equal Mindsets 

Economics play a strong role in sexual behaviors and trends. The pregnancy rates 

for non-Hispanic black and Hispanic teenagers are about twice as high as non-Hispanic white teenagers. The lower pregnancy rates are due to differences between 

groups in economic opportunity and family stability (National Vital Statistics Reports, Vol. 47, No. 29, December 15, 1999). 

In 1995, 57% of non-Hispanic black teenagers and 52% of Hispanic teenagers compared to 46% non-Hispanic white teenagers are sexually active. About 1 in 3 sexually active black and Hispanic teenagers became pregnant in 1995, compared with 

about 1 out of 6 sexually active non-Hispanic white teenagers. The differences in 

sexually activity and pregnancy are associated in part with differences between 

groups in economic opportunities and family stability. 

Condoms cannot address the social ills that plague our nation, but abstinence can. 

Pregnancy rates are economically derived (Wilson, W.J. The Truly Disadvantaged: 

The Inner City, The Underclass, and Public Policy. University of Chicago Press. Chicago. 1987). Many children from impoverished backgrounds do not even have the 

desire to avoid teenage pregnancy. In fact, many desire to have a child and see the 

birth of a baby as a direct link to public assistance. In many inner city neighborhoods, early sexual activity and teenage pregnancies has become a lifestyle. I have 

seen first hand the influence that economics play in sexual attitudes. An alarming 

truth that was uncovered during my labor in the field is that nearly 45-50% of the 

participants we serve have no value for marriage or the family. They have never 

seen a wedding and live in a home with a single parent and that parent’s live-in 

companion. Many do not have negative ideas about teenage pregnancy and do not 

see it is a danger to their future, but rather, a way of life in their world. Abstinenceonly education is the weapon that can fight in this war. 

As a nation, we need to be about addressing the behaviors versus applying the 

band-aid to the behavior. In this case, this is what contraceptives represent. Sadly 

enough, however, if a child does not deem avoiding teenage pregnancy a worthy 

cause, they will never use contraceptives as a means to prevent something that is 

not perceived as being a threat to their future. Abstinence is a necessary extension 

of welfare reform. It is a means to elevate the mindset of at-risk populations who 

are not engaging in sexual intercourse because Sally loves Johnny, but because it 

is a part of the behaviors that this subculture has adopted. This scenario has weakened the fiber of our nation as generational cycles of teen pregnancy and poverty 

threaten our stance as a national power. 

Contraceptives cannot protect a 15-year-old from the erosion of her dignity and 

self-worth. There must be another value that causes teens to raise their standards 

and protect their emotional and physical health. This message is embodied in the 

plan defining abstinence-only education. Title X Funding has not undergone the 

same scrutiny but has received funding for the past 30 years. Abstinence-only deserves an opportunity to demonstrate its impact in the field. 

RTV is developing teens that are abstaining from premarital sex, remaining in 

school, and even better, improving their grades and behavior as evidenced by improved GPA and reduced suspensions. They are learning to work for success and 

to protect their futures. We are fostering teens that may be the first in several generations to become self-reliant and support themselves versus a life on and off public 

assistance. They are the core of a better nation. Their offspring will receive a perception quite different from that of their parents and grandparents. They won’t be 

the product of a single family nor will they be 50% more likely to be involved in 

criminal behavior. They will have a good start in life and will manifest a true turn 

of the tides of teenage pregnancy.

Mr. BILIRAKIS. Thank you very much, Ms. Del Rosario. 

47

Dr. McIlhaney? Please, pull the mike closer. Obviously, your 

written statements are part of the record and we would hope that 

you would—Ms. Del Rosario did complement or supplement it, if 

you will. Please, Doctor, go ahead. 

STATEMENT OF JOE S. McILHANEY, JR. 

Mr. MCILHANEY. Thank you, Mr. Chairman, and distinguished 

members. I’m a gynecologist who practiced medicine for 28 years. 

I had a rewarding practice, caring for infertile women, doing in 

vitro fertilization, taking care of lots of adolescents. I left my practice to commit the remainder of my medical career to helping prevent two of the problems that I saw hurting my patients the most, 

the out-of-wedlock pregnancy and sexually transmitted disease 

problems. And today, I’m president of the Medical Institute for Sexual Health, a nonprofit medical educational organization which I 

founded in 1992. 

In 1996, I testified on the proposed Welfare Reform Act. My message then was that sexually transmitted disease and nonmarital 

pregnancy are much, much more common than most Members of 

Congress and most Americans realize. To its credit, Congress provided funding that has helped more than 700 abstinence programs 

around the country devoting serious and much needed attention to 

these problems. 

The good news today is that since 1990, the number of teens becoming sexually active and the number of teens becoming pregnant 

has been declining so that today more than half of teens in high 

school across, high schools across the country are still virgins and 

we have the lowest teen birth rate that we’ve had since the 1950’s 

as this first chart shows. 

It’s reasonable to conclude that one factor contributing to this improvement has been the concombinant rise in abstinence education 

programs, there’s some specific programs, as a matter of fact, such 

as the one in Monroe County, New York and others that have actually found declining teen pregnancy rates as a result of their education programs. But the bad news is that 25 percent of teens are 

infected with a sexually transmitted disease. There are 3 to 4 million teens that get a new sexually transmitted disease every year. 

In addition, the epidemic has evolved to a new and more dangerous 

epidemic, no longer gonorrhea and syphilis which are treatable 

with a shot of penicillin, but now we have an epidemic of viral diseases. HPV which is human papillomavirus, herpes, HIV, and 

we’ve never cured any human viral infection. 

One study shows that 50 percent, half of sexually active 15 to 20 

year olds are infected with human papillomavirus. Approximately 

6 percent of teenagers are infected with genital herpes. Then 

there’s chlamydia which is dangerous because it’s so common in 

teens. It’s rarely symptomatic and it causes infertility. Twelve percent of 17 year old female Army recruits were found to be infected 

with chlamydia on induction and they didn’t know it. 

Today, 1 in 4 adolescents is infected with an STD. Today, there 

are more diseases, 25 sexually transmitted diseases as opposed to 

2 when I started medical practice back in 1968. Today, the diseases 

that are most dominant are viral diseases and with no cure. And 

there is no evidence, for example, that condom reduces sexual 

48

transmission of the common sexually transmitted disease which is 

human papillomavirus because it’s 99 percent of all cervical cancer, 

killing more women than AIDS kills and causing almost all abnormal Pap smears and there’s an epidemic of abnormal Pap smears 

among teenagers today, when I saw almost no adolescents with abnormal Paps when I started practicing in 1968. 

One reason STDs have become so common among teenagers is 

that the younger age of sexual initiation is happening. The more 

sexual partners, as a matter of fact, that teens tend to have is associated with or beginning sexual activity at a younger age as this 

next chart shows. The biggest risk for becoming STD-infected is 

how many sexual partners you or I have had in our lifetime. Even 

though the pregnancy rate among teens has declined, as I mentioned, a devastating trend has developed. Whereas in 1960, 15 

percent of teen births were to unmarried teens. Today, 78 percent 

of teen births are out of wedlock. There seems to be a resurgence 

of insistence that so-called abstinence plus or dual message programs, discussing abstinence while also teaching all about contraception, that these are the solution to these epidemics. But let me 

remind you that for many years these programs were the predominant approach for sexuality education in this country. These programs, as a matter of fact, were almost unchallenged during the 

1980’s and it was during those years that the problem I’ve just outlined grew the most. As a matter of fact, it was during those years 

when my attention was grabbed by what was happening to my patients and what I saw in research literature. In addition, these programs developed and were studied extensively by the most prestigious academic institutions in America. 

Let me remind you that what those studies show. Only a handful 

of these programs and there are multitudes of them have shown 

any significant impact on any behavioral or health outcome. Only 

two of the Centers for Disease Control’s ‘‘Programs That Work’’

have reported statistically significant delays in the initiation of sexual activity and only one of those has reported a truly substantial 

impact on this delay of sexual activity. Not one of those CDC programs has studied the incidents of sexually transmitted disease or 

of pregnancy rates in kids that were exposed to those education 

programs. 

Much has been made of reports that parents want their children 

to have dual message programs. None of these surveys included 

parents who have been given even as little information as I have 

provided you today about how often condoms and contraceptives 

fail and how prevalent diseases have become. I believe parents 

would want a vigorous effective abstinence education program for 

their children if they knew the facts, even that I’ve provided you 

today. 

There’s abundant evidence that the safer sex paradigm has not 

solved the problem. As a matter of fact, Doug Kirby who is a wellknown advocate of safer sex programs, if we would put up the next 

chart, after he did extensive research of the sexuality programs 

said it may actually be easier to delay the onset of intercourse than 

to increase contraceptive use. 

49

We recognize that we not yet have sufficient data to positively 

determine the degree of effectiveness of abstinence education, but 

results are promising. 

Mr. BILIRAKIS. Please summarize. 

Mr. MCILHANEY. I have just about two more sentences. The National Evaluation of Abstinence Programs of Mathematica will be 

completed in the year 2005. If we don’t continue with the current 

level of funding or if we change the focus of the programs funded, 

for example, by changing the A through H definitions, we’ll lose an 

invaluable opportunity to learn how we can effectively help young 

people avoid sexual activity, at risk behavior at least as detrimental to their health as the use of alcohol drugs and tobacco. 

Thank you very much. 

[The prepared statement of Joe S. McIlhaney, Jr. follows:]

PREPARED STATEMENT OF JOE S. MCILHANEY, JR., PRESIDENT, THE MEDICAL

INSTITUTE FOR SEXUAL HEALTH

Thank you, Chairman Bilirakis and distinguished members of the Subcommittee. 

I am a gynecologist who practiced medicine for twenty-eight years. I had a rewarding practice of in vitro fertilization and surgery, but I left my practice to commit the remainder of my medical career to helping prevent two of the most profound 

medical problems of our day, out-of-wedlock pregnancy and sexually transmitted 

disease. I have been doing this through an organization called The Medical Institute 

for Sexual Health, which I founded in 1992. The mission of the Medical Institute 

for Sexual Health is to identify, evaluate and communicate credible scientific data 

in practical, understandable and dynamic formats to promote healthy sexual decisions and behavior in order to dramatically improve the welfare of individuals and 

society. 

THE GOOD NEWS

In 1996, I testified before the House Ways and Means Subcommittee on Human 

Resources on the proposed Welfare Reform Act. My message then was that sexually 

transmitted disease and non-marital pregnancy are hurting far more people in society than most members of Congress and other Americans realize. To its credit, in 

an effort to constructively and meaningfully deal with these pregnancy and disease 

problems, Congress funded abstinence education with $50 million a year for five 

years through the Title V provision of the Welfare Reform Act. This funding has 

helped more than 700 abstinence education programs around the country to devote 

serious and much needed attention to these problems. 

I come today with good news and bad news. The good news is that there is credible evidence showing that abstinence education is having an impact. More young 

people are living an abstinent lifestyle, and fewer teens are becoming pregnant. 

Today, more than half of all high school students are virgins.1 Also, beginning in 

1990, the number of teens becoming pregnant began declining. Today we have the 

lowest teen birth rate that we have had since the 1950s, and teen pregnancy rates 

are lower than they have been any time since 1976.2,3

A ray of light and hope is emerging. Trend data showing declining sexual activity 

among adolescents and declining teen pregnancy rates reveal a societal shift in a 

positive direction—it is reasonable to conclude that one contributing factor is the 

concomitant rise in abstinence education programs, though how large of a contributing factor we do not know. Some specific programs, such as the one in Monroe 

County, New York, and the Best Friends program that began in inner city Washington, DC, show a very marked decline in pregnancy rates.4,5

THE BAD NEWS

But the bad news is that we still have an enormous problem. Sexually transmitted infection is highly prevalent among adolescents. Three to four million STDs 

are contracted yearly by 15 to 19 year-olds, and another five to six million STDs 

are contracted annually by 20 to 24 year-olds.6 Approximately six percent of adolescent females tested at family planning clinics and nine percent of female U.S. Army 

recruits (12.2% of 17 year-olds) are infected with Chlamydia trachomatis.7,8 5.6% of 

12 to 19 year-olds and 17% of 20 to 29 year-olds are infected with herpes simplex 

virus type 2 (the virus that causes genital herpes).9 And whereas in the 1960s, only 

50

two STDs were of real concern, we are now aware of more than 25 (Appendix A). 

It is clear that, if and when young people begin sexual activity prior to marriage, 

they are at very high risk of acquiring an STD. 

One reason STDs have become so prevalent among young people is that, in spite 

of the recent trend toward later sexual initiation, we had for years been experiencing a trend toward earlier sexual initiation, and the trend toward later marriage 

continues.10,11 The combination of these two factors means that people are likely to 

be single and sexually active for a significant period of time—5 to 10 years or 

longer—during which they will normally accumulate a number of sexual partners. 

In fact, age of sexual onset is a very strong predictor of lifetime number of sexual 

partners.12 And an individual’s risk of ever having contracted a sexually transmitted disease is strongly linked to his or her lifetime number of sexual partners.13,14,15

In addition, a major shift has occurred over the past three decades. The diseases 

primarily infecting young people are no longer syphilis and gonorrhea, which are 

frequently symptomatic and treatable with penicillin, but viral diseases such as 

human papillomavirus (HPV), herpes, and the unusual bacterium, chlamydia. The 

viral diseases cannot be cured—only managed. And chlamydia, a major cause of infertility in young women, is asymptomatic in up to 85% of infected women 16 but 

can still cause significant problems even without the presence of noticeable symptoms. 

The sexually transmitted disease that has become the most common is a virus 

called human papillomavirus (HPV). The most recent major study about young 

women and HPV shows that 50% of sexually active women between the ages of 18 

and 22 are infected with HPV.17,18 The National Institutes of Health Workshop On 

The Scientific Evidence On Condom Effectiveness For STD Prevention reported that 

there is no evidence that condoms reduce the sexual transmission of this infection.19

The NIH report also found no evidence for risk reduction for the transmission of 

herpes. A recent study has shown that condom use can produce a significant reduction (but not elimination) in the risk of herpes acquisition by women; however, the 

study did not find any impact for men.20 In addition, researchers at Johns Hopkins 

University, upon completing a study of STD prevalence at an adolescent clinic, 

found re-infection rates of chlamydia in adolescent girls to be so high that they recommended testing every sexually active adolescent girl in the United States every 

six months for chlamydia infection (regardless of reported condom use).21

Even though the pregnancy rate among teens has declined, today, 78% of teen 

births are out-of-wedlock, compared to 15% in 1960.22 These out-of-wedlock births 

contribute to poverty, crime, and negative outcomes for children including physical 

and emotional health problems, and educational failure. For example:

1. Poverty—In 1995, 66% of families with children headed by a never-married single 

parent were living in poverty.23

2. Child health ‘‘White infants born to unmarried mothers are 70% more likely to 

die in infancy. Black infants born to unmarried mothers are 40% more likely 

to die.24

3. Education—Living in a single-parent family approximately doubles the likelihood 

that a child will become a high-school dropout.25

4. Crime—Boys raised in single-parent homes are twice as likely to commit a crime 

that leads to incarceration by their early thirties.26

‘‘ABSTINENCE PLUS’’ EDUCATION IS NOT THE ANSWER

Many have suggested that so-called ‘‘abstinence plus’’—dual message programs 

discussing abstinence while also teaching all about contraception—is the appropriate answer to the twin epidemics of sexually transmitted diseases and out-of-wedlock pregnancies. Yet, for many years, it is just such programs that have been the 

predominant approach of sexuality education. And what did we see during these 

years? A genuine epidemic of sexually transmitted diseases is devastating our young 

people. 

There have been many studies of dual message educational programs. Only a 

handful of these studies have found any significant impact on ANY behavioral or 

health outcome.27 And most of these have only made ‘‘statistically significant’’ impacts on behavioral outcomes (many times of questionable practical significance—

such as ‘‘condom use at last intercourse’’ and ‘‘frequency of unprotected sex’’ in the 

past few months). Only two of the CDC’s ‘‘Programs That Work’’ have reported statistically significant delays in the initiation of sexual activity, and only one of these 

has reported a truly substantial impact on this outcome.28,29 Recently and to the 

acclaim of the media, a study reported a reduction in pregnancy rates among participants in a teen pregnancy prevention program. The intervention made no impact 

51

on rates of sexual activity and did not even measure STD rates. And the impact 

on teen pregnancy was almost entirely attributable to injectable contraception use, 

which provides NO risk reduction for HIV or any other STD.30 Additionally, this 

intervention was so expensive, per student, that it cannot be considered a reasonable option in most settings. Finally, not a single one of the CDC’s so-called ‘‘Programs That Work’’ has even investigated its impact on STD or pregnancy rates!31

Despite what you may sometimes hear, there is no abundance of evidence that ‘‘dual message’’ or ‘‘comprehensive’’ programs are effective at preventing teen pregnancies and STDs. In fact, there is precious little evidence that these programs are 

really successful at all. Proponents of dual message programs face the same problems today as they have for many years—an inability to document tangible success 

in protecting adolescent health. And to whatever extent these programs give young 

people the impression that ‘‘sex is really not a big concern, as long as you ‘protect 

yourself’,’’ such programs may even contribute to the problem. 

Additionally, ‘‘safer sex’’ programs do not even address the problem of out-of-wedlock pregnancy. At best, these programs may encourage young people to wait before 

having sex; but there is rarely if ever any mention of the importance of actually 

being abstinent UNTIL MARRIAGE. As I have already stated, in spite of the recent 

decline in teen pregnancy rates, there has been a steady increase in the proportion 

of teen births occurring to unmarried teens. Similarly, the proportion of all births 

occurring out of wedlock has risen dramatically in the past few decades, so that in 

1999, 33% of all American births occurred to unmarried women (compared to just 

18% in 1980) 32. Could this increase be related to the lack of an emphasis on marriage in our classrooms over that period? It has only been in the past few years that 

this trend has begun leveling off, but certainly there must be a much greater emphasis placed on abstinence until marriage, not just until some unspecified later 

date—an emphasis that is clearly required by the Section 510 definition of abstinence education. 

Much has been made of the fact that many parents and sexuality education teachers believe it is necessary, as an element of public sexuality education, to teach kids 

very directly how to use condoms and contraceptives. Clearly, parents care about 

their adolescent children and desperately want to protect them from harm. Unfortunately, far too many parents are inadequately informed about the problems of contraceptive and condom use. How many parents know, for example, that condoms do 

not appear to reduce the risk of infection with human papillomavirus, which is the 

cause of almost all cervical cancer and most abnormal Pap smears? Do most parents 

understand that even with 100% consistent condom use, their sexually active adolescents are at risk of contracting one of the other prevalent STDs (gonorrhea, 

chlamydia, trichomoniasis, etc. . . .)? Do parents understand that, for many sexually 

transmitted diseases, if condoms are not used 100% of the time it is little or no better than not using a condom at all, ever? 33 If America’s parents knew the facts—

and these are scientifically supported facts, not conjecture nor ideology—we know 

they would agree with us: Their children need to hear that the only reliable way 

to protect themselves from a sexually transmitted disease that can have lifelong, 

physically and emotionally painful ramifications, is to abstain from sexual activity. 

MARRIAGE IS A HEALTH ISSUE

Title V clearly articulates an abstinence-until-marriage message. Marriage involves both personal and public health issues. An individual’s number of sexual 

partners is directly linked to his or her risk of contracting a sexually transmitted 

disease. The one environment where people are most likely to have one sexual partner for a long period of time is marriage. The largest study ever done examining 

sex in America was conducted by researchers at the University of Chicago and published in the aptly named book, Sex in America.34 These researchers reported that, 

in contrast to what most Americans believe, when a marriage is intact, married couples almost never have sex outside of that marital relationship. Young people should 

be encouraged to maximize their own personal health by reserving sexual activity 

for marriage. 

CONCLUSION

With STD prevalence among young people continuing at high levels, condoms 

clearly not eliminating the risk of any STD, and a continued increase in the proportion of births occurring to unmarried mothers, there is abundant evidence that the 

‘‘safer sex’’ paradigm, despite more than 20 years and a variety of education programs designed to promote condom use, has not solved the problem. Since new research is beginning to suggest that abstinence education can effectively address 

these problems, it is important that we continue the effort begun in 1996 and allow 

52

these programs sufficient time to continue to prove their effectiveness. Title V, including the definitions A through H, must be maintained as is. Doing so will ensure 

that research and evaluation can continue so that we can learn how this option is 

best delivered, and how abstinence education can best protect young people. 

We recognize that we do not yet have sufficient data to positively determine the 

degree of effectiveness of abstinence education. But results are promising. The national evaluation of abstinence programs by Mathematica will be completed in 2005. 

If we do not continue with the current level of funding, or if we change the focus 

of the programs funded under Title V, we will lose an invaluable opportunity to 

learn how we can effectively help young people avoid sexual activity—a risk behavior at least as detrimental to their health as the use of alcohol, drugs, and tobacco. 

And there will be no going back. If we damage the integrity of Title V the opportunity to fully explore this public health option will be lost. This is not about politics 

or ideology. This is about medicine, science, and data. All of which tell us the old 

approaches aren’t working, not when millions of adolescents are contracting sexually 

transmitted diseases. We owe it to our young people to fully explore and evaluate 

the abstinence education approach, and that means continuing the Title V program 

as it is currently designed and being implemented. 

References: 

1. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance System: Sexual Behaviors. 1999. Available at: http://apps.nccd.cdc.gov/YRBSS. Accessed on April 19, 2002. 

2. Ventura SJ, Mathews TJ, Hamilton BE. Births to teenagers in the United States, 1940- 

2000. National Vital Statistics Reports; 49(10). Hyattsville, Maryland: National Center for 

Health Statistics. 2001. 

3. Ventura SJ, Mosher WD, Curtin SC, Abma JC, Henshaw S. Trends in pregnancy rates for 

the United States, 1976-97: An update. National Vital Statistics Reports; 49(4). Hyattsville, 

Maryland: National Center for Health Statistics. 2001. 

4. Doniger AS, Riley JS, Utter CA, Adams E. Impact evaluation of the ‘‘Not Me, Not Now’’ abstinence-oriented, adolescent pregnancy prevention communications program, Monroe County, 

NY. J Health Communications. 2001;6:45-60. 

5. Rowberry DR. An Evaluation of the Washington, DC Best Friends Program [thesis]. Boulder, CO: Graduate School of the University of Colorado; 1995. 

6. American Social Health Association. Sexually Transmitted Diseases in America: how Many 

Cases and at What Cost? Menlo Park, CA: Kaiser Family Foundation; 1998. 

7. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 

2000. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control 

and Prevention, September 2001. 

8. Gaydos CA, Howell MR, Pare B, et al. Chlamydia trachomatis infections in female military 

recruits. N Engl J Med. 1998;339:739-744. 

9. Fleming DT, McQuillan GM, Johnson RE, et al. Herpes simplex virus type 2 in the United 

States, 1976 to 1994. N Engl J Med. 1997; 337:1104-1111. 

10. Centers for Disease Control and Prevention. Current trends premarital sexual experience 

among adolescent women—United States, 1970-1988. MMWR. 1991;39(51-52):929-932. 

11. U.S. Census Bureau. Estimated Median Age at First Marriage, by Sex: 1890 to the Present. 

2001. Available at: http://www.census.gov/population/www/socdemo/hh- fam.html. Accessed on 

April 19, 2002. 

12. Abma J, Chandra A, Mosher W, Peterson L, Piccinino L. Fertility, family planning, and 

women’s health: New data from the 1995 National Survey of Family Growth. National Center 

for Health Statistics. Vital Health Statistics; 23(19). 1997. 

13. Ho GYF, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural history of cervicovaginal 

papillomavirus infections in young women. N Engl J Med. 1998;338:423-428. 

14. Ibid # 9. 

15. Eng TR, Butler WT, eds. The Hidden Epidemic-Confronting Sexually Transmitted Disease. 

Institute of Medicine. Washington, DC: National Academy Press; 1997. 

16. Ibid. 

17. Wheeler CM, Parmenter CA, Hunt WC. Determinants of genital human papillomavirus 

infection among cytologically normal women attending the University of New Mexico student 

health center. Sex Transm Dis. 1993;20:286-289. 

18. Peyton CL, Gravitt PE, Hunt WC, et al. Determinants of genital human papillomavirus 

in a U.S. population. J Infect Dis. 2001;183:1554-1564. 

19. National Institutes of Health. Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention. 2001. Available at: http://

www.niaid.nih.gov/dmid/stds/condomreport.pdf. Accessed on April 19, 2002. 

20. Wald A, Langenberg AG, Link K, et al. Effect of condoms on reducing the transmission 

of herpes simplex virus type 2 from men to women. JAMA. 2001;285:3100-3106. 

21. Burstein GR, Gaydos CA, Diener-West, Howell MR, Zenilman JM, Quinn TC. Incident 

Chlamydia trachomatis infections among inner-city adolescent females. JAMA. 1998;280:521-

526. 

22. Ventura SJ, Bachrach CA. Nonmarital childbearing in the United States, 1940-99. National Vital Statistics Reports; 48(16). Hyattsville, Maryland: National Center for Health Statistics. 2000. 

23. Fagan PF. How broken families rob children of their chances for future prosperity. 

Backgrounder. 1283. Washington, DC: Heritage Foundation. 1999. Available at: 

www.heritage.org/library/backgrounder/bg1283.html. Accessed on April 19, 2002. 

53

24. Waite LJ, Gallagher M. The Case for Marriage: Why Married People are Happier, 

Healthier, and Better Off Financially. Broadway Books. New York. 2000. 

25. Ibid. 26. Ibid. 27. Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. 

Washington, DC: National Campaign to Prevent Teen Pregnancy. 2001. 

28. Kirby D, Barth RP, Leland N, Fetro JV. Reducing the Risk: Impact of a new curriculum 

on sexual risk-taking. Fam Plan Persp. 1991;23:253-263. 

29. St. Lawrence JS, Brasfield TL, Jefferson KW, Alleyne E, O’Bannon RE, Shirley A. Cognitive-behavioral intervention to reduce African American adolescents’ risk for HIV infection. 

Journal Consulting Clinical Psychology. 1995;63:221-237. 

30. Philliber S, Kaye J, Herrling S. The National Evaluation of the Children’s Aid Society 

Carrera-Model Program to Prevent Teen Pregnancy. Philliber Research Associates. 2001. 

31. Centers for Disease Control and Prevention. HIV Prevention Fact Sheets. Available at: 

www.cdc.gov/nccdphp/dash/rtc/hiv-curric.htm. Accessed on April 19, 2002. 

32. Ibid # 22. 

33. Ibid # 19. 

34. Michael RT, Gagnon JH, Laumann EO, Kolata G. Sex in America. Boston, MA: Little, 

Brown and Company; 1994. 

APPENDIX A: LIST OF SEXUALLY TRANSMITTED DISEASES

1. Gonorrhea; 2. Chlamydia; 3. Lymphogranuloma venereum (caused by certain 

strains of Chlamydia trachomatis); 4. Syphilis; 5. Chancroid; 6. Donovanosis (Granuloma inguinale); 7. Ureaplasma urealyticum; 8. Human Immunodeficiency Virus 

(HIV) Types I and II; 9. Shigellosis*; 10. Salmonellosis*; 11. Herpes Simplex Virus 

Types I and II; 12. Cytomegalovirus*; 13. Human Papillomavirus (approximately 30 

sexually transmitted strains); 14. Molluscum contagiosum; 15. Hepatitis A; 16. Hepatitis B; 17. Hepatitis C*; 18. Hepatitis D*; 19. Body or pubic lice; 20. Trichomoniasis; 21. Scabies*; 22. Giardiasis*; 23. Amoebiasis*; 24. Bacterial vaginosis*; and 

25. Human Herpes Virus type VIII;

* Sexual transmission occurs but is not the primary mode of transmission.

Mr. BILIRAKIS. Thank you very much, Doctor. 

Dr. Kaplan. 

STATEMENT OF DAVID W. KAPLAN 

Mr. KAPLAN. Mr. Chairman, thank you very much for inviting 

me to testify before the subcommittee today on the important topic 

of sex education for our Nation’s youth as you consider reauthorizing the abstinence only provisions of the 1996 law and formally 

known as welfare reform. 

I am Chief of Adolescent Medicine and Professor of Pediatrics in 

the Department of Pediatrics at the University of Colorado School 

of Medicine and head of Adolescent Medicine at the Children’s Hospital in Denver. As a physician who sees the realities of adolescent 

life on a daily basis, the struggles with emerging sexuality, the impact of peer pressure and the media, the effort to make responsible 

decisions and the consequences of poor choices, I wish to appeal to 

the subcommittee and indeed to the Congress as a whole to be realistic and responsible when it comes to sex education and to provide 

young people with all the information they need to protect their 

health and lives in the era of AIDS. 

Do not make this an either/or issue because it’s not. Young people need information about abstinence and they need information 

about contraception. They need information about abstinence because, as the American Academy of Pediatrics policy statement on 

adolescent HIV prevention states, ‘‘it is the surest way to prevent 

STDs including HIV infection and pregnancy.’’

The Academy policy statement goes on to say ‘‘although abstinence is the safest method of avoiding sexual exposure to HIV, it 

is impossible to predict which adolescents will remain abstinent. 

Therefore, education about safer sexual practices including the use 

54

of condoms and other barrier methods needs to be provided to adolescents in order to protect them.’’

More than half of all the teens ages 15 to 19 in this country have 

had sex. That figure is nearly 70 percent for 18-year-olds. Whether 

you are a pediatrician or a policymaker, a parent or a teacher, this 

reality confronts us. We must stop politicizing the issue and acknowledge the need for teens to learn how to protect themselves 

from unintended pregnancy and STDs. Parents themselves are far 

more pragmatic and realistic than conventional wisdom would have 

us believe. The Kaiser Family Foundation released a major survey 

of parents, their teens, sex education teachers and principals and 

in that survey 85 percent of parents said how to use condoms and 

other forms of birth control should be covered as well as how to 

talk about their use with partners. 

Young people themselves share similar views and say that there 

should be more, not less, information provided in sex education 

classes. Young people say there should be more information on how 

to use and where to get birth control. They also say they need more 

information on how to talk with the partner about birth control 

and sexually transmitted diseases. 

I’m a physician. My testimony is based both on my experience in 

providing health care to teenagers over the last 30 years and scientific evidence. Neither the evidence justifies nor my experience 

supports further funding of abstinence only programs. In 2001, the 

National Campaign to Prevent Teenage Pregnancy found no credible studies of abstinence only education showing any significant 

impact on participants’ initiation of or frequency of sex and contrary to the governing myth underpinning abstinence only education comprehensive sex education actually delays the onset of sex 

and reduces its frequency and increases contraceptive use. That’s 

why comprehensive sex education, not abstinence only is worth 

funding. 

Again, the American Academy of Pediatrics reached a similar 

conclusion on censoring information and denying access to contraception and I quote, ‘‘there is no evidence that refusal to provide 

contraception to adolescents results in abstinence or postponement 

of sexual activity. In fact, if adolescents perceive obstacles to obtaining contraception and condoms, they are more likely to have 

negative outcomes to sexual activity. In addition, no evidence exists 

that the provision of information to adolescents about contraception 

results in increased rates of sexual activity, earlier age of first 

intercourse or greater number of partners. 

‘‘Two school-based controlled studies have demonstrated a delay 

on the onset of sexual intercourse in the intervention group that 

used a comprehensive approach that included a discussion of contraception. Availability of contraception is not causally related to 

sexual experimentation.’’

Simply put, informing young people about contraception does not 

cause them to have sex. The basic foundation of sound public 

health policy is education. 

There is a clear consensus among experts that abstinence only 

education that censors information about contraception does not 

constitute sound public health policy. Indeed, I cannot think of any 

55

1 Committee on Adolescence, American Academy of Pediatrics (AAP), Condom Use By Adolescents, 107(6) Pediatrics 1463, 1467 (June 2001). 2 Committees on Pediatric AIDS and Adolescence, AAP, Adolescents and Human Immunodeficiency Virus Infection: The Role of the Pediatrician in Prevention and Intervention, 107(1) 

Pediatrics 188-190 (Jan. 2001). 3The Alan Guttmacher Institute (AGI), Teen Sex and Pregnancy, Facts in Brief (1999). 

other issue which is so strongly endorsed by the leading health and 

medical organizations, yet remains held hostage to politics. 

In 2001, the Surgeon General recommended giving information 

on both abstinence and contraception. The National Academy of 

Sciences Institute of Medicine criticizes abstinence only education 

and supports comprehensive sex and HIV education programs 

which it says can reduce high risk sexual behaviors among adolescents. 

The National Institute of Health concluded ‘‘abstinence only programs cannot be justified in face of the effective programs given effect that we face an international emergency on HIV.’’ Mr. BILIRAKIS. Please summarize, Doctor. 

Mr. KAPLAN. In summary, I would suggest a few key principles. 

First of all, do no harm. Provide medically accurate information 

about abstinence and contraception. Second, teachers should not be 

censored from answering young people’s questions about their 

health. Third, we need to follow research, what really works, and 

last, we need to be realistic and provide young people with all the 

information they need to protect their lives and health in an era 

of AIDs. 

Thanks very much. 

[The prepared statement of David W. Kaplan follows:]

PREPARED STATEMENT OF DAVID KAPLAN, CHIEF OF ADOLESCENT MEDICINE, DEPARTMENT OF PEDIATRICS, UNIVERSITY OF COLORADO SCHOOL OF MEDICINE

Thank you very much for inviting me to testify before the subcommittee today on 

the important topic of sex education for our nation’s youth, as you consider reauthorizing the abstinence-only provisions of the 1996 law informally known as ‘‘welfare reform.’’ I am Chief of Adolescent Medicine and Professor of Pediatrics in the 

Department of Pediatrics, at the University of Colorado School of Medicine, and 

head of adolescent medicine at the Children’s Hospital in Denver. I am also the 

Chairman of the Committee on Adolescence at the American Academy of Pediatrics. 

As a physician who sees the realities of adolescent life on a daily basis—the struggle with emerging sexuality, the impact of peer pressure and the media, the effort 

to make responsible decisions and the consequences of poor choices’ I wish to appeal 

to the subcommittee—and, indeed to the congress as a whole—to be realistic and 

responsible when it comes to sex education and to provide young people with all the 

information they need to protect their health and lives in the era of AIDS. 

Do not make this an either/or issue—because it is not. Young people need information about abstinence and contraception. They need information about abstinence 

because, as the american academy of pediatrics policy statement on adolescent HIV 

prevention states, ‘‘it is the surest way to prevent stds, including HIV infection, and 

pregnancy.’’ 1

The academy policy statements go on to say: ‘‘although abstinence . . . is the safest 

method of avoiding sexual exposure to HIV, it is impossible to predict which adolescents will remain abstinent. Therefore, education about safer sexual practices, including latex condom use, and other barrier methods should be provided so adolescents might opt to stop or alter their sexual behavior.’’ 2

More than half of all teens aged 15-19 in this country have had sex. That figure 

is nearly 70% for 18 year-olds.3 Whether you are a pediatrician or a policymaker, 

a parent or a teacher, this reality confronts us. We must stop politicizing the issue 

and acknowledge the need for teens to learn how to protect themselves from unintended pregnancy and STDs. 

Parents themselves are far more pragmatic and realistic than conventional wisdom would have us believe. The Kaiser Family Foundation released a major survey 

56

4 News Release, Kaiser Family Foundation (KFF), National Study on Sex Education Reveals 

Gaps Between What Parents Want and Schools Teach (Sept. 22, 2000). 5 Id. 

6Douglas Kirby, The National Campaign to Prevent Teen Pregnancy, Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy (2001), at 88, 95. 7 Committee on Adolescence, AAP, Contraception and Adolescents, 104(5) Pediatrics 1161 (Nov. 

1999). 8The Surgeon General’s Call to Action to Promote Sexual Health and Responsible Sexual Behavior (July 9, 2001), at http://www.surgeongeneral.gov/library/sexualhealth/call.htm. 9 Committee on HIV Prevention Strategies in the United States, Institute of Medicine, No 

Time to Lose: Getting More from HIV Prevention 118-20 (National Academy Press 2001). 10 National Institutes of Health, Interventions to Prevent HIV Risk Behaviors, NIH Consensus 

Statement (Feb. 11-13, 1997), at 16. 11 AAP, supra note 2. 12 Council on Scientific Affairs, American Medical Association, Report 7 of the Council on Scientific Affairs (1-99): Sexuality Education, Abstinence, and Distribution of Condoms in Schools, 

at http://www.ama-assn.org/ama/pub/article/2036-2376.html (last visited Mar. 4, 2002). 

of parents, their teens, sex education teachers, and principals. In that survey, 85% 

of parents said how to use condoms and other forms of birth control should be covered, as well as how to talk about their use with partners (88%).4

Young people themselves share similar views, and say there should be more, not 

less, information provided in sex education classes. Young people say there should 

be more information on how to use and where to get birth control; they also say 

they need more information on how to talk with a partner about birth control and 

STDs.5

I am a physician. My testimony is based both on my experience providing health 

care to teenagers over the last 30 years and the scientific evidence. Neither the evidence justifies nor my experience supports further funding of abstinence-only programs. In 2001, the national campaign to prevent teen pregnancy found no credible 

studies of abstinence-only education showing any significant impact on participants’

initiation of or frequency of sex. And contrary to the governing myth underpinning 

abstinence-only education, comprehensive sex education actually delays the onset of 

sex, reduces its frequency and increases contraceptive use.6 That’s why comprehensive sex education—not abstinence-only—is worth funding. 

Again, the american academy of pediatrics reached a similar conclusion on censoring information and denying access to contraception: 

‘‘There is no evidence that refusal to provide contraception to an adolescent results in abstinence or postponement of sexual activity. In fact, if adolescents perceive obstacles to obtaining contraception and condoms, they are more likely to have 

negative outcomes to sexual activity. In addition, no evidence exists that provision 

of information to adolescents about contraception results in increased rates of sexual 

activity, earlier age of first intercourse, or a greater number of partners. Two schoolbased controlled studies that demonstrated a delay of onset of sexual intercourse in 

the intervention group used a comprehensive approach that included a discussion 

of contraception. Availability of contraception is not causally related to sexual experimentation.’’ 7

Simply put, informing young people about contraception does not cause them to 

have sex. The basic foundation of sound public health policy is education. 

There is a clear consensus among the experts that abstinence-only education that 

censors information about contraception does not constitute sound public health policy. Indeed, I cannot think of any other issue which is so strongly endorsed by the 

leading health and medical organizations, yet remains hostage to politics.

• In 2001, the surgeon general recommended giving information on both abstinence 

and contraception.8

• The National Academy of Sciences’ Institute of Medicine criticizes abstinence-only 

education and supports comprehensive sex and hiv/aids education programs, 

which, it says, can reduce high-risk sexual behaviors among adolescents.9

• The National Institutes of Health concluded: ‘‘abstinence-only programs cannot be 

justified in the face of effective programs and given the fact that we face an 

international emergency in the AIDS epidemic.’’ 10

• The American Academy of Pediatrics recommended last year that ‘‘all adolescents 

should be counseled about the correct and consistent use of latex condoms to 

reduce risk of infection.’’ 11

• The American Medical Association urges schools to implement comprehensive sex 

education programs that include information about contraceptives.12

57

13 American College of Obstetricians & Gynecologists (ACOG) Statement of Policy, Statement 

on Sexuality Education (July 1996); ACOG Statement of Policy, The Limitations of AbstinenceOnly Sexuality Education (May 1998). 14 American Public Health Association, Policy Statement 9309: Sexuality Education (Jan. 1, 

1993). 15 Ventura et al., Declines in Teenage Birth Rates, 1991-98: Update of National and State 

Trends, National Vital Statistics Report (Centers for Disease Control & Prevention) (Oct. 25, 

1999), at 2. 16 AGI, Teenage Pregnancy: Overall Trends and State-by-State Information (Apr. 1999), table 

3. 17Pregnancy and STD statistics are for teens aged 15-19; HIV statistics are for young people 

aged 13-24. Id.; KFF & American Social Health Association, Sexually Transmitted Diseases in 

America: How Many Cases and at What Cost? 4, 8 (1998); Office of National AIDS Policy, The 

White House, Youth and HIV/AIDS: A New American Agenda (Sept. 2000), at v. 

• The American College of Obstetricians and Gynecologists supports sex education 

programs that include information about contraception.13

• And the American Public Health Association urges that comprehensive sex education be included as an integral part of all school systems’ curricula.14

The Office of the Surgeon General. The Institute of Medicine. The NIH. The 

American Academy of Pediatrics. The AMA. ACOG. APHA. Those are the professionals, the most respected leadership in our country. Unanimously, they take the 

same, evidence-based approach I urge congress to adopt. Yet, in programs funded 

with abstinence-only dollars, teachers can’t even answer students’ questions about 

prohibited topics—despite experts’ recommendations. 

Information is a tool, not an opponent, of responsible, healthy decision-making. 

Our young people are not all the hormone-driven stereotypes we see portrayed so 

often in our culture. They are capable of making good choices. Depriving them of 

medically accurate information will not protect them. It will only make them more 

vulnerable. 

Mr. Chairman, our nation’s youth face a reproductive health crisis: despite some 

encouraging signs that adolescent pregnancy rates are declining 15, teens still confront the twin epidemics of teen pregnancy (numbering almost 900,000 a year 16) 

and HIV, as well as other sexually transmitted diseases. Every day in America 

10,000 young people contract a sexually transmitted disease, 2400 become pregnant, 

and tragically, 55 contract HIV.17 I know in my heart that we can do a better job 

for our youth. 

In closing, I would suggest that we follow a few key principles:

• Do no harm. Provide medically accurate information about abstinence and contraception. • Teachers must not be censored from answering young people’s questions about 

their health. • Follow the research on what really works. • Be realistic. Provide young people with all the information they need to protect 

their health and lives in the era of aids. 

Thank you very much.

Mr. BILIRAKIS. Thank you very much, sir. 

Ms. Mann. 

STATEMENT OF CINDY MANN 

Ms. MANN. Thank you, Mr. Chairman, and members of the committee for the opportunity to testify about health care coverage for 

families leaving welfare and specifically the Transitional Medical 

Assistance program. 

Let me start with what I think is a sobering fact and that is if 

you are a parent, caring for a child, and you are poor, that is your 

income is below poverty, you are more likely to be uninsured if you 

have a job, than if you don’t have a job. Poor parents who work 

are—43 percent of poor parents who work don’t have health insurance coverage. This anomaly occurs because poor and near poor 

parents are caught between two systems of coverage. The first system, I think which most of us are most familiar with is the employer-based health care system. Most of us get our health insurance coverage from our employers, but that’s not true with low 

58

wage workers. If you have low wages, you’re much less likely to get 

coverage through your job. A study in 1988 looking at people with 

earnings of about $7 an hour or less showed that only 50 percent 

of them had employer-based coverage either through their own employer or through their spouse’s employer. Forty percent weren’t offered coverage at all, and 10 percent declined that coverage largely 

because of their costs. 

The second system that poor parents are caught between is publicly funded coverage. Medicaid and the States Children’s Health 

Insurance Program now offered coverage to most of the children in 

low income working households, however, the parents in those 

households are largely left out of publicly financed coverage. Medicaid eligibility for parents is no longer tied to welfare. Delinking 

Medicaid and welfare eligibility was part of the welfare law that 

was enacted in 1996. However, most States set their eligibility levels for parents in Medicaid at income levels that are about the 

same levels as welfare. If you earn about the average wage that 

people earn when they leave welfare for work, about $1300 a 

month, which is about the poverty line for a family of three, you 

are ineligible for Medicaid in 39 States. That’s where TMA comes 

in and the Chairman aptly described the purpose of TMA. It provides time-limited Medicaid coverage to those parents who already 

have Medicaid coverage and who then get a job and would lose 

their on-going regular Medicaid coverage because of their earnings. 

They don’t get employer-based coverage. They’re no longer eligible 

for regular Medicaid. TMA provides them an extension of coverage. 

It doesn’t last forever. It’s limited to 12 months and some people 

get it for less than 12 months, but it does assure that a parent can 

take the job and not immediately at least lost their Medicaid coverage when they join the workforce. 

It’s a program that’s enjoyed broad bipartisan support for almost 

20 years. It was first created actually in 1984, amended and expanded in 1998 and revisited and extended again in 1996 at the 

Welfare Law and extended again in the year 2000. 

While there seems to be very broad consensus in this committee 

and beyond that TMA ought to be continued, there has been some 

concern about low participation rates in the TMA program. In the 

past several years there’s been a considerable amount of attention 

paid as to why Medicaid rolls have declined at the same welfare 

rolls have declined, even though the two programs have become 

delinked. There were many reasons for some of the problems that 

were experienced, particularly having to do with State and local 

implementation of the delinking provisions and some slowness at 

the State and local level to change computer systems to ensure that 

when people left the welfare system, they were properly continued 

on Medicaid, generally, and on TMA if that was the category of 

Medicaid that they qualified for. Other problems arose because 

families didn’t always know they were eligible for TMA. 

Some of these problems have been addressed and Medicaid enrollment is beginning to rebound in a number of States. However, 

other problems have come to surface that have interfered with 

TMA participation. Let me mention a few steps that can be remedied only with legislative changes. 

59

First, TMA is limited to those people who have been on Medicaid 

for at least 3 out of 6 months prior to getting a job. That seems 

to conflict with State efforts to encourage quick attachment to the 

labor market. Let me give you an example. If you are a family, 

you’re on welfare in January and Medicaid is starting in January, 

you get a job in February that doesn’t offer health insurance coverage and you’re no longer eligible for Medicaid because of your 

wages, you would not be able to qualify for TMA under Federal 

rules because you will not have met that 3 out of 6 months requirement. 

Second, TMA is limited to 12 months, as we’ve noted. Some 

States would like to extent TMA beyond that period of time, but 

they don’t have the statutory discretion to do that. 

And third, I’d like to mention some very prescriptive reporting 

requirements that are built into the Federal law. States must send 

families forms and families must fill out forms in the 4th, 7th and 

10th month of this limited 12-month period of coverage. It’s really 

the only area in the Medicaid statute that I can think of where the 

reporting requirements are laid out in this kind of way. Generally, 

States have the responsibility to make sure that people who are in 

the Medicaid program are eligible, but in the area of TMA, the 

statute is very prescriptive and tells States exactly how they need 

to proceed. These reporting requirements have been administrative 

barriers for States and they have caused eligible families to lose 

coverage. 

Let me close by noting how important health care coverage is to 

the population that’s targeted by TMA. Low-income parents tend to 

have greater health care problems than other people and those 

health care problems, as members have noted, will interfere with 

their ability to care for their children and to support their families 

through employment. Health coverage doesn’t guarantee good 

health, but it certainly provides access to care that can bring a 

measurable difference in the lives of poor families. 

When the welfare reform was debated in 1996, there was nearly 

universal agreement that health care coverage was a critical part 

of the support system to help struggling families stay afloat with 

limited wages. TMA is not the solution to the coverage problems 

faced by poor families, but it is certainly a very critical component 

of our far from perfect system. 

Mr. BILIRAKIS. Please summarize, Ms. Mann. 

Ms. MANN. Without TMA, there can be little doubt that more 

poor working parents will, in fact, join the ranks of the uninsured. 

I’ll close there. 

[The prepared statement of Cindy Mann follows:]

PREPARED STATEMENT OF CINDY MANN, SENIOR FELLOW, KAISER COMMISSION ON

MEDICAID AND THE UNINSURED

Thank you for the opportunity to offer testimony on Transitional Medical Assistance. 

I am Cindy Mann, Senior Fellow with the Kaiser Commission on Medicaid and 

the Uninsured. The national nonpartisan Commission services as a policy institute 

and forum for analyzing health care coverage and access for low-income populations 

and assessing options for reform. Before joining the Commission, I served as the Director of the Family and Children’s Health Program Group at the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) overVerDate 0ct 02 2002 09:18 Oct 05, 2002 Jkt 010199 PO 00000 Frm 00063 Fmt 6633 Sfmt 6621 W:\DISC\79467 79467
60

seeing the administration of Medicaid for families and children, including Transitional Medical Assistance. 

Low-income people (those with incomes below 200% of the federal poverty line, or 

$30,040 for a family of three), including parents who have left welfare and are now 

employed, have a much higher risk than others of being uninsured. A third of lowincome parents, including 40 percent of parents with incomes below poverty, lack 

health insurance coverage. (The poverty level is $15,020 for a family of three.) Figure 1. Ironically, poor parents are more likely to be uninsured if they are employed 

than if they are not employed (43% uninsured v. 31% uninsured) because low-wage 

workers often do not have access to employer-based coverage and, in most states, 

Medicaid eligibility standards for parents are so low that even parents with very 

low wages are ‘‘over income’’ and cannot qualify for ongoing Medicaid coverage. 

Transitional Medical Assistance (TMA) is one policy that helps address this troubling dynamic. TMA offers critical support to many of the most vulnerable families 

in this nation. It provides temporary health care coverage to families with low 

wages, primarily those who have left welfare to take a job. TMA covers children and 

their parents, but it is particularly important for low-income working parents for 

whom TMA is often their only source of coverage. If TMA lapses at the end of this 

fiscal year, poor and near-poor parents will become uninsured, with adverse effects 

for their health, their ability to care for their children, and their capacity to retain 

employment and support their families. On the other hand, if TMA is extended and 

improved, even more low-income working parents will have a guarantee of coverage 

at least for a limited period of time. 

TMA has been supported and expanded over the years 

TMA is a common-sense ‘‘welfare-to-work’’ initiative that was created with strong 

bipartisan support years before the current era of welfare reform. It was first established in 1984 and was revised and expanded in 1988 as part of the Family Support 

Act of 1988. During this time, Medicaid eligibility for families with children was 

linked to welfare. In general, this meant that families that received welfare (Aid to 

Families with Dependent Children, or AFDC) were automatically enrolled in Medicaid and that when a family left welfare its Medicaid coverage would end. Congress 

recognized that parents leaving welfare for work are often not offered coverage at 

their workplace and was concerned that the loss of Medicaid coverage could discourage families from seeking jobs and make it difficult for them to retain employment. 

The 1987 Report of the House Energy and Commerce Committee accompanying the 

measure that broadened TMA noted that ‘‘(F)ormer AFDC families that work their 

way off welfare have the greatest need for health care coverage, because they are 

least able to pay for services out of pocket and because their health is more likely 

to be poor. Yet these are precisely the families that are among those most likely 

to be uninsured.’’ 1 TMA assured that parents receiving welfare could take a job 

without losing Medicaid at least for a limited period of time.2

In 1996, when Congress drafted the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) to replace AFDC with the Temporary 

Assistance to Needy Families (TANF) block grant, it revisited Medicaid coverage 

rules, including TMA. Welfare reform underscored the important role Medicaid 

plays for low-income families, including those who may not be receiving welfare. 

PRWORA broke the historic link between Medicaid and welfare and created in its 

place a new Medicaid eligibility category for families with children. Under these 

new rules, families qualify for Medicaid based on their income, not based on their 

status as welfare recipients. PRWORA also extended TMA to 2001, demonstrating 

Congress’ continued commitment to assuring that families would not immediately 

lose health care coverage if they left welfare because a parent in the family found 

employment. The TMA sunset date was extended for one more year in legislation 

enacted in 2000.3

Under current law, states must provide TMA to families who otherwise would become ineligible for ongoing Medicaid coverage under the new family coverage category (‘‘section 1931’’) created by PRWORA.4 TMA is available if the family was receiving Medicaid for three out of the prior six months and is losing regular Medicaid 

because of earnings or child support payments. If the receipt of child support triggers TMA coverage, the family is eligible for four months of coverage. If TMA is 

based on earnings, the family is eligible for six months of coverage, plus an additional six months if family income, less child care expenses, stays below 185 percent 

of the poverty level ($27,787 for a family of three) and the family complies with federal reporting requirements. Families with access to employer-based coverage can 

combine this coverage with Medicaid. TMA would cover some medical services not 

covered by the employer plan, and help pay premiums and cost sharing imposed by 

61

the employer plan. Employer-based coverage is often not available to parents leaving welfare 

While most Americans receive their health care coverage through employer-subsidized plans, low-wage workers are substantially less likely to have job-based coverage. In 1998, only half of the workers earnings less than $7 an hour (which is 

close to the average wage earned by those leaving welfare who are employed) were 

covered by plans offered either by their employers or their spouses’ employer. Forty 

percent were not offered health insurance and an additional 10 percent declined an 

offer of coverage, largely as a result of costs. Figure 2. Even without considering 

deductibles and co-payments, the average cost of maintaining coverage offered 

through the work place is often well beyond the reach of parents leaving welfare. 

The average employee contribution for family coverage in 2001 would consume 11 

percent of the average gross earnings reported by families leaving welfare for employment ($1,360 a month).5 Individual coverage is less costly but still difficult for 

many families living below or close to the poverty level to afford, and premium costs 

are rising rapidly. 

Other factors that typify the circumstances of many of the families leaving welfare 

also contribute to low rates of employer-based coverage among TANF leavers. Parents leaving welfare are often new employees both because they may be entering 

the labor market for the first time and because they change jobs often due to the 

dynamics of the low-wage labor market and the challenges of maintaining child care 

and reliable transportation. New employees are often not offered employer-based 

coverage even in firms that offer longer-term employees coverage. In addition, 

women leaving welfare frequently find work at retail or service firms where employer-based coverage is less prevalent. 

For all these reasons, only a small portion of families leaving welfare have employer-based coverage. The Urban Institute found that, in 1999, on average, only 

one out of five parents had employer-based coverage in the first year after leaving 

welfare. Employer-based coverage picked up substantially after one year, but still, 

even at a time when the economy was particularly strong, only a minority (44%) 

of parents had employer-based coverage more than one year after leaving welfare.6

For parents, regular Medicaid often does not fill the gap left by employer-based coverage 

Medicaid and now the State Children’s Health Insurance Program (SCHIP) fill in 

much of the gap in coverage for children left by relatively low rates of job-based coverage among low-income workers and their dependents. Under federal minimum eligibility standards, all states must provide Medicaid coverage to children under age 

six if their incomes are below 133 percent of the federal poverty line ($19,977 for 

a family of three). Older children must be covered if their income is below the poverty level. Options available to states to receiving federal matching funds to cover 

children at higher levels have prompted most states to expand coverage through 

Medicaid and SCHIP beyond these minimum levels. As of January 2002, every state 

covered children with incomes up to at least 140 percent of the poverty line, and 

all but 11 states covered children with incomes up to 200 percent of FPL. As a result, most (83%) low-income children are now eligible for Medicaid or SCHIP.7 Many 

immigrant children are still left out of coverage, but for most other children the primary challenge is to improve participation rates in Medicaid and SCHIP. 

The story is far different for the parents of these children. There is no uniform 

national minimum eligibility standard applicable to parents under Medicaid; the 

federal minimum standard varies by state pegged to the state’s 1996 AFDC income 

standard. States have options to broaden their family coverage to reach more lowincome working parents, but to date, only 18 states cover parents with incomes at 

100 percent of the poverty level through regular Medicaid (or through a waiver). In 

seven states the income eligibility standard for a parent with earnings is below 33 

percent of the poverty line ($4,957 for a family of three). Figure 3. 

As a result of these low eligibility standards, in most states low-income working 

parents, including many of those leaving welfare, have too much income to qualify 

for regular Medicaid. The earnings of those who leave welfare and find jobs average 

$1,360 a month.8 This is below the poverty level for a family of three, yet in 39 

states a parent with two children earning this amount will be ‘‘over income’’ for regular Medicaid.9 In the absence of TMA, most parents at these wage levels would 

not have any route to Medicaid coverage unless they are pregnant or disabled. 

Given limited access to employer-based coverage, parents moving into the labor 

market earning these wages would be at great risk of being uninsured if TMA were 

not available. 

62

TMA implementation issues 

While TMA has been a valuable source of coverage for millions of people in lowincome working families, TMA has not always operated smoothly for either families 

or for states. Some problems have arisen as a result of implementation problems 

at the state and local level. In addition, some families do not take advantage of 

TMA because they are unaware of the coverage it offers. Families often close their 

Medicaid case when someone in the household finds employment, unaware that they 

may continue to be eligible for Medicaid. Many families wrongly assume that they 

have to be receiving welfare in order to qualify for Medicaid.10

Implementation problems were identified following the enactment of the federal 

welfare law in 1996. The welfare rolls plummeted, and, in many states, Medicaid 

enrollment dropped sharply as well even though most families leaving welfare 

should have been eligible for Medicaid at least for a temporary period of time.11

Some of the decline occurred because state and local procedures and computer systems did not ensure that families who were leaving welfare were being properly 

evaluated for continuing Medicaid eligibility, including TMA. Studies have found 

that only one third to one half of the adults leaving welfare had Medicaid coverage 

following their TANF exit. According to an analysis by the Urban Institute relying 

on 1999 data, half of the women leaving welfare had Medicaid coverage during the 

year after leaving TANF. More than one-third (37%) percent were uninsured.12 Figure 4. TANF ‘‘leavers’’ studies funded by the Department of Health and Human 

Services had similar findings.13

As a result of the unanticipated drop in Medicaid enrollment following welfare reform, many states began to focus in on the problem and make corrections, sometimes as a result of litigation or the threat of litigation.14 In 1999 through 2000, 

the Centers for Medicare and Medicaid Services (formerly HCFA) visited each of the 

50 states and issued reports on state and local policies and procedures, and in April 

of 2000, CMS instructed all states to take steps to address any problems that might 

continue to exist and to restore coverage to children and parents who had been terminated from coverage improperly.15

Partly as a result of these state and federal efforts, Medicaid enrollment began 

to rebound in 1998, although enrollment trends varied significantly across states. 

Indiana’s experience is instructive. The state identified implementation problems 

and outreach needs and took a number of steps to improve policies and procedures 

so that families moving in and out of the welfare system as well as those who did 

not apply for welfare did not lose out on Medicaid coverage. After three years of enrollment declines, Indiana saw its family caseload in Medicaid rise by 40 percent 

between May 1998 and April 2000. TMA enrollment quadrupled during this period.16 Indiana’s experience shows that proper implementation coupled with aggressive outreach can make a substantial difference in the extent to which Medicaid 

generally and TMA specifically live up to their potential for covering low-income 

working families. 

TMA design issues 

There appears to be broad consensus that TMA is an important component of the 

Medicaid program and state and federal welfare-to-work initiatives. Some changes 

in the federal design of TMA could, however, boost participation. Some of these 

changes have been proposed in pending legislation. 17

• Currently, TMA is available only to families that have been enrolled in regular 

Medicaid for at least three out of the last six months. Some states have noted 

that this requirement is not consistent with their welfare program’s ‘‘work first’’ approach, which stresses a quick attachment to the labor market. If a family 

begins receiving welfare and Medicaid in January and the parent finds a job 

in February with wages that would make the family ineligible for regular Medicaid, that family would not be eligible for TMA because it would not have satisfied the ‘‘three out of six months’’ requirement. • The federal law includes prescriptive TMA reporting requirements. In order to retain eligibility throughout the full 12-month period, families must submit written reports of their earnings and child care expenses in the 4th, 7th, and 10th 

months. These reporting requirements create administrative burdens for states 

and can cause coverage problems for families. The GAO has recommended that 

Congress consider allowing states flexibility to change or eliminate these reporting requirements.18

• Some states have been interested in extending TMA beyond the 12 months allowed under the law. A few states have waivers extending TMA, but these waivers are generally no longer available due to budget neutrality rules.19 A legislative change would be necessary to allow states the option to provide TMA for 

longer periods of time. 

63

Health Coverage Makes a Difference 

With or without improvements in the way TMA operates, there is nearly universal agreement that TMA plays an important role promoting welfare-to-work efforts and providing health care coverage to some of the most vulnerable families. 

Health care coverage alone does not guarantee quality health care, but coverage 

makes it much more likely that people will get the health care they need. A recent 

study showed that low-income adults are almost three times more likely to have an 

unmet medical need if they are uninsured.20 Those with Medicaid coverage do not 

report these same levels of unmet needs. For example, a study found that low-income women are 2.5 times more likely to report unmet or delayed health care needs 

than are low-income women with either Medicaid or private coverage.21 Figure 5. 

As the Congress recognized when it expanded TMA in the Family Support Act of 

1988, parents relying on welfare and those leaving welfare for work are often in 

poor health. Poor health status is generally correlated with low incomes. 22 Healthrelated problems take their toll on poor women’s ability to care for their families 

and to work and retain employment. The National Governors Association has identified health-related problems as a key barrier to work and a challenge to state welfare-to-work initiatives.23 Recent reports have highlighted the importance of quality 

coverage as a means of decreasing absenteeism and increasing productivity at 

work.24 While coverage does not assure good health, it affords individuals access to 

health care, which can help them manage and address health problems and better 

care for their children and participate in the work force. 

TMA is a critical component of the labyrinth of mechanisms by which some of the 

people who do not have access to employer-based coverage can obtain health care 

coverage. It has a limited reach both because it is a targeted program and because 

it provides time-limited coverage. Even with TMA, four out of ten poor parents are 

uninsured, and with a souring economy, rising health costs, and state budget cutbacks, the number of low-income people who lack health insurance coverage is expecting to rise. By extending TMA and perhaps improving how it works, Congress 

will be assuring that some of America’s hardest working families do not join the 

ranks of the uninsured. 

References 

1 H.R. Rep. No. 159, 100th Congress, 1st Sess., Part 3, at 12. 

2TMA was also extended to families who might otherwise lose Medicaid due to child support 

income so that successful efforts to increase child support payments from absent parents did 

not result in the immediate loss of health care coverage. 3 Congress extended the sunset date to September 30, 2002 in P.L. 106-554, section 707(a). 

4Technically this means that a family does not have to be receiving welfare in order to qualify 

for TMA, since welfare receipt is no longer an eligibility requirement for Medicaid. However, 

as explained below, in most states the income standards for the family coverage category are 

so low that in those states TMA still largely functions as a welfare-to-work initiative. 5Data on average premium costs for employees are from Kaiser Family Foundation and 

Health Research and Educational Trust, Employer Health Benefits, 2001 Annual Survey, 2001; 

data on average wages of parents leaving welfare are from P. Loprest, How are Families That 

Left Welfare Doing? A Comparison of Early and Recent Welfare Leavers, New Federalism Policy 

Brief, Urban Institute, April 2001. 6 Urban Institute analysis of 1999 National Survey of America’s Families. 7L.Dubay, J.Haley, G.Kenney, Children’s Eligibility for Medicaid and SCHIP: A View from 

2000, Urban Institute, January 2002. These figures take into account restrictions in Medicaid 

and CHIP based on immigration status. About eight percent of low-income children are not eligible for coverage based on federal Medicaid immigration-related eligibility restrictions. 8P. Loprest, How are Families That Left Welfare Doing? A Comparison of Early and Recent 

Welfare Leavers, New Federalism Policy Brief, Urban Institute, April 2001. 9KCMU analysis of K. Maloy et al, Can Medicaid Work for Working Families, George Washington University, and M.Broaddus et al, Expanding Family Coverage: States’ Medicaid Eligibility Policies for Working Families in the Year 2000, Center on Budget and Policy Priorities. 

In some states, a parent receiving Medicaid who finds a job may be able to receive Medicaid 

at somewhat higher income levels for a limited period of time due to earning disregards that 

are available to persons already receiving Medicaid. 10M. Perry, Kannel, S., Valdez, R.B., Chang, C. Medicaid and Children: Overcoming Barriers 

to Enrollment, Kaiser Commission on Medicaid and the Uninsured, January 2000. 11GAO, Medicaid Enrollment: Amid Declines, State Efforts to Ensure Coverage After Welfare 

Reform Vary, GAO HEHS-99-163, September 1999. 12 Urban Institute analysis of 1999 National Survey of America’s Families, April 2002. These 

figures do not add up to 100 percent because some people have both private coverage and Medicaid. 13G. Acs, P. Loprest, T. Roberts, Final Synthesis Report of Findings from ASPE ‘‘Leavers’’

Grants, Urban Institute, December 2001, Chapter IV, http://aspe.hhs.gov/hsp/leavers99/

synthesis02/index.htm. 14 Efforts taken by Washington state and Pennsylvania and Maryland are described at http:/

/www.hcfa.gov/medicaid/wrmdpawa.htm. See also, Adjusting Computer Systems for the TANF 

64

De-link, prepared by C. Gerhardt, State of Maryland, Department of Health and Mental Hygiene, hcfa.gov/med/mmis/927mann.pdf. 15 CMS, Letter to State Medicaid Directors, April 7, 2000; http://www.hcfa.gov/medicaid/letters/

smd40700.htm. 16Statement of Kathleen Gifford, Assistant Secretary, Office of Medicaid Policy and Planning, 

Indiana Family and Social Services Administration, House Ways and Means Committee, Subcommittee on Human Resources on Health Coverage for Families Leaving Welfare, May 16, 

2000. 17 HR 2630, HR 2775, and S.1269. 18GAO, Medicaid Enrollment: Amid Declines, State Efforts to Ensure Coverage After Welfare 

Reform Vary, GAO HEHS-99-163, September 1999. 19 According to CMS, 11 states had waivers to extend TMA beyond 12 months, but only 6 of 

these waivers are currently in effect and 3 will expire in 2002. In the past, states were able 

to show that these waivers would not add to federal costs because they would lower AFDC costs 

by preventing some families from having to fall back on welfare because they lacked health coverage while they were working. Now that AFDC has been replaced by the TANF block grant, 

a decline in the welfare caseload due to extended TMA would not reduce federal expenditures. 20 B. Strunk, P. Cunningham, Treading Water: American’s Access to Needed Medical Care, 

1997-2001, Health Systems Change Tracking Report, Results from the Community Tracking 

Study, No. 1, March 2002. 21 R. Almeida, L. Dubay, G.Ko, ‘‘Access to Care and Use of Health Services by Low-income 

Women’’, Health Care Financing Review, 2001; 22:27-47. 22See, for example, H. Mead, K. Witkowski, B.Gault, H. Hartmann, ‘‘The Influence of Income, 

Education and Work Status on Women’s Well-being’’, Womens Health Issues, 2001; 11:160-172, 

comparing the health status of poor women with that of women with incomes above 200 percent 

of the poverty level. The study found that poor women were more than three times as likely 

as nonpoor women to report fair or poor health (34% v. 9%). The GAO has found that a significant portion of TANF recipients are disabled have poor mental and physical health, suffer from 

substance abuse and have experienced domestic violence. GAO, Welfare Reform: Moving Hardto-Employ Recipients Into the Workforce 2001, GAO-01-368. Other studies have found that many 

current and former TANF recipients have mental health problems, including depression. 

Lennon, Blome, English, Depression and Low-Income Women: Challenges for TANF and Welfareto-Work Policies and Programs, Research Forum on Children, Families and the New Federalism, 

National Centers for Children in Poverty, 200l. 23S. Callahan, Understanding Health-Status Barriers that Hinder Transition from Welfare to 

Work, National Governors Association, 1999. 24TC Buchmueller, The Business Case for Employer-Provided Health Benefits: A Review of the 

Relevant Literature, California Health Care Foundation, 2000.

Mr. BILIRAKIS. Thank you very much. 

Dr. Scanlon. 

STATEMENT OF WILLIAM J. SCANLON 

Mr. SCANLON. Thank you very much, Mr. Chairman and members of the subcommittee. I’m pleased to be here today to talk 

about our work on the uninsured and the traditional Medicaid program as it relates to Transitional Medical Assistance that you’re 

considering reauthorizing. 

This additional year of Medicaid coverage can play a critical role 

in supporting individuals as they transition from welfare to work. 

As everyone agrees and as Ms. Mann indicated, having health insurance is important for all persons. Health insurance and the access to the services it affords may be particularly important for 

those who are coming off of welfare who may have more health 

problems than average. Access to health insurance and health care 

on a timely basis helps avoid the development of some problems 

and the exacerbation of others which may result in longer term impairments and costs. For example, the uninsured are much more 

likely to be hospitalized for avoidable conditions such as asthma 

and diabetes. The uninsured are much more likely to be diagnosed 

with cancer at a later stage where there’s less of a positive prognosis for improvement. 

While securing a job to leave welfare is a very positive first step, 

however, our work and the work of others on the uninsured and 

on the insurance markets makes it clear that these newly employed 

individuals may have significant difficulty obtaining adequate 

65

health insurance. As you know, and as Ms. Mann indicated, we 

rely heavily on the employer-based health insurance system. Over 

two-thirds of non-elderly Americans get their health insurance 

through their employers, but at the same time it’s true that 75 percent of the uninsured adults are employed. This is because not all 

employers offer insurance and not all workers that are offered insurance choose to purchase it. Especially vulnerable are individuals 

who work part-time, are employed in low wage jobs or who work 

in certain industries such as retail services. These are exactly the 

types of jobs that many former welfare recipients have. 

Even when employers offer coverage, a significant number of individuals leaving welfare may not accept it. The cost may be simply 

too high as employees of some firms are asked to pay a significant 

share of premiums. Transitioning workers commonly have jobs that 

pay $7 or $8 per hour. Getting coverage on their own through the 

individual insurance market may be even more expensive or even 

potentially impossible. It will depend upon State laws whether 

these individuals are guaranteed access to insurance coverage or 

whether there is any limitation on premiums. We have found repeatedly in our work on the individual insurance market that persons with health problems can be denied coverage completely or 

charged considerably more than the standard premium, unless prohibited by State law. 

In this context, Transitional Medical Assistance provides an important protection to families in their efforts to move from welfare 

to work. In our prior work on transitional Medicaid, we found wide 

differences across the States in the shares of persons eligible for 

the program that actually enrolled, and large shares of persons 

who, when enrolled, did not receive the full year of coverage authorized. 

Several States have worked to facilitate beneficiaries’ access 

through outreach, education and other efforts and have achieved 

participation rates of over 70 percent among families transitioning 

to the workforce. Interestingly, some of the outreach and education 

is directed at State and county eligibility workers, to ensure that 

they properly assist potential eligibles to enroll. Other efforts target eligible individuals and employers to increase awareness of the 

benefit. 

A key factor though in why many families did not receive their 

full program benefits was that they did not report their incomes as 

required, that is, at the 4th, 7th and 10th months of their enrollment, the requirements that Ms. Mann had indicated. In fact, 

State officials told us that families typically receive coverage for 

only 6 months and that was generally the result of the required income reports not being submitted, not because the families’ incomes had become too high to be eligible for the program. The reporting requirements are aimed at assuring the program benefits 

go to persons who are genuinely eligible. This is an important objective. Nevertheless, that goal needs to be weighed against the 

cost of achieving it. 

Administrative costs submitting and reviewing required documentation for beneficiaries and State workers are one element to 

consider. Also, very important is whether the primary objective of 

the program providing coverage to eligible beneficiaries is being 

66

1The Family Support Act of 1988 created the transitional Medicaid assistance program as 

§ 1925 of the Social Security Act, and was scheduled to expire on September 30, 1998. See Pub. 

L. No. 100-485, § 303(a), 102 Stat. 2343, 2385, and 2391. The Personal Responsibility and Work 

Opportunity Reconciliation Act of 1996 extended states’ obligation to provide transitional Medicaid assistance through 2001. See Pub. L. No. 104-193, § 114(c), 110 Stat. 2105, 2180. The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, extended the sunset provision to September 30, 2002. See Pub. L. No. 106-554, Appendix F, § 707, 114-2763A463, 114-2763A-577. 2See The Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. 

No. 104-193, § 103, 110 Stat. 2105, 2137. 3See U.S. General Accounting Office, Welfare Reform: States Provide TANF-Funded Work 

Support Services to Many Low-Income Families Who Do Not Receive Cash Assistance, GAO-02-

615T (Washington, D.C.: April 10, 2002). 4See GAO related products at the end of this statement. 

compromised. Some States have secured waivers of the reporting 

requirements so that their eligibles can get their full year of coverage. This committee has previously endorsed giving all States 

that flexibility to alter the reporting requirements and providing 

this flexibility for States to provide a full year of transitional Medicaid coverage would likely improve access to the benefits considerably. And it would put transitional Medicaid on a par with some 

other coverage options in the Medicaid program. 

Thank you very much, Mr. Chairman. This concludes my statement and I will be happy to answer any questions. 

[The prepared statement of William J. Scanlon follows:]

PREPARED STATEMENT OF WILLIAM J. SCANLON, DIRECTOR, HEALTH CARE ISSUES, 

UNITED STATES GENERAL ACCOUNTING OFFICE

Mr. Chairman and Members of the Subcommittee: I am pleased to be here today 

as you consider the role of Medicaid in helping families’ transition from welfare to 

the workforce. Since 1988, the Medicaid program has offered transitional Medicaid 

assistance, which provides certain families who are losing Medicaid as a result of 

employment or increased income up to one year of additional Medicaid health insurance coverage. Transitional Medicaid assistance was originally enacted for a 10-year 

period, and has twice been extended to help provide continued health insurance coverage to families moving into employment.1

The enactment of federal welfare reform in August 1996 significantly changed federal welfare policy for low-income families with children in several ways, including 

establishing a 5-year lifetime limit on cash assistance.2 The welfare reform law also 

extended transitional Medicaid assistance through 2001, thus continuing an important link to health insurance coverage for individuals as their economic circumstances changed. States have implemented a variety of initiatives intended to 

help families move from cash assistance to the workforce, including some enhancements to transitional Medicaid. These initiatives have likely contributed to a drop 

in cash assistance caseloads of more than 50 percent from 1996 through mid-2001.3

Because the transitional Medicaid provision is due to expire in September 2002 

and you are considering its extension, you asked us to provide information on the 

role this program plays in supporting transitions from welfare to work. Accordingly, 

my remarks today will focus on how

• transitional Medicaid assistance provides low-income working families an option 

to maintain health insurance coverage, and 

• states have used transitional Medicaid to provide health insurance coverage to 

families. 

My comments are based largely on our previously issued reports and testimony 

on Medicaid and welfare reform.4

In summary, transitional Medicaid assistance is a key protection offered to families at a critical juncture in their efforts to move from welfare to work. Employment 

in low-wage or part-time positions—which is common for these newly working individuals—frequently does not provide adequate access to affordable health insurance, 

whether through employer-sponsored or individually purchased health insurance, 

thus making transitional Medicaid coverage an important option. Our earlier work 

showed that, for 21 states we reviewed, the implementation of transitional Medicaid 

assistance varied across the states and that certain state practices had enhanced 

beneficiaries’ ability to retain Medicaid coverage. For example, some states reported 

67

5See U.S. General Accounting Office, Medicaid Enrollment: Amid Declines, State Efforts to 

Ensure Coverage After Welfare Reform Vary, GAO/HEHS-99-163 (Washington, D.C.: Sept. 10, 

1999). In this report, we recommended that the Congress consider allowing states to lessen or 

eliminate requirements for beneficiary income reporting in transitional Medicaid assistance. We 

also recommended that the Administrator of the Health Care Financing Administration (HCFA) 

(1) determine the extent to which transitional Medicaid is reaching the eligible population and 

(2) provide states with guidance regarding best approaches for implementing this benefit. Since 

that time, HCFA, now the Centers for Medicare and Medicaid Services has acted on the second 

recommendation, but not the first. 6States administer Medicaid within broad federal guidelines that specify the categories of lowincome individuals that states must cover and the categories that are optional. However, not 

all low-income individuals are eligible for Medicaid; for example, most childless adults are not 

eligible. In fiscal year 1999 (the most recent enrollment data available), Medicaid financed coverage for nearly 41 million individuals. 7Prior to welfare reform, some states received waiver authority under § 1115 of the Social Security Act to extend Medicaid benefits beyond the 12 months allotted in § 1925 of the Social Security Act. After August 22, 1996, this waiver became subject to a budget neutrality test, which 

meant that the cost of extending coverage had to be offset by transitional coverage. 8 In 2002, the federal poverty level for a family of three was $15,020, or about $1,252 per 

month. 9GAO/HEHS-99-163, September 10, 1999. 

10GAO-02-615T, April 10, 2002. 11See U.S. General Accounting Office, Welfare Reform: Moving Hard-to-Employ Recipients Into 

the Workforce, GAO-01-368, (Washington, D.C.: March 15, 2001). 

increasing training for state eligibility determination workers to better inform beneficiaries of this entitlement and how to access it. We also found, however, that many 

families did not receive their full transitional Medicaid assistance benefits because 

they failed to report their income three times, as required, throughout the 12-month 

period of coverage. Amending the Medicaid statute to provide states with additional 

flexibility to ease income-reporting requirements for the coverage period of transitional Medicaid assistance, as has been done for other aspects of the Medicaid program, could further facilitate uninterrupted health insurance coverage for families 

moving from cash assistance to the workforce.5

BACKGROUND

Transitional Medicaid assistance offers families moving from cash assistance to 

employment the opportunity to maintain health insurance coverage under Medicaid, 

a joint federal-state health insurance program. Medicaid spent about $216 billion in 

fiscal year 2001 on coverage for certain low-income individuals.6 Transitional Medicaid assistance provides certain families losing Medicaid as a result of employment 

or increased income with up to one year of Medicaid coverage.7 Families moving 

from cash assistance to work are entitled to an initial 6 months of Medicaid coverage without regard to the amount of their earned income, and 6 additional months 

of coverage if family earnings, minus child care costs, do not exceed 185 percent of 

the federal poverty level.8 To qualify for either 6-month period, a family must have 

received Medicaid in 3 of the 6 months immediately before becoming ineligible as 

a result of increased income.9

When federal welfare reform was enacted in 1996, states implemented a variety 

of initiatives intended to help families move from welfare to the workforce. Welfare 

reform provided states additional flexibility in helping cash assistance recipients to 

both find work and achieve family independence. As a result, states have expanded 

and intensified their provision of work support services such as those for job search, 

job placement, and job readiness.10 Many individuals in this population had low 

skills and faced a number of barriers to maintaining work and independence. For 

example, our work has shown that factors such as limited English proficiency, poor 

health, and the presence of a disability were some of the factors that affected the 

extent to which former cash assistance recipients were able to find and keep employment.11

Maintaining health insurance coverage is important to persons entering the workforce because there are important adverse health and financial consequences to living without health insurance. The availability of health insurance enhances access 

to preventive, diagnostic, and treatment services as well as provides financial security against potential catastrophic costs associated with medical care. Research has 

demonstrated that uninsured individuals are less likely than individuals with insurance to have a usual source of care, are more likely to have difficulty in accessing 

health care, and generally have lower utilization rates for all major health care 

services. Uninsured individuals are more likely than those insured to forgo services 

such as periodic check-ups and preventive services, well-child visits, prescription 

drugs, dental care, and eyeglasses. As a result, individuals not covered by health 

68

12Mercer/Foster Higgins, National Survey of Employer-sponsored Health Plans 2001: Report 

on Survey Findings (New York: William H. Mercer, 2001), p. 13. The Mercer/Foster Higgins survey is representative of all employers in the United States with at least 10 employees. 

insurance can require acute, costly medical attention for conditions that may be preventable or minimized with early detection and treatment. 

TRANSITIONAL MEDICAID ASSISTANCE CAN FILL GAPS IN ACCESSIBILITY OF PRIVATE

HEALTH INSURANCE FOR LOW-INCOME WORKERS

Limitations in private sources of coverage underscore the importance of transitional Medicaid assistance as an option for those moving from cash assistance to 

employment. Private health insurance is not accessible to or affordable for everyone. 

Although most working Americans and their families obtain health insurance 

through employers, many workers do not have coverage because their employers do 

not offer it or the coverage offered is limited or unaffordable. Lack of insurance is 

more common among certain types of workers, employers, and industries and may 

disproportionately represent individuals transitioning from cash assistance to work. 

For example, individuals who work part-time or are employed in low-wage jobs are 

less likely to have access to affordable employer-sponsored coverage. Furthermore, 

those who do not have employer-sponsored coverage may find alternative sources of 

coverage, such as the individual insurance market, expensive or altogether unavailable. Without continued access to Medicaid, some of these individuals, who are often 

in low-wage jobs, will have limited or no access to alternative coverage and could 

end up uninsured. 

Private Sources of Health Insurance Are Not Universally Available And May Have 

Coverage Limitations 

Employment-based coverage is the primary means for nonelderly Americans to obtain health insurance, and over two-thirds of nonelderly adults obtained their coverage through an employer in 2000. However, a significant number of workers do 

not have health insurance because either their employers do not offer it or they 

choose not to purchase it. In 2000, 30 million nonelderly adults were uninsured, 

even though 75 percent worked for some period during the year. (See fig. 1.) 

Lack of insurance coverage is more common among certain types of workers, employers, and industries. Part-time employees and employees of small firms (fewer 

than 10 employees) are more likely to be uninsured than employees who work fulltime or for a large company. Individuals working in certain industries are less likely 

to be offered health insurance. For example, in 1999, more than 30 percent of workers in the construction, agriculture, and natural resources (for example, mining, forestry, and fisheries) industries were uninsured, as were about 25 percent of workers 

in wholesale or retail trade. In contrast, 10 percent or less of workers in the finance, 

insurance, real estate, and public employment sectors were uninsured. These patterns may disproportionately affect individuals leaving cash assistance because they 

often work in low-wage jobs, part-time, or in industries such as retail that often do 

not provide health coverage. 

Young adults, aged 18 to 24, are more likely than any other age group to be uninsured, largely because certain characteristics of their transition to the workforce— working part-time or for low wages, changing jobs frequently, and working for small 

employers—make them less likely to be eligible for employer-based coverage. Among 

those aged 18 to 24, 27 percent were uninsured and among those aged 25 to 34, 

21 percent were uninsured in 2000. (See fig. 2.) 

Even when employer-sponsored coverage is available, its costs may be prohibitive 

or its benefits very limited. Employer-sponsored health plans may not subsidize coverage for dependents, may restrict or exclude certain benefits, or may subject participants to out-of-pocket costs either through premium contributions or cost-sharing 

provisions that low-wage workers may find unaffordable. For example, a 2001 survey by Mercer/Foster Higgins found that, on average, large employers (500 or more 

employees) require employees enrolled in preferred provider organizations (PPO) to 

contribute $56 each month for employee-only coverage, or $191 each month for family coverage.12 For lower-wage workers, such as individuals leaving cash assistance 

and entering the workforce, even coverage that is affordable for a worker may be 

too expensive for covering the rest of the family members. 

Those without access to employer-sponsored coverage may look to the individual 

insurance market to obtain coverage, and in 2000, 5 percent of nonelderly Americans (or 12.6 million individuals) relied on individual health insurance as their only 

source of coverage. However, restrictions on who may qualify for coverage and the 

premium prices charged can have direct implications for consumers. For example, 

depending on their health status and demographic characteristics such as age, genVerDate 0ct 02 2002 09:18 Oct 05, 2002 Jkt 010199 PO 00000 Frm 00072 Fmt 6633 Sfmt 6621 W:\DISC\79467 79467
69

13The Health Insurance Portability and Accountability Act of 1996 (HIPAA) guarantees some 

individuals leaving employer-sponsored group health plans access to continued coverage or to 

a product in the individual market. See 29 USC § 1181 (2000), 42 USC § 300gg (Supp. II 1996). 

Although individuals leaving public insurance programs, such as Medicaid, are not eligible for 

this HIPAA protection, they may obtain coverage in most states from high risk pools that provide coverage for applicants denied individual coverage due to health status. These policies tend 

to cost 25 to 100 percent more than rates charged to healthy individuals. 14Georgetown University Institute for Health Care Research and Policy and K.A. Thomas and 

Associates, How Accessible is Individual Health Insurance for Consumers in Less-Than-Perfect 

Health? (Washington D.C.: The Kaiser Family Foundation, 2001), http://www.kff.org 

(downloaded on August 14, 2001). The authors examined underwriting treatment of hypothetical 

applicants by 19 insurers in eight markets around the country. 15Gregory Acs, Pamela Loprest, and Tracy Roberts, Final Synthesis Report of Findings from 

ASPE ‘‘Leavers’’ Grant (Washington, D.C.: The Urban Institute, 2001). To conduct studies of 

families that had left welfare, the Office of the Assistant Secretary for Planning and Evaluation 

of the Department of Health and Human Services awarded competitive grants to select states 

and large counties in September 1998. This report synthesizes the findings from 15 of these 

studies.

der, and geographic location, individuals in the majority of states may be denied 

coverage in the private insurance market or have only limited benefit coverage 

available to them. In addition, while all members of an employer-sponsored group 

health plan typically pay the same premium for employment-based insurance regardless of age or health status, in most states individual insurance premiums are 

higher for older or sicker individuals than for younger or healthier individuals, potentially making this option unaffordable.13 For example, a recent study examined 

individual insurers’ treatment of applicants with certain pre-existing health conditions, such as hay fever. The study of insurers in eight localities found that for applicants with hay fever, 8 percent would decline coverage, 87 percent would offer 

coverage with a premium increase, benefit limit, or both, and 5 percent would offer 

full coverage at the standard rate.14 Cost differences are often exacerbated by the 

fact that individuals must absorb the entire cost of their health coverage, whereas 

employers usually pay for a substantial portion of their employees’ coverage. 

Transitional Medicaid Assistance Can Provide Continued Insurance Coverage 

Because of limitations in the availability of private insurance—especially for lowpaid, part-time workers and those in certain industry sectors that often characterize 

jobs available to individuals moving from cash assistance to work—transitional 

Medicaid assistance is an important option for health insurance coverage. Individuals with lower incomes have a much higher than average probability of being uninsured. (See fig. 3.) Typically, former welfare recipients entering the workforce work 

part-time or in low-wage jobs that are less likely to provide health coverage or only 

provide coverage at a prohibitive cost. For example, we noted in our 1999 report on 

states’ experiences in implementing transitional Medicaid assistance that one state 

found that out of nearly l,600 former welfare recipients surveyed, 43 percent of the 

heads of households worked fewer than 32 hours per week and did not have health 

insurance, and 32 percent held low-wage jobs, such as in retail stores, hotels, restaurants, and health care establishments. 

In addition, although some employers of former cash assistance recipients may 

not offer health insurance, numerous studies have shown that a significant number 

of these individuals have access to employer coverage but choose not to accept it. 

For example, a recent study showed that although about 50 percent of individuals 

transitioning from cash assistance to employment had access to employer coverage, 

only about one-third opted to participate in the employer-sponsored plan.15 The relatively low ‘‘take-up’’ rate is due largely to the high costs of many employer health plans. Transitioning workers, who commonly earn between $7 and $8 an hour, may 

simply be unable to afford their share of the premium, since their annual earnings 

range from 73 percent to 111 percent of the federal poverty level. (See Table 1.) 

Table 1: Hourly Wages as a Percentage of the Federal Poverty Level for a Family of Three, 2002

Hourly wage Hours per 

week 

Annual

earnings 

Salary as a 

percentage of 

the federal 

poverty level 

$5.15 1 ..................................................................................................................... 30 $8,034 53

40 $10,712 71

$7.00 ....................................................................................................................... 30 $10,920 73

40 $14,560 97

$8.00 ....................................................................................................................... 30 $12,480 83

70

Table 1: Hourly Wages as a Percentage of the Federal Poverty Level for a Family of Three, 

2002—Continued

Hourly wage Hours per 

week 

Annual

earnings 

Salary as a 

percentage of 

the federal 

poverty level 

40 $16,640 111

1 Represents the minimum wage, which was last increased on September 1, 1997. 

Source: GAO analysis of salaries in relation to the 2002 federal poverty level of $15,020 for a family of 3. 

STATES’ EFFORTS ENCOURAGED USE OF TRANSITIONAL MEDICAID, BUT NOT ALL

ELIGIBLE FAMILIES RECEIVED ASSISTANCE

While the Medicaid statute provides families moving from welfare to work with 

up to 12 months of transitional Medicaid coverage, we have reported that certain 

states had obtained waivers from HCFA to extend the length of coverage provided, 

and that the share of eligible families that actually received this entitlement varied 

significantly by state. States offered from 1 to 3 years of transitional Medicaid assistance in 1999. In the several states that were able to provide data on participation in transitional Medicaid assistance, we found that participation rates among 

newly working Medicaid beneficiaries ranged from 4 to 94 percent. Several states 

had made efforts to facilitate beneficiaries’ participation in transitional Medicaid. 

For example, nine states reported developing outreach and education materials to 

inform families and eligibility determination workers about transitional Medicaid 

assistance. While such approaches helped make transitional Medicaid more available, beneficiaries’ failure to report income as required often resulted in their losing 

eligibility after the first 6 months. 

Length of Coverage and Program Participation Was Mixed Among States 

States’ implementation of transitional Medicaid coverage varied, resulting in differing lengths of time for which coverage was provided and differing rates of family 

participation. As of 1999, the most currently national data reported, 10 states—Arizona, Connecticut, Delaware, Nebraska, New Jersey, Rhode Island, South Carolina, 

Tennessee, Utah, and Vermont—provided over 1 year of coverage, while the remaining states provided 1 year of coverage. (See fig. 4.) In the several states that were 

able to provide such data, transitional Medicaid participation rates ranged from 

about 4 percent of the families moving from cash assistance in one state to 94 percent of such cases in another. However, low participation rates in transitional Medicaid assistance did not always indicate that families had lost Medicaid coverage altogether. For example, officials in the state with a 4 percent participation rate said 

that most families losing cash assistance were still enrolled in Medicaid through 

other eligibility categories for low-income families. 

States’ Initiatives Facilitated Beneficiary Use of Transitional Medicaid Assistance, 

But Not All Families Maintained Coverage 

We found that several states had initiatives in place to facilitate beneficiaries’ access to transitional Medicaid assistance. The following are examples of such initiatives.

• Nine states reported developing specific materials regarding transitional Medicaid 

assistance in easy-to-understand language for eligibility determination workers 

and beneficiaries. 

• One state revised its computer systems so that eligible families leaving cash assistance due to employment were automatically transferred to transitional Medicaid assistance coverage. In addition, this state’s eligibility workers randomly 

contacted families who were leaving cash assistance to determine their health 

insurance status and to ensure that they obtained the additional months of 

Medicaid coverage for which they were eligible. As a result of this state’s efforts, 

about 70 percent of the families leaving cash assistance or Medicaid received 

transitional Medicaid coverage. 

• Officials in three other states encouraged increased participation in transitional 

Medicaid assistance by contacting families with closed cash assistance cases to 

determine whether these families had obtained the additional months of Medicaid coverage if so entitled. One of these states, which also provided 24 months 

of transitional Medicaid assistance, reported that 77 percent of eligible families 

were receiving this benefit. 

However, even with such successful enrollment efforts, many families did not receive the full transitional Medicaid assistance benefits because they failed to periVerDate 0ct 02 2002 09:18 Oct 05, 2002 Jkt 010199 PO 00000 Frm 00074 Fmt 6633 Sfmt 6621 W:\DISC\79467 79467
71

16See Pub. L. No. 105-33, § 4731, 11 Stat. 251, 519 (1997). According to an official from the 

Centers for Medicare and Medicaid Services (CMS), the transitional Medicaid assistance reporting requirements override other Medicaid provisions, such as continuous eligibility. Thus, according to CMS’ interpretation, a state’s use of continuous eligibility does not eliminate the periodic income reporting requirements for transitional Medicaid assistance. 17Donna Cohen Ross and Laura Cox, Making It Simple: Medicaid for Children and CHIP Income Eligibility Guidelines and Enrollment Procedures, Individual State Profiles (Washington, 

D.C.: The Kaiser Commission on Medicaid and the Uninsured, October 2000). 

odically report their income as required. The Medicaid statute requires that beneficiaries report their income three times during the 12 months of transitional Medicaid assistance: once in the first 6-month period and twice in the second 6-month 

period. Failure to report income status in either of these 6-month periods results 

in termination of transitional Medicaid benefits. 

In 1999, we reported that families’ failure to periodically submit required income 

reports often resulted in their not receiving transitional Medicaid coverage for the 

full period of eligibility. For example, officials in three states we reviewed told us 

that families typically received only 6 months of transitional Medicaid, generally because they failed to submit the required income reports—and not because of a 

change in income that made them ineligible for transitional Medicaid. In contrast, 

the state that had a 94 percent participation rate for transitional Medicaid offered 

coverage for 24 months and had received HCFA approval to waive the periodic income reporting requirements. Overall, we found that states that waived income-reporting requirements reported higher participation rates than states that did not. 

In implementing public programs such as Medicaid, difficult trade-offs often exist 

between ease of enrollment for eligible individuals and program integrity efforts to 

ensure that benefits are provided only to those who are eligible. The experience of 

some states in easing statutory periodic income reporting requirements proved successful in increasing participation for eligible beneficiaries. In view of concerns that 

beneficiary reporting requirements were limiting the use of the transitional Medicaid benefit, HCFA proposed legislation to eliminate beneficiary reporting requirements for the full period of eligibility (up to 1 year). To date, no action has been 

taken on this proposal. In our earlier report we recommended that the Congress 

may wish to consider allowing states to lessen or eliminate periodic income-reporting requirements for families receiving transitional Medicaid assistance, provided 

that states offer adequate assurances that the benefits are extended to those who 

are eligible. Precedent for a full year of coverage in Medicaid has been provided in 

other aspects of the Medicaid program. For example, the Balanced Budget Act of 

1997 allowed states to guarantee a longer period of Medicaid coverage for children, 

such as 12 months, regardless of changes in a family’s financial status.16 As of July 

2000, 14 states had implemented this option.17 A similar approach could facilitate 

uninterrupted health insurance coverage for families that are moving from cash assistance to the workforce. 

CONCLUDING OBSERVATIONS

Transitional Medicaid assistance can play an important role in helping individuals move successfully from cash assistance to employment, thus further advancing 

the goals of welfare reform. Without access to Medicaid coverage, these individuals, 

who are often in low-wage jobs, might have limited or no alternative health coverage 

and join the ranks of the uninsured. While our earlier work demonstrated that 

states varied in the extent to which families were participating in transitional Medicaid assistance, states that worked to minimize obstacles—particularly by reducing 

or eliminating income reporting requirements—had higher participation rates. Removing periodic reporting requirements would help further increase the use of transitional Medicaid assistance, provided that sufficient safeguards remained in place 

to ensure that only qualified individuals receive the benefits. 

Mr. Chairman, this concludes my prepared statement. I will be happy to answer 

any questions that you or Members of the Subcommittee may have.

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Mr. BILIRAKIS. Thank you very much, Dr. Scanlon. Of course, my 

gratitude to all of you. The Chair would yield to Chairman Tauzin 

to inquire. 

Chairman TAUZIN. Thank you, Mr. Chairman. Dr. Kaplan, in the 

time we have, let me ask you a couple of questions. In your written 

testimony you indicated that teachers cannot answer students’

questions about prohibited topics in programs funded with abstinence only dollars. I assume you’re talking about prohibited topics 

you mean contraceptives and sexually transmitted diseases, don’t 

you? 

Mr. KAPLAN. That’s correct, yes. 

Chairman TAUZIN. Now we have the Project Reality Game Plan 

curriculum before us. Chapter 4 deals specifically with sexually 

transmitted diseases and HIV and talks about condoms. It’s my understanding that 30 plus programs receiving Title V funds use this 

curriculum. How do you reconcile that? This is the plan in front of 

me here. If it allows you to talk about sexually transmitted diseases, HIV and condoms and 30 programs use the curriculum, isn’t 

it clear that any program funded under Title V can indeed provide 

information about contraceptives? It just can’t promote or endorse 

contraceptive use. Isn’t that correct? 

Mr. KAPLAN. Yes. It’s my understanding that the Title V prohibits programs from discussing how to use contraception or how 

to use condoms to actually prevent sexually transmitted disease. 

Chairman TAUZIN. It can’t promote or endorse the use, but it can 

discuss condoms. It can discuss HIV and sexually transmitted diseases, can’t it? 

Mr. KAPLAN. Well——

Chairman TAUZIN. That’s what the game plan says. 

Mr. KAPLAN. Right. 

Chairman TAUZIN. In Chapter 4. 

Mr. KAPLAN. Describing a sexually transmitted disease is one 

thing and getting an understanding of how you get it and how to 

prevent it is something else. 

Chairman TAUZIN. I just find it a little inconsistent to say they 

can’t answer questions in that program. I think they can, clearly, 

under the 30 plus programs that use this curriculum. 

Let me also ask you, isn’t it true that any school that has an abstinence only program can also provide sex education programs in 

other settings such as health, physical education classes which is 

often done? 

Mr. KAPLAN. My understanding is if they do not use Title V 

funds, then they could have a comprehensive sex education——

Chairman TAUZIN. But even if they use Title V funds, they can 

have a separate one in health and p.e. courses, can’t they? 

Mr. KAPLAN. They probably could, yes. 

Chairman TAUZIN. Yes, they can. Even more of a concern to me 

is Dr. McIlhaney’s testimony. Amazing information. And I want to 

get your comments on this, Dr. Kaplan. He brought to our attention a fact that I had not heard before. I knew that there were 

more sexually transmitted diseases now than there were when we 

were growing up, at least to be concerned about. According to testimony today, there were basically two then. There are 25 today. 

Most of these are viruses that are not curable. But he also indiVerDate 0ct 02 2002 09:18 Oct 05, 2002 Jkt 010199 PO 00000 Frm 00078 Fmt 6633 Sfmt 6602 W:\DISC\79467 79467
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cates in his testimony that the National Institutes of Health Workshop on Scientific Evidence and Condom Effectiveness for Sexually 

Transmitted Disease Prevention reported that there is no evidence 

that condoms reduce the sexual transmissions of HPV, which is 

now found in 50 percent of sexually active women between the ages 

of 18 and 22. If that is true and I assume, Dr. McIlhaney, your 

facts are correct here, how do you not—how could you not recommend an abstinence only program being effective, when in 20 

years these other programs have literally produced these kind of 

statistics today? 

Mr. KAPLAN. Can I respond? 

Chairman TAUZIN. Yes, please. 

Mr. KAPLAN. You know, I think the thing that unifies all of us 

is that we’re all very concerned about our youth. 

Chairman TAUZIN. Well, yes. 

Mr. KAPLAN. We’re very concerned about the epidemic of STDs 

in this country which is higher than any other industrialized country. We’re excited to see the pregnancy rates are coming down, but 

our pregnancy rates among teens are still the highest in industrialized countries. This is a very complex problem and one that is 

very difficult to resolve. 

Chairman TAUZIN. Why wouldn’t you want——

Mr. KAPLAN. Youth development programs are very important to 

engage our youth, not only because of STDs, but also because of 

substance abuse. 

Chairman TAUZIN. Of course, of course. 

Mr. KAPLAN. So anything that we can do to engage our youth 

and help them through this difficult period is very, very important. 

Chairman TAUZIN. J.C. Watts puts it this way. He said if you 

knew that you had a program that was reducing accidents in a 

plant and you added a new program in that helped reduce it even 

further, why wouldn’t you want to continue the second program, 

even if it reduced it 1 percent, 10 percent, 15 percent, if you knew 

this was helping, why wouldn’t you want it reauthorized? 

Mr. KAPLAN. In my practice I spend a tremendous amount of 

time talking with kids about abstinence and encouraging those kids 

that are not sexually active, not to become sexually active and yet 

at the same time I want to be sure that those kids understand how 

to prevent getting a sexually transmitted disease once they start 

having sex. It’s that 100 percent——

Chairman TAUZIN. If they learn that condoms won’t even prevent 

them, why wouldn’t you want a program that emphasizes abstinence when that’s the only program that’s going to prevent some 

of these viral diseases. 

Mr. KAPLAN. Condoms are not 100 percent. They’re just not, but 

they’re better than nothing. 

Chairman TAUZIN. According to Dr. McIlhaney’s testimony, 

there’s no evidence at all that they reduce the sexual transmission 

of HPV virus. If there’s no evidence they help at all, and abstinence 

clearly helps, why wouldn’t you want that program as part of the 

Federal mix? 

Mr. KAPLAN. According to the CDC and you probably need to talk 

to the CDC about this in their recommendations about the prevention of HPV they say in addition, the use of latex condoms has been 

76

associated with a reduction in the risk of HPV associated diseases 

such as cervical cancer. Are they 100 percent? No, they’re probably 

not. Does more research have to be done? Absolutely so. 

Chairman TAUZIN. My time is up. But I want to finish with one 

thought. 

Ms. Del Rosario, I just the read the article by this young man 

Clifford Mack and your words were so beautiful today when you 

talked about this program helping to build the character of these 

kids. It was this young man who basically makes my point. He 

ends by responding to the question why not wait? ‘‘It’s why I wait 

because I am worthy of it.’’ I am worthy of it. 

Ms. ROSARIO. Yes. 

Chairman TAUZIN. That statement really makes the case you’ve 

made today that you’re building character while you may be protecting kids from all the statistics that Dr. McIlhaney and Dr. 

Kaplan have both cited to us. Thank you very much. 

Mr. BILIRAKIS. Mr. Brown to inquire. 

Mr. BROWN. Thank you, Mr. Chairman. We’ve talked today about 

families’ eligibility for up to 12 months of coverage for Transitional 

Medical Assistance once they leave welfare and go back to work. 

Ms. Mann, the problem that people have illustrated is that there 

are various reporting requirements making it difficult sometimes 

during this 12 months to the point that some people lose their coverage. Some have suggested Congress should allow the States the 

option to make these families automatically eligible for up to 12 

months. Tell me what’s good about that or not good about that, 

how that would change the system? 

Ms. MANN. There are two different ways to go and they’re not 

mutually exclusive. One would be to give States the option to eliminate the reporting requirements or to eliminate them all together. 

And an additional option may be to allow States to do what’s called 

continuous eligibility, meaning once you’re on TMA you’re guaranteed the 12 months of coverage regardless of any fluctuations in income or changes in income. And Congress actually took exactly 

that step in the Medicaid program for children in 1997 in the Balanced Budget Act when it enacted the CHIP program, found that 

a lot of children would get into coverage, but would lose that coverage and the benefits of continuous eligibility and continuous access to care and allowed States the option to do continuous coverage. And so it’s another direction you might want to go with respect to TMA. 

Mr. BROWN. How many States have done that? 

Ms. MANN. I believe at last count about 12 States have adopted 

that option. 

Mr. BROWN. To shift to Dr. McIlhaney, to shift to the abstinence 

only, we debate the merits of abstinence only programs whether we 

should continue to fund them. I want to note that in his fiscal year 

2003 budget, the President argues for the elimination of Federal 

programs that he says have not undergone rigorous evaluation. He 

feels so strongly about this he proposes to eliminate 35 programs 

entirely, simply because legitimately perhaps because there’s no 

evidence that they are effective. He mentions—the elimination of 

programs such as dropout prevention, $10 million; alcohol abuse, 

reduction grants, $25 million; student mentoring programs, $17.5 

77

million; foreign language assistance, $14 million; and on and on 

and on and on. Interestingly, by contrast, the President’s budget 

continues funding abstinence only education despite the fact that 

it seems from evidence that such an approach has not proven effective. The budget states the President is committed ‘‘to stop the 

cycle of funding decisions based on wishes, rather than performance information.’’

My question is you were advisor to the Kirby Study, correct? And 

the study said currently there does not exist any research with reasonably strong evidence demonstrating that any particular abstinence only program actually delayed the onset of sexual intercourse or reduced any other measure or sexual activity. I’m told 

your job was to ensure the Kirby Study was accurate and reliable. 

I also remember the technical work group for the evaluation of 

Title V abstinence education programs, the interim report which 

was delivered to this office here only an hour before the hearing, 

said empirical evidence on the effectiveness of abstinence education 

is limited. Moreover, most studies of abstinence education programs have methodological flaws that prevent them from generating reliable estimates of pregnancy impacts. That being two 

statements from organizations you’ve supported, been involved in, 

advised, now your testimony today says there’s credible evidence 

showing that abstinence education is having an impact. Reconcile 

that, what those two studies and organizations said and what you 

are saying today in terms of impact. 

Mr. MCILHANEY. First, I believe that there are reams of evidence, 

as I mentioned before. We’ve got 20 years of the dual message program studied by the very best academic institutions that show 

very, very little evidence of any kind of success at all. They almost 

never even measure pregnancy rates or STD rates. That’s the first 

part of my answer to your question. 

Second is, as far as my being a member of Doug Kirby’s research 

task force for the National Campaign, there was no way to do a minority report on that and I dissented with him and he and I are 

friends. We’ve talked about this extensively. As a matter of fact, 

when the Monroe County program was reported and I mentioned 

it in my testimony I went to him and I said now Doug, are you 

going to advertise that study as broadly as you did Emerging Answers and he said well, no. 

Let me remind you of two or three things. In all the programs 

that Doug Kirby reported in Emerging Answers, sort of implying 

that they were going to be successful, two thirds of those programs 

did not impact a student’s sexual activity. Two thirds did not lower 

sexual activity. Half of them didn’t even increase contraceptive use. 

So the title Emerging Answers is relatively appropriate. Now there 

are a number of emerging answers about abstinence education. The 

problem is unlike the dual message programs which have been 

around for a long time, have had lots of money for having studies 

done, these programs have been relatively unfunded until 1996. It 

takes 2 or 3 years. I think we can probably perhaps hear this from 

the fellow panelists that it takes 2 or 3 years to get a program even 

up and really going well. And that’s why it’s so important, in my 

opinion, to continue this funding. The other programs have not 

worked. It’s been during their dominance that the STD and unmarVerDate 0ct 02 2002 09:18 Oct 05, 2002 Jkt 010199 PO 00000 Frm 00081 Fmt 6633 Sfmt 6602 W:\DISC\79467 79467
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ried pregnancy rates have grown the most. It’s time for us to turn 

a corner and try something truly different and the best direction 

we have for this is to continue abstinence education, study it well, 

see what the results are. There are studies that are giving this 

good direction. I mention Monroe County. The Ad Health study, the 

biggest study ever done one adolescents in America show that kids 

who were taking pledges of abstinence and about 10 percent of boys 

and 15 percent of girls who had taken those pledges, above every 

other thing in their lives, that was the thing that was impacting 

their delaying the onset of sexual activity. That in itself is tremendous evidence about their success. 

Mr. BILIRAKIS. I thank the gentleman. Ms. Del Rosario, how 

much of your life have you dedicated to working with at risk youth? 

Ms. ROSARIO. Well, I’ve been in the system of education for the 

past 15 years and I’ve been dedicating 8 years to abstinence only 

education through Recapturing the Vision. 

Mr. BILIRAKIS. Did you found that organization? 

Ms. ROSARIO. I did. 

Mr. BILIRAKIS. You’re the Executive Director. 

Ms. ROSARIO. I am. 

Mr. BILIRAKIS. And you’ve been at it for 8 years. What’s the average age of your target audience? 

Ms. ROSARIO. Our program targets middle school to high 

schoolers and we have smaller populations of teen parents which 

range in age from 17 to about 20. 

Mr. BILIRAKIS. Middle schoolers? 

Ms. ROSARIO. That would be age about 11 to about 16. 

Mr. BILIRAKIS. What’s your percentage, roughly, of your entire 

targeted audience that falls in that category, middle school category? 

Ms. ROSARIO. I’d say that 80 percent of those that we serve fall 

in the middle school age. 

Mr. BILIRAKIS. Eighty percent? 

Ms. ROSARIO. Yes, and then about 20 percent would fall in the 

other two groups. 

Mr. BILIRAKIS. Well, our world is grateful to people like you to 

devote your life to these types of problems. 

Ms. Del Rosario, we’ve heard testimony today and I certainly 

don’t question Dr. Kaplan’s dedication to the subject and his intent, 

but his testimony calls for a more balanced approach to educate the 

Nation’s teens, that abstinence only education is not enough. 

You’ve been listening, I’m sure, to the others’ testimony. It does an 

injustice to our youth by inadequately preparing them for real life, 

leaving them unprotected against sexually transmitted diseases 

and out of wedlock pregnancies. How would you refute those statements, if, in fact, you would refute those statements and how does 

your program prove those statements wrong? 

Ms. ROSARIO. Well, firstly, I would begin by stating that I don’t 

think that at all abstinence only education leaves them unprotected. As I mentioned before, every one in our State does receive 

at least one comprehensive sex education course before they graduate. So that’s the first thing. No. 2, we do have $15.2 at the State 

level that are given for Title X and $8 million given for abstinence 

only education. So it’s kind of very obvious to weigh the difference. 

79

There’s half nearly of those dollars are given for abstinence whereas the other portion is given——

Mr. BILIRAKIS. Your organization receives Title X dollars? 

Ms. ROSARIO. We do not. 

Mr. BILIRAKIS. You do not. 

Ms. ROSARIO. We do not. 

Mr. BILIRAKIS. Just Title V? 

Ms. ROSARIO. Correct. I don’t really foresee that there’s anything 

about Title V abstinence only education that leaves kids uncovered 

or unprotected. As a matter of fact, it is the program that teachers 

toward the antecedence of teenage pregnancy which is a more holistic philosophy and concept. 

Some of the outcomes of our program, for example, would be that 

89 percent of those kids, these are the antecedents that I’ve speaking of, show a decrease in outdoor suspension; 80 percent a decrease in indoor suspension; 75 percent improve in their grade 

point average; 60 percent in attendance and 100 percent improve 

in self-esteem and this is demonstrated by an assessment instrument, an attitudinal survey that’s administered pre and post-program intervention. 

Mr. BILIRAKIS. Well, some information has been distributed to 

Members of Congress give the impression and the chairman got 

into this that those who receive funding under Title V cannot also 

receive family planning funding, so you’ve already told us that’s not 

correct. 

Ms. ROSARIO. That is absolutely not correct. Additionally, I am 

able to answer questions, if a student asks a question about—first 

of all, we teach on STDs and condom effectivity. However, we are 

able to answer questions. We’re also directed to make direct referrals so that they’re able to actually get the contraceptive help. 

Mr. BILIRAKIS. In practice, that’s what you do? 

Ms. ROSARIO. That is correct. 

Mr. BILIRAKIS. If you were able to receive Title X, could you receive Title X funding? 

Ms. ROSARIO. I could via the stipulations. It must be a totally 

separate program. 

Mr. BILIRAKIS. Yes, that was going to be my next question. How 

would you then treat that? How would you handle that? 

Ms. ROSARIO. Oh, I think that first of all, you have to have a 

staff that’s going to believe in what they’re doing and even as we’re 

electing teachers to teach the Recapturing the Vision program in 

the different States that we’re in, one of the things that we look 

for, people that believe that they can bring change and that kids 

can perform and so I think that if you’re going to do both types of 

programs, I would suggest that you have different staff and that 

is one of the dictates that our State officials do kind of ask that, 

they strongly encourage, let me say that, that you have separate 

staff for the Title X versus the Title V. 

Mr. BILIRAKIS. Separate staff, separate locations, that sort of 

thing? 

Ms. ROSARIO. Well, they don’t stress the location, but just separate staff and separate programs so that you’re doing, you’re not 

mixing the message within one. 

80

Mr. BILIRAKIS. You’ve already said that you’re not prohibited 

from answering questions under Title V about critical topics such 

as sexually transmitted diseases, is that correct? 

Ms. ROSARIO. That’s true. This is correct. 

Mr. BILIRAKIS. Oh yes, before I yield, the report, the NIH report 

that was referred to by the chairman in his questioning, entitled 

Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease Prevention dated June 12-13, I would ask unanimous consent it be made a part of the record. And I yield to Mr. 

Waxman. 

Mr. WAXMAN. I thought Mr. Hall was very reluctant. 

Mr. BILIRAKIS. And I trust he won’t be chairing this committee 

any time soon, but when he does he can then chair it as he pleases. 

In the meantime, I yield to Mr. Waxman. 

Mr. WAXMAN. I will abide by your rules, Mr. Chairman. 

Mr. McIlhaney, I just want to get some things straight about 

your views. Let’s take as a given that total abstinence is always the 

best protection against pregnancy, transmission of sexually transmitted diseases including HPV and HIV. We all agree with that. 

Do you agree though that despite our best efforts, people will engage in sexual activity including young people, even adolescents? 

Mr. MCILHANEY. I think some will, but I think it’s fewer than we 

have assumed. 

Mr. WAXMAN. Some will. 

Mr. MCILHANEY. Some will, but I’m not fatalistic about the number that most people would say. 

Mr. WAXMAN. If you agree with the idea that some are going to 

be sexually active, even if condoms are not 100 percent effective, 

aren’t people better off using a condom than going without if they 

want to avoid pregnancy and transmission of sexually transmitted 

diseases and HIV? 

Mr. MCILHANEY. I think people need to be aware of the fact of 

what the NIH report said and I was—I was actually on that—in 

that group that made those findings. The research is very clear. If 

we looked at the world’s research that condoms will fail for HIV 

transmission about 15 percent. There’s a relative risk for people 

that, if they hadn’t used condoms would have gotten infected; 15 

percent of those would get infected even if they used condoms 100 

percent of the time. 

Mr. WAXMAN. Well, my question is, aren’t they better off using 

a condom than not using a condom? 

Mr. MCILHANEY. They’re less likely to get infected with HIV. 

Mr. WAXMAN. And less likely to get pregnant too, right? 

Mr. MCILHANEY. They’re less likely to get pregnant. The failures 

are much higher and as a physician, what I would do if my patients and what I would advocate programs do is advocate and 

teach and encourage what is the safest. As a matter of fact, the 

only reasonable way to avoid these problems. 

Mr. WAXMAN. We all agree that that is the safest way, but we’re 

talking about the millions of people who are going to engage in sexual activity notwithstanding your advice and my advice to them to 

the contrary, but even if we disagree, we know that condoms prevent transmission of STDs and HIV and can prevent pregnancy, 

81

the question of HPV is still up in the air, but wouldn’t you still prefer that a condom be used if sexual activity is occurring? 

Mr. MCILHANEY. I think that there are different types of messages at different places. Okay——

Mr. WAXMAN. I’m not talking about the message. I’m talking 

about the reality. Wouldn’t you prefer, if after the messages fail to 

stay abstinent, if there’s going to be sexual activity that in order 

to prevent transmission of sexual diseases and pregnancy and HIV 

that you would prefer someone from a medical point of view use a 

condom? 

Mr. MCILHANEY. I would prefer they protect themselves if they 

are insistent on having sexual intercourse and are not married individuals. The problem I have with what we’re talking about here, 

at least what I understand we’re talking about here at this hearing 

with these sexuality education programs though is that we have 

clear evidence that they have not been successful. As I said, two 

thirds of the programs that Doug Kirby talked about in Emerging 

Answers were ineffective in lowering sexual activity rates. Half of 

them were ineffective in getting people to use——

Mr. WAXMAN. The question also is do we have clear evidence that 

these abstinence only programs do work? 

Mr. MCILHANEY. We have what we would call emerging answers 

on that, the fact that in Monroe County the actual pregnancy rates 

declined. With the pledge programs, we actually have one that now 

has reported declining pregnancy rates which is something the 

dual message programs almost never even talked about or even 

measured. 

Mr. WAXMAN. Let me ask Dr. Kaplan, because I see my light is 

on yellow, so I’m going to get the gavel on me any minute now. 

What do you think about this? 

Mr. KAPLAN. Well, the evidence on condoms, even more recent 

evidence since the NIH report really does document that condoms 

will prevent gonorrhea, will prevent chlamydia. There’s a new 

study out that it will prevent the most common STDs, herpes, not 

HPV. The most common STDs, condoms can have an impact. HPV 

is still a major issue and any teenager who’s going to have sexual 

intercourse has got to be aware that they are putting themselves 

at risk. There’s no doubt about that. It’s not 100 percent. 

Mr. WAXMAN. Thank you. My time has expired. Thank you, Mr. 

Chairman. 

Mr. BILIRAKIS. Thank you, Mr. Waxman. Mr. Upton to inquire. 

Mr. UPTON. Thank you, Mr. Chairman. Continuing the entire 

welfare reform bill is very critical to all of us here and some of us 

on both the Education and Workforce Committee as well as obviously this one, Energy and Commerce. I can remember well when 

Chairman Boehner presented the administration’s bill that’s been 

introduced and there were a number of us there that said where 

is the extension of Medicaid benefits? That was one of the most important things we were able to do and of course, we have jurisdiction of it here in this committee instead of the Education and 

Workforce Committee, so we’re pleased to tell them we had jurisdiction and in fact, that was going to be continued. And I appreciated your testimony on that issue and as I met with a number 

of folks from my Family Independence Agency which is in essence 

82

the welfare office in Michigan just yesterday, we talked extensively 

about making sure that that program continue, as well as the job 

training money which is so important to get people the skills needed to get into the workforce. And Dr. Scanlon and Ms. Mann, we 

appreciated your testimony for sure on that issue in its full detail 

and I would only ask Dr. Scanlon, I noted as a frequent visitor to 

our subcommittee on a whole number of topics, you talked only 

about extending Medicaid benefits. Does that mean that the GAO 

has not been brought into this sex education debate at all? 

Mr. SCANLON. That’s correct. We have not been asked. 

Mr. UPTON. So with a letter, we can get you involved and indeed 

double versed. Is that correct? 

Mr. SCANLON. We always try to respond to the requests. 

Mr. UPTON. We’ll look forward to that in the future. I think we 

might be able to work on a letter. 

As my friend, Mr. Greenwood, indicated, he’s the father of two 

teenage girls. I’m the father of one teenage daughter and soon to 

be a teenage son as well. And I visit a school every week across 

my District. One of the toughest meetings that I’ve had is to visit 

what I call the kids with kids, single moms, 15, 16 years old. They 

have a very rough life ahead of them. It’s all we can do to encourage them to stay in school, to get that high school diploma and 

GED later, if they have to, because of all the pressures that are on 

them. As I have sat down with these kids on a number of occasions, 

even though I feel like maybe I’m still a kid and I turned 49 years 

old today and only last week was carded——

Ms. HARMAN. Will the gentleman yield? 

Mr. UPTON. Yes. 

Ms. HARMAN. On a bipartisan basis, we’d like to wish him a 

happy birthday. 

Mr. UPTON. Well, I was carded only again last week twice. 

I even made Paul Harvey in my hometown. But as much as I’d 

like to identify with these kids, with kids particularly, I know that 

peer pressure, I think, as I’ve said, to get them talking about all 

the problems that they have as new moms is awfully tough and it’s 

that message I think works best, trying to dissuade kids to be sexually inactive and I think that it’s important that we do look at 

these abstinence only programs and I know that when I talk to my 

Michigan folks and with my staff, Michigan, as I indicated in my 

opening statement, has done a remarkable job of decreasing not 

only abortion rates, but also pregnancy rates among teens and it’s 

only been since the mid-1990’s, I think it was 1996, that the abstinence programs have started in Michigan schools. And therefore, 

we’re just beginning now to see the results of it which is finally, 

we’re seeing a real decline. I guess the point that I would make as 

we listen to the testimony and read it as well some of the questions 

here that this important element of the legislation that we’re going 

to consider and mark-up this week doesn’t take a single dime away 

from the sex education, the programs that talk about condoms and 

the use of that, the parental involvement and all those different 

things, but this is a program that if the States decide to use it as 

Michigan has, where we match if $4 for every—$4 Federal dollars 

for every $3 State, it is a program that can be used to help supplement and get that message not only to young men, but obviously 

83

as well to young women. My sense is that it works. Did you turn 

that thing on at the right time? 

Mr. BILIRAKIS. This is green and this is red. 

Mr. UPTON. I was going to say this must be DC and they got the 

red light cameras in the wrong spot. Okay, good. 

Mr. BILIRAKIS. Anyhow your time is expired? 

Mr. UPTON. It did? 

Mr. BILIRAKIS. It’s 26 seconds over. Did you have something you 

wanted to finish up, please feel free? 

Mr. UPTON. I just wanted to make the point that it doesn’t take 

a dime away. That in fact, it does work and we’ve seen real results 

in Michigan and that’s why it’s important that the rest of the country experience it as well if they choose. 

Thank you. 

Mr. BILIRAKIS. I thank the gentleman. Mr. Hall to inquire. 

Mr. HALL. Mr. Chairman, thank you. I’ll be fairly brief. You 

know, we talked about children. I had three sons and then a grandson until he was 20 years old before a little girl every showed up 

and now we have two little girls and I’m a lot more interested in 

abstinence now than I have been, but let me tell you this, abstinence, condoms, day-after pill and all that needs some additional 

thrust and I certainly plan, as long as I’m around, to stand at the 

corner of the high school drive and my grandchildren’s home with 

a two by four and every damn little kid that comes by there on a 

bicycle that’s a boy is going to be going a lot faster than he got 

headed there. 

So what I’m saying and saying it probably poorly is it takes family and backup and love and care and kindness and understanding. 

I was County Judge in a rural county for 12 years when I had 

many young girls come to me. I was 24 then and looked about 19, 

but a lot of young girls come before me that their fathers had disowned because they were pregnant at a time when they were most 

needed were least understood. I think all everything we’re talking 

about here gets back to family, gets back to educating the family 

and through them the children, but I thank you all for your testimony. 

I don’t think any of us have any problem with the abstinence 

thrust, that you think it’s that and Ms. Del Rosario thinks it does 

maybe a little more than some of you do. She agrees that it can 

use help, it can use assistance and I think all of you have that 

same feeling, so—and by the way I think your State takes $4 million out in the abstinence program and I don’t want to be bragging, 

but I think Texas takes the biggest amount which means they 

match, they have the greatest matching fund and it’s around $5 

million and that’s very close where our two States are. But I think 

it’s a good program. It’s about $50 million a year and doesn’t touch 

any other titles, Title XX money so far as I know, so I don’t think 

we have any problem on supporting it and it’s what goes with it 

and what we’re going to put with it. 

Now on the Transitional Medical Assistance part, and these are 

both reauthorizations and there’s a battle for bucks and I’d like to 

add things to the Transitional Medical Assistance, but I’m not sure 

that we can and can survive the Senate or survive the Conference 

84

Committee. I think you have to get what you can get when you can 

get it and that’s what we’re trying to do in these two bills. 

I’d like to—this bill has a 6-month waiting period and I don’t like 

that any more than anyone else, but if you give up on the 6-month 

waiting bill and also include the legal immigrants that were cut 

out in 1996 it doubles the cost and I think any conference committee that’s going to be looking at this is going to be looking at 

the cost and I’d like to get what we can get and maybe come back 

at another year or another conference or in another bill to go further. 

Do you, any of you have any problem with that thrust? 

Ms. MANN. If I——

Mr. HALL. Other than the two by four part. 

A two by four is a stick about this big around and yeah long. 

Ms. MANN. I won’t speak to the two by four. I’ll just mention that 

one of the implementation issues around Transitional Medical Assistance, as both Dr. Scanlon and I mentioned, had to do with State 

implementation, change in their computer systems, making sure it 

worked, that when people left welfare, they were properly evaluated for Medicaid. Part of the problem of not having a longer extension of TMA is it leaves States wondering is it going to expire, is 

it going to continue and their willingness and ability to invest their 

time and their funds to improving the systems and boost participation may be dampened. That may be something to consider, certainly the fiscal constraints are clear. 

Mr. HALL. Do you have any facts or figures on what the effect 

of it would be? 

Ms. MANN. The effect of extending Transitional Medical Assistance? 

Mr. HALL. Of curing the problem that you’ve set forth. 

Ms. MANN. In terms of improving participation rates, we have 

and in my testimony I cite some information provided by the State 

of Indiana that did a number of improvements when it found it was 

losing a lot of people who were eligible and with those improvements no change in eligibility rules, just improvements in reaching 

people that they quadrupled the number of people who actually got 

TMA. 

So the improvements can really make a large difference if the 

States invest the time and energy and to some extent the resources 

to make it work. 

Mr. HALL. The cost effectiveness that you talk about is in results 

and not particularly in money? 

Ms. MANN. Well, and then there’s some cost effectiveness that 

Dr. Scanlon mentioned in terms of avoiding unnecessary hospitalizations and other care that could be more expensive down the 

line, if parents don’t get their primary care initially. 

Mr. HALL. I yield back my time, Mr. Chairman. 

Mr. BILIRAKIS. Mr. Greenwood. 

Mr. GREENWOOD. Thank you, Mr. Chairman. I’d like to have a 

chat with you, Ms. Del Rosario. First of all, I want to tell you that 

I thought your statement was beautiful, elegant and I find very little, if anything, to disagree with. I liked what you had to say. And 

as I said, I’m the father of teenaged girls and I think you mentioned MTV. I cut MTV off from coming into our house when they 

85

were 5 and 6 and they’re still mad at me because I still won’t let 

it come because I think it’s part of the poisonous environment that 

our children are exposed to. I think the media is entirely irresponsible when you’re talking about television, music, movies. It is a 

difficult, difficult thing to try to bring up a teenager to be safe in 

this society. 

And I truly believe in abstinence as a value. I truly believe that 

these kids who are 14 and 15 and 16 and 17 need to be abstinent. 

They’re far better off if they’re abstinent. They’re safer and they’re 

healthier and their lives will probably be better if that’s—if they 

are. 

Here’s my problem. I think that education, as I said in my opening statement, that education about abstinence is necessary for 

kids. I don’t think it’s sufficient. I think education about biology, 

including about how contraceptives work and don’t work is necessary. I don’t think it’s sufficient. And I worry about what happens when you separate the two. I think society is reacting to the 

fact that many of our sex education courses have just been about 

the cold, hard facts without any discussion about emotional impact 

and no discussion of abstinence and values and what all of this 

means in the context of your lives and I understand why that was 

insufficient. And I understand the concern about dual message. I 

understand that, how do you say I think you’re better off if you’re 

abstinent, but in case you’re not, here’s how to use these methods 

of contraception. I understand that, but I also think I can remember enough about my own teenage years and I think I’ve been 

around. I’ve been a social worker. I’ve been around kids long 

enough to know that if they don’t think that they’re getting the full 

story from you, they’re not going to believe that what they’re getting is really wisdom. And I worry why it is that we can’t integrate 

these messages with kids. Why it is that we don’t trust the truth, 

why can’t we tell kids the truth, the whole truth and nothing but 

the truth and if we believe in our hearts that—we believe the 

truth. We believe that kids are better off abstaining. We believe 

that contraceptives are not fullproof. We believe that kids can get 

hurt emotionally by premature sexual activity. Why can’t we tell 

kids the whole truth and then they’ll know, they’ll trust us because 

when I look at this abstinence program, there’s a lot of good stuff 

in here. I wouldn’t mind having my daughters read this, but it also 

has the flavor of I’m only going to tell you so much, I’m going to 

give you one side of the story and I’m afraid kids go, we know what 

this is, this is propaganda. This is one side of the story. So my 

question is you seem to indicate that you think because you can answer any questions that are posed to you that you are providing 

a balanced education, but this whole notion of having to separate 

faculties and programs gives me the sense that the abstinence programs, abstinence only programs aren’t giving kids the whole story, 

about trusting kids with the whole story and therefore are going 

to be suspect because they feel that they’re not really getting the 

scoop. 

Ms. ROSARIO. First of all, in response to your question, in my 8 

years I’ve never heard, first of all, I’ve never had a student to ask 

me to give them a large amount of information about contraceptives, never. No. 2, I’ve never heard it stated that they felt that 

86

anything was being withheld from them. I think what I want to address is this fact or fiction? If 9 out of 10 schools out of the 2 million our U.S.A. are offering comprehensive sex education, why 

would we think that they’re not getting this information? 

Mr. GREENWOOD. Let me interrupt you and I’ll implore the chairman to give you enough time to get everything you want to say, 

but why would we want to have them divided at all? This notion 

that over here we have this insufficient——

Ms. ROSARIO. I was about to address that. I think it’s because we 

are dealing with a mixed message. I think that’s what I came into 

the ballgame not really validating. I didn’t believe that was an 

issue. I’d heard it, but I did not believe until I heard it from the 

children. So now I am and I will have to disagree. I think there 

is no other way. If you’re going to keep a mixed message out of the 

picture, I can’t tell you on one side to do this and then tell you 

something else on the other side. However, if I withheld information from you or did not give you access, then I think that you have 

validity with your case. But the statement that you made, first of 

all, I believe that it’s false. It’s not correct. It’s not what’s happening. 

Mr. GREENWOOD. Which statement is that? 

Ms. ROSARIO. Meaning that kids are not getting both sides. I 

think that they’re getting both sides not only in their school setting, from television. It’s good that you did turn off MTV, but there 

are millions of other kids that don’t have a good father like yourself 

at home, that are not able to turn off the television and they are 

getting those messages. 

Mr. GREENWOOD. My question is we don’t like dual messages to 

the extent that one message undermines the other. I understand 

that. But when we’re saying 9 out of 10 kids are going to get this 

sort of sterile sex education that doesn’t talk about their values 

and their emotions over here and then we would like to make sure 

they get this over here, they’re getting two messages and it seems 

to me that that’s a less effective way——

Ms. ROSARIO. If I could just state——

Mr. GREENWOOD. Than combining them. 

Ms. ROSARIO. Let me give you an idea. If you have in one particular school, like our average high school has about 4,000 students, every one of those 4,000 students is going to get sex education. The amount that’s going to get an abstinence only education 

might be less than 5 percent of that population. So I think that 

that changes your perspective on it. We’re talking about 4,000 kids 

that are going to absolutely get that message at least once, sometimes twice, before they graduate. 

Mr. GREENWOOD. And that’s why I would support Federal 

funds——

Ms. ROSARIO. Abstinence only education is to make sure——

Mr. GREENWOOD. To make sure that no kid got sex education 

that didn’t have an abstinence component. 

Ms. ROSARIO. But then how do you address the issue of a mixed 

message? And then how do you also address——

Mr. GREENWOOD. By telling the truth, the whole truth and nothing but the truth and trusting the truth. 

87

Ms. ROSARIO. This is the problem though. You can say that from 

here, but when it gets carried out down here, a lot of different 

things are going to transpire. 

Mr. GREENWOOD. My time has expired. 

Mr. BILIRAKIS. Mr. Green to inquire. 

Mr. GREEN. Thank you, Mr. Chairman, and I want to follow up 

my colleague because of the mixed messages. I have a lot of followup and concerns. One is that as far as I know, the Federal Government outside of Title X has no comprehensive sex education requirement or funding for public schools. Is that correct? The 4,000 

students you talked about, is that those 4,000 students, they’re not 

receiving that because of something that Congress passed? 

Ms. ROSARIO. I’m not aware. 

Mr. GREEN. As far as I know, there’s not. 

Ms. ROSARIO. What I was discussing was in my written statement which are the Title V dollars which are 2 to 1 in most States. 

Mr. GREEN. Okay. 

Mr. MCILHANEY. And the Federal Government certainly funds 

CDC and to the Division of Adolescent School Health. There are 

programs that work. We say fund it extensively. 

Mr. GREEN. But there’s no requirement that we do that. CDC 

sets that out, but my local school district makes that decision. 

Mr. MCILHANEY. Yes, but your local school decision might make 

a decision about whether to bring in a Title V program or not too. 

Mr. GREEN. I know that’s true. Let me go back to my colleague 

on the mixed message. 

Ms. Del Rosario, in your testimony that abstinence plus programs are ineffective because they send children a mixed message, 

and I guess you have a lot of anecdotal information today, whether 

it’s my colleague from Texas, Ralph Hall or myself, to have a son 

and a daughter who are now adults, but at what age do you think 

a child develops analytical skills necessary to comprehend all the 

information? 

Ms. ROSARIO. I think that that can be gathered by looking at statistics. We’re seeing that the onset of sexual intercourse is beginning earlier. That’s why we targeted middle school because first of 

all they can understand the information, but also it’s a time when 

the peer pressure is going to be mounting. It’s going to be of the 

greatest impact to their future. 

Mr. GREEN. So middle school, you think these children are having to make these decisions now. do you think they comprehend a 

mixed message? If all you say is just say no, I think you’ll be 

laughed out of most of 6th and 7th grade schools. 

Ms. ROSARIO. That’s not what we do and that’s not what I support at all. As a matter of fact, it’s the opposite. I support a comprehensive program that teaches to the antecedence of out of wedlock births, teenage pregnancy. 

Mr. GREEN. And I don’t think most of us disagree. I want abstinence to be taught, but I also know I want to make sure that if 

they don’t have the fortitude or the wherewithal or the ability to 

have the abstinence, we need to have them educated on how they 

can do and that’s, I think, the concern from some of us on the committee. 

88

Let me, when you talk about the need for background in the 

studies, both Dr. Kaplan and Ms. Del Rosario, references in your 

testimony, both of you all, leading organizations, there are no references, whether it’s the Institute of Medicine, Surgeon General, 

National Institutes of Health or American Academy of Pediatrics, 

they all support comprehensive sex education. Is that correct? 

Ms. ROSARIO. Well, let me go back and correct my last statement, 

because if you’re using that term to refer to the type of sex education, I was saying comprehensive in terms of holistic education. 

I just want to make that clear. 

Mr. GREEN. Well, again, maybe we’re semantics, but I don’t mind 

holistic as long as it includes everything. 

Ms. ROSARIO. To make it clear that’s called abstinence plus or 

comprehensive sex education. And I think we need to clarify our 

terms. 

Mr. GREEN. Which again gives the child the information as children are making these decisions much earlier, as you testified, so 

they have all the information to make that decision. 

Ms. ROSARIO. And they have gotten it already outside of the abstinence only course. 

Mr. GREEN. And I’ll mention this, I’ve been proud of using in 

speeches and I think some of my colleagues on both sides have 

used them. We’ve seen a decline in unwed pregnancies over the 

last number of years and I can’t recall whether it’s 4 or 5 years. 

Now I know and what you’re saying maybe they are getting that 

mixed message now, but obviously something is working and I’d 

just like to continue it and I don’t know if ‘‘Just Say No’’ will work 

with the typical child. 

Ms. ROSARIO. Can I respond to that? 

Mr. GREEN. Sure. 

Ms. ROSARIO. One of the issues that I really think is very important is my recommendation as we even examine the reauthorization of abstinence funding, but also those programs that are awarded funding. I think that you can’t just—you’re trying to change a 

lifestyle by a 5-minute presentation telling kids to say no. I don’t 

support that. What I’m saying is that holistic approaches such as 

those that are outlined in the congressional guidelines are what’s 

necessary, approaches that are going to address the entire child, 

build self-esteem, character, deal with the value of marriage and 

family. 

Mr. GREEN. Again, I don’t think there’s any doubt that we agree 

with that. 

Ms. ROSARIO. But what I’m saying is that there are programs 

that are out there now that will give say five, 1-hour presentations 

on abstinence only and they might say say no and let me teach you 

one or two refusal skills. I say that my suggestion would be that 

we choose programs that are going to be a little bit more holistic. 

Mr. GREEN. Mr. Chairman, could I get Dr. Kaplan to respond because——

Mr. BILIRAKIS. Very briefly now. It’s really unfair to Ms. Harman 

and Mr. Pitts who have been sitting through the entire hearing 

and—very briefly, Dr. Kaplan. 

Mr. KAPLAN. Sure, I just wanted to make it clear why we’ve seen 

a decrease in teenage births. Since the 1990’s, the Centers for DisVerDate 0ct 02 2002 09:18 Oct 05, 2002 Jkt 010199 PO 00000 Frm 00092 Fmt 6633 Sfmt 6602 W:\DISC\79467 79467
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ease Control has studied this and 75 percent of the decrease is due 

to more effective means of contraception, especially longer forms of 

contraception, Depo Provera and Norplant, really has resulted in 

the huge decrease that we’ve seen. 

There’s been some decrease in sexual activity and we’ve seen a 

delay of onset of kids becoming sexual active in that other remaining 25 percent, but the big change really has been more effective 

and better use of contraceptions and also an increased use of 

condoms during that period of time. 

Mr. BILIRAKIS. Mr. Pitts, to inquire. 

Mr. PITTS Thank you, Mr. Chairman. Ms. Del Rosario, thank you 

for your testimony. These handouts are marvelous. You mentioned 

an astounding statistic, a success rate I believe you said of 99.9 

percent. Why is your program so effective? Tell us how you such 

a success rate? 

Ms. ROSARIO. I think that first of all our program does address 

in the congressional guidelines, it’s a very comprehensive program. 

It doesn’t just want to give a message that kids parrot back, saying 

no, no. But first of all we begin to build the skills. We begin to 

build their value of themselves and we get them vested in their future. 

I think that kids postpone sex and they also decide to value their 

future opportunities in not getting pregnant, if they feel that they 

have future opportunities. So that is a very vital component of the 

program. We don’t just work also with the students that are in the 

program,but we also begin to work with their siblings and their 

parents. The whole purpose is to build stability in the family and 

to build the family, so that we’re not just reaching one generation, 

but we’re reaching three in the process. 

And I think that when we’re not trying to put the bandaid, but 

we’re trying to find out why kids behave the way that they do and 

address that at the root source, versus let them continue to behave 

in a way that’s unproductive for them and then just try to cover 

it the best way that we can, that’s when we see true success. 

There’s another case that I cited in my written testimony. 

There’s a program in Denmark, South Carolina that has similar 

outcomes. Their prevention rate was 59 percent in teen pregnancy 

during the 21⁄2 years that they ran their program. At our local 

level, in the city of Miami, it is estimated that 14.2 births would 

occur in a population of 1,000 teens within a year’s period. That 

would mean that by this time if you multiplied that by the 5,500 

youth that we served that we should have a substantial amount of 

pregnancies beyond that, which we do. How do you explain it, particularly seeing that we’re working with truly high risk populations 

who do not have proper role models, who have never seen—one of 

my biggest challenges was to build the value for marriage which 

is one of the reasons why I remember my mom told me, you know, 

you’re going to don that beautiful white dress. We’re going to go all 

out. I would say that to these kids and they would look at me like, 

hm, because they’ve never seen anyone married. Everybody cohabitates, you know, and these are the greater issues and that’s what 

I believe that this legislation has allowed us to really address. 

School systems are under funded and over burdened. They cannot 

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iors that make for successful living. It allows us to kind of bridge 

the gap. I’m not saying that there’s any one program that’s going 

to do everything. You don’t understand what I’m saying. Don’t misunderstand. But I’m saying this is a vital program. It has proven 

itself successful and like I said before, there are so many for it and 

so many against it, I think that we can all sit here all day long 

and come up with different studies that will document one stance 

or the other. But our program has been in effect for 8 years. Our 

research, we’re research-driven, and it’s sound. This is what has 

happened. So of course, I believe strongly in it and will continue 

to serve our communities with this approach. 

Mr. PITTS Thank you. I just hope we find a lot of other States 

using your or similar programs. 

Dr. McIlhaney, it’s evident that you’re well-qualified to speak 

about STDs. Would you speak about the long-term effects for adolescents who contract an STD? You mentioned you were on the 

NIH panel to determine the effectiveness of condoms and you spoke 

of HPVs. Can you just elaborate a little bit more about do condoms 

protect against the transmission of HPV and what are the effects 

of getting this virus? 

Mr. MCILHANEY. I appreciate your asking that because I think 

the impact is much worse than most people realize. First, HPV is 

the most common sexually transmitted disease. As I said, it infects 

about 50 percent of sexually active adolescent females, even up to 

the age of 22. Most of those young people’s bodies will clear it, but 

those of about 5 percent will probably develop abnormal Pap 

smears and a certain number of those will proceed to cancer. 

Human papillomavirus is a cause of 99 percent of cervical cancer 

in women, and as I said earlier it’s a cause of almost all truly abnormal precancerous Pap smears of which we have an epidemic 

going on with kids today. 

When any woman gets an abnormal Pap smear, if it persists and 

indicates pre-cancer, they may have to have a proceed done called 

a LEEP procedure where a portion of the cervix is cut out. If 

there’s no immunity, they can get infected again with human 

papillomavirus and have to have that done again. That can ultimately, rarely, but occasionally, lead to prematurity or even infertility. 

It’s very clear there is no evidence at all that condoms prevent 

the sexual transmission of that. 

Herpes is infected in about 1 in 5 Americans. There’s been a 500 

percent increase in Herpes among white adolescents over the past 

few years. And there are two problems with it. If people are Herpes 

infected, they are more susceptible and if a subsequent sexual partner has HIV to becoming HIV-infected. And if a woman has a Herpes outbreak at the time of delivery, it’s possible that her baby can 

become infected. Half of those babies will die, half of them will become severely brain damaged. So although it doesn’t happen very 

much, it’s an extremely emotional issue for a woman who has Herpes and then might be delivering a baby 5 or 10 years later and 

still be having outbreaks. 

Mr. PITTS I didn’t mean to cut you off, sir. 

Mr. MCILHANEY. We could just go on and on——

Mr. BILIRAKIS. I don’t want you to go on and on. 

91

Mr. MCILHANEY. I feel strongly about these problems and I saw 

them in my practice. 

Mr. BILIRAKIS. I know that Mr. Pitts does too. 

Mr. MCILHANEY. May I mention just one other? 

Mr. BILIRAKIS. Please, sure. 

Mr. MCILHANEY. Chlamydia. Chlamydia is infecting—adolescents 

have a special predilection to it. They seem to be especially susceptible to it. And it occurs, it reinfects girls so often that Johns Hopkins in their adolescent clinics who are studying chlamydia infection in young women found reinfection rates so often that they recommend that every adolescent in America who is sexually active, 

adolescent girl who is sexually active be tested for chlamydia every 

6 months regardless of condom use. And although Dr. Kaplan mentioned some recent studies which I’m very familiar with about reduction of risk, he used the word ‘‘prevent’’ which I would object 

to because they reduce the risk. But the problem is the condoms 

leave the risk of Herpes, for example, even with these new studies 

of at least 35 to 50 percent. They leave the risk of chlamydia infection and so often it’s asymptomatic. Girls don’t know they have it. 

It leaves the risk of infection with HIV, even as I’ve mentioned. So 

I think that those things people need to know about. 

Mr. PITTS Thank you very much. 

Mr. BILIRAKIS. Ms. Harman. 

Ms. HARMAN. Thank you, Mr. Chairman. Thank you for including me in this hearing and I really feel privileged to have listened 

to what I think is a very constructive and quite long conversation 

among us about this subject. 

I voted for welfare reform in 1996. I’m a mother of four children, 

two of whom are female, and the subject of teen pregnancy and reducing teen pregnancy is on my mind a great deal personally, as 

I know it is on the minds of many members of this Panel. Two of 

my kids are still teenagers and this is a conversation we have often 

in my family. 

I agree with Ms. Del Rosario that parents have to set limits and 

that parents have to provide clear lines, but I will tell you this is 

very hard to do, even if one is well-informed, one loves one’s kids 

dearly, one believes in active parenting, one has read everything 

there is to read, and one went through all these issues oneself and 

hopefully came to reasonably wise conclusions. 

Having said that, tomorrow, I plan to offer one or two amendments to this section of the bill because I want to give more flexibility to States. I come from California which has turned down the 

Federal funds under this title—turned down $30 million because 

my State believes that abstinence-only education doesn’t work. It 

tried abstinence-only education from 1992 to 1994—under a Republican Governor—and concluded that it didn’t work. I understand 

the data is emerging that these programs can work. That’s terrific. 

But the present data in every piece of information I can find, including the bible here which Dr. McIlhaney worked on, shows that 

the programs that do work involve something more. And I feel, consistent with the President’s view of the 2003 budget, that we 

should only fund things that we know work. He’s canceled a number of programs in the budget, including dropout prevention, alcohol abuse reduction grants, student mentoring programs and so 

92

forth because he can’t find evidence that they work. So let’s fund 

things that we know work. That’s where I’m coming from. If we can 

prove in the future that abstinence-only works, that would be fine 

with me, let’s fund it. In fact, if we can prove now, prove scientifically now that it works, let’s fund it. 

Having said all that I have a couple of questions to you, Ms. Del 

Rosario because you’ve obviously run a fabulously successful program over 8 years, well before these funds were available. 

Are your participants self-selected or are they a general population pool in the area that you serve? 

Ms. ROSARIO. Well, basically, they are referred or even kids come 

and volunteer and say that they want to take the course. That’s basically how we get those students enrolled. 

Ms. HARMAN. But they don’t have to take it. 

Ms. ROSARIO. Oh no. 

Ms. HARMAN. So the pool that’s there is there more or less, is 

this fair, because it wants to be there? 

Ms. ROSARIO. Right. 

Ms. HARMAN. There may be a different group than your general 

average public school group. 

Ms. ROSARIO. It could be that their parents want them to be 

there, that they want to be there. 

Ms. HARMAN. But there’s some motivation, probably, personal 

motivation in each participant——

Ms. ROSARIO. Well, it’s consequence-driven, so they understand 

that there’s a lot of things that they have to follow the rules of. So 

if they’re willing to do that, then they’re in the program. 

Ms. HARMAN. So you’re not teaching the general population, 

you’re teaching a self-selected population? 

Ms. ROSARIO. The funds are so limited, you have to be self-selected. 

Ms. HARMAN. And when you measure your results, you’re measuring the results of the kids who stay in the program? 

Ms. ROSARIO. Uh-huh. 

Ms. HARMAN. So if some kids leave your program, you don’t 

measure their results? 

Ms. ROSARIO. Well, we’re a part of the national evaluation. 

Ms. HARMAN. What does that mean? 

Ms. ROSARIO. Congress commissioned a study, Mathematic Policy 

Research has begun that study. I believe we’re in year 3. And we’re 

one of the top six programs in the Nation that was chosen for Title 

V funding to be evaluated. So in that study, they are using cohort 

groups and program students and they’re tracking them for a period of about 4 to 5 years. 

Ms. HARMAN. Four to 5. That was my next question. So they do 

track kids who have left your prgram? 

Ms. ROSARIO. Yes. 

Ms. HARMAN. But I’m still correct that the kids in your program 

are a self-selected group, not a random group? 

Ms. ROSARIO. See, I’m just not clear on what you mean by selfselected. 

Ms. HARMAN. I mean that they want to be there. 

Ms. ROSARIO. Yes. So do the control group. 

93

Ms. HARMAN. Okay. Time is short. I just have one other question 

to you. You said several times that 9 out of 10 schools offer comprehensive sex information. What is the basis for that statement? 

Ms. ROSARIO. It’s in my written statement. It was data that I researched. I think there’s three States that allow parents to absolutely protest and remove students from that sex education course, 

but basically all of the States do. 

Ms. HARMAN. Who funds that comprehensive——

Ms. ROSARIO. I know that some of the funding is done under 

Title X, but it’s not done at the school level. I’m not really certain 

on what constitutes——

Ms. HARMAN. Right. My understanding is that Federal funding 

under Title X is not for school-based education. Title X does provide 

for family planning and health care and does provide for some teen 

services, but they’re at medical centers, not in schools. 

Ms. ROSARIO. There is some because I work at some of the centers where we do have programs that they’re offering onsite, 

condoms and any type of contraceptive use that the kids might 

need. And those are those types of schools that are called Schools 

of Choice. 

Ms. HARMAN. Okay, but I would appreciate it if you could provide 

us with—Mr. Chairman, I’d like to request this, the justification for 

that statement that 9 out of 10 schools offer this education and 

where the funding comes from because my understanding is that 

most of it does not come from Federal funds. Some States have 

these funds, some States don’t have these funds. We’re talking here 

about extending a Federal program—welfare reform—and trying to 

reduce teen pregnancy, to provide some funds for that. And so it 

is my view, Mr. Chairman, that the funds we provide in this Federal program to reduce teen pregnancy should go to programs that 

work. I don’t think anyone is really disagreeing with this idea, and 

funds should be available in schools for programs that work. 

Ms. ROSARIO. I’ll also try to include additional information such 

as Title V funding that is done through wages or TANF dollars. We 

received initially those dollars to provide comprehensive sex education and we elected to do abstinence only and had to really fight 

to be able to do that, so I know those are another set of funds that 

are under TANF that we’re able to do sex education with. 

Ms. HARMAN. Well, I appreciate that. I’d appreciate maybe staff 

can clarify that for me too before tomorrow. I want to be sure that 

what I talk about is based on fact. Does any, I think, even though 

the light is green, I have a feeling it’s red. 

Mr. BILIRAKIS. Very brief. We’ve got to finish up. 

Mr. KAPLAN. Yes, I think you’re correct, that there are not Federal dollars for family planning in the schools and actually, in Colorado, my state, you know, it’s pretty sketchy as to how much comprehensive sex education is actually offered and there was a study 

in family planning perspectives in 2000 and the thing that I’m concerned about is that we’ve seen a real deterioration in comprehensive sex education. In this study they found in 1999 that 25 percent 

of secondary teachers were teaching abstinence only as the only 

way to prevent pregnancy and STDs, so we’ve sort of lost the general education that kids need to have about these problems. 

94

Ms. HARMAN. Well, thank you again, Mr. Chairman for allowing 

me to participate. 

Mr. BILIRAKIS. Dr. McIlhaney, I know you’re anxious to say 

something, are you? 

Mr. MCILHANEY. Sure, sure. 

Mr. BILIRAKIS. You look like you’re chomping at the bit. 

Mr. MCILHANEY. May I, sir? 

Mr. BILIRAKIS. Very briefly. Okay, first, I’ll help with providing 

the data about the Federal funds for sexuality education because 

we’ve recently added that up to well more than $135 million, almost up to $400 million that will help provide some information for 

that through all sorts of agencies, Agriculture, Interior and surprisingly, other places. 

I’d just like to mention one thing and that is that there’s sort of 

this—it almost feels like sort of this dreamy thing about the comprehensive sex ed., that they truly are comprehensive. They are far 

from comprehensive. The abstinence element, as a matter of fact, 

in many of these programs that even are sometimes referred to as 

abstinence plus programs have either no abstinence information at 

all or very little. 

Another problem with them——

Mr. BILIRAKIS. You’re referring to Title V programs? 

Mr. MCILHANEY. No sir. I’m referring to the abstinence plus or 

comprehensive sex education or these programs that we’ve been 

talking about as well, providing full information. They don’t do 

that. As a matter of fact, abstinence part of those programs is very 

minimal. 

Doug Kirby himself also showed that unless a teacher feels 

strongly that the young person can access this information, understand it and use it, that it’s not going to be effective. We understand that even for Algebra teachers, they’ve got to believe kids can 

understand Algebra. And there are essentially none of these programs I know of that those who really understand abstinence programs would say that the abstinence part of these dual-message 

programs would even be considered an abstinence education program. 

As a matter of fact, in most of these programs, we’ve seen some 

recent stuff that would say that the information in these dual-message programs is really alarming and is something if parents and 

many of you knew, were there, you’d probably be almost shocked 

about. So these are not comprehensive programs in providing either kind of message for kids. We have to—I totally agree with Ms. 

Del Rosario that young people who are taught about abstinence 

have to be taught by somebody who truly believes that those young 

people can understand this and will do it. 

Mr. BILIRAKIS. Ms. Del Rosario, let me ask you, do you all, those 

of you who work in the Title V programs around the country, the 

49 States, do you share, the way you present the programs and the 

results and the success rate, etcetera? 

Ms. ROSARIO. We do. 

Mr. BILIRAKIS. You do. 

Ms. ROSARIO. Under SPRANS and under Title V abstinence only 

dollars. It’s even contractually stated that you have to gather at 

95

least once a year and that’s what we do to really strengthen the 

programs and to perfect them. 

Mr. BILIRAKIS. Are you confident that the other Title V programs 

use the same concept that yours does? 

Ms. ROSARIO. Some of them do. I’ve traveled and I’ve been speaking around the country and I’ve seen some that are and some that 

are not. And that’s why I made that suggestion about the types of 

programs that we’re looking at. Because I mean we can have a 

good intention, but if we fund poor programs or weak programs, I 

don’t care what their message is, it’s not going to work. 

Mr. BILIRAKIS. Well, I’d really like to thank you all. You’re a very 

respected panel of witnesses. Obviously, you all care about this 

issue. We didn’t hear too much from Ms. Mann and Dr. Scanlon, 

I guess, because we sort of got caught up in this other more controversial issue. 

Mr. BROWN. Mr. Chairman? 

Mr. BILIRAKIS. I’ll recognize you in a moment, sir, but there’s in 

the national newspaper, Today, there’s an article that highlighted 

the issue of abstinence only education and one of the teens interviewed in the piece mentioned and I quote, ‘‘the abstinence messages are getting through’’ according to this teen. So I guess she 

sort of agrees with Ms. Del Rosario. 

Well, tomorrow we have our hearing and—I mean our mark-up. 

And not much time in between and it’s unfortunate, but if you all 

have—and I’ll yield to Mr. Brown in a moment—but if you have 

any suggestions, all of you in terms of issues, that we should be 

discussing or maybe the legislation, please feel free to pass that on 

to us. 

Mr. Brown? 

Mr. BROWN. Thank you, Mr. Chairman. I’d like to thank the 

panel, too. 

Two years ago, this subcommittee passed a 1-year extension of 

the transitional Medicaid program. We also passed under the leadership of Chairman Bilirakis two improvements to TMA, one was 

a State option to waive the reporting requirements which Dr. Scanlon, Ms. Mann mentioned. The other is an exemption from the 

TMA requirements for States that already broadly covered the population, this population up to 285 percent of poverty. These improvements, as you know, Mr. Chairman, never made it into law 

last year, but I hope—2 years ago—but I hope that we can work 

together. I know tomorrow we won’t make that change, but 

through this process we can work together to do that, if we could. 

Mr. BILIRAKIS. Well, and you made the point in your opening 

statement, Mr. Brown, that there are no new additional Medicaid 

dollars in the budgets, so in order to have these transitional funds, 

we’re going to have to find some sort of an offset and hopefully we 

can all work together, because I know we all want that to take 

place. 

Mr. BROWN. And I also would ask unanimous consent to enter 

this into the record. This is the endorsement by members of the 

clergy and lay religious leaders of the Planned Parenthood Federation, America’s Statement on Comprehensive Sexuality Education. 

Mr. BILIRAKIS. Without objection, that will be the case. 

[The material follows:]

96

1See Douglas Kirby, Emerging Answers (Washington: The National Campaign to Prevent 

Teen Pregnancy, 2001). 2 Jacqueline Darroch, et. al., ‘‘Changing Emphasis on Sexuality Education in U.S. Public Secondary Schools.’’ Family Planning Perspectives 32(5): 204, 205 (2000). 3See Kirby, op. cit. 

4Debra Haffner, A Time to Speak: Faith Communities and Sexuality Education (N.Y.: 

SIECUS, 1998). 

PREPARED STATEMENT OF PLANNED PARENTHOOD FEDERATION OF AMERICA

CLERGY ADVISORY BOARD

We, the undersigned, are clergy and lay religious leaders who represent diverse 

religious traditions and come from all walks of life. We believe that an individual’s sexuality must be affirmed as an essential dimension of being human. Concerned 

about the sexual health of our country, we strongly support the bold and courageous 

recommendations of the ‘‘Surgeon General’s Call to Action to Promote Sexual Health 

and Responsible Sexual Behavior’’ for more knowledge, more services, and more 

open discussion. 

Accordingly, we call on our elected leaders to ensure that our young people receive 

medically accurate and balanced sexuality education. 

Speak the Truth 

As clergy, we have a responsibility to remind our congregations, our communities, 

and our elected leaders that both the Hebrew Bible and the New Testament, as well 

as the teachings of other religious faiths, view the body and the physical world as 

a sacred arena in which God acts. Did not God bless human beings with the opportunity to bear children as a singular sign not only of the sacredness of life but also 

as a sign of their capacity for sexual intimacy? 

Yet we treat human sexuality as inherently dangerous and off-limits for discussion. Discomfort with their own sexuality inhibits many parents from talking with 

their children about this most natural part of life. A lack of information and understanding about sexuality also contributes to painful discrimination against sexual 

minorities. 

Our sexuality is God given, and so, too, is the command that we instruct our children so that they will gain understanding and the ability to make wise choices. 

Fund Programs That Work 

The current debate over sexuality education in the nation’s public schools is one 

more example of how theological abstraction and moral absolutes have been permitted to substitute for common sense and compassion, not to mention the lessons 

that medicine and science can teach us. 

For the sake of our young people, we urge our elected leaders not to ignore the 

expert findings that there is no reliable, scientific evidence to demonstrate that abstinence-only sexuality education works, while there is substantial evidence to show 

that comprehensive sexuality education has been successful in preventing teen pregnancy.1

Substituting dicta for instruction stifles the kind of open discussion that fosters 

the development of healthy and responsible attitudes toward our God-given gift of 

sexuality. 

As community leaders who care about the well being of young people, we, like a 

substantial majority of Americans, encourage teens to abstain from sexual intercourse. But, like a substantial majority of Americans, we also recognize that many 

will not.2

Giving young people complete information does not influence them to engage in 

sexual activity any earlier—that’s what the research shows.3 How can we, in all 

good conscience, deny young people knowledge that would protect them from becoming parents before they are ready to have children and would also protect them from 

either contracting or spreading sexually transmitted infections? 

Don’t Discriminate 

Finally, we believe that public funding that supports only abstinence-only education discriminates against the religious denominations that support comprehensive sexuality education. Twelve denominations favor curriculums that discuss abstinence as one option and include information about all aspects of human sexuality, 

with the objective of developing sexually healthy adults who can make responsible 

choices about their reproductive lives.4

Many faith traditions teach that children must be treated, with due allowance for 

their ages, as responsible persons who can make critical decisions about their lives. 

Each child has a conscience. Each can be taught to become a reasoning and reasonVerDate 0ct 02 2002 09:18 Oct 05, 2002 Jkt 010199 PO 00000 Frm 00100 Fmt 6633 Sfmt 6621 W:\DISC\79467 79467
97

able person. Each must be taught about human sexuality, so that each can make 

informed and responsible choices about his or her sexual life, including the choice 

to remain abstinent. As an integral part of this process, our young people have a 

right to the best information possible. We pledge to dedicate ourselves to ensuring 

that they receive nothing less.

Title First and Middle Name Last Name Organization/Affiliation City State 

Chaplain Lesley ......... Adams ........... St. John’s Chapel .................................................. Geneva ................ NY 

Ms. ........ Janis ........... Adams ........... Presbytery of Cincinnati ....................................... Cincinnati ........... OH 

Dr. ......... Michael J. ... Adee ............... First Presbyterian Church ..................................... Sante Fe .............. NM 

Rev. ....... Julia J. ........ Aegerter ......... Unitarian Universalist Church of Evansville ........ Evansville ............ IN 

Rev. ....... Clifford L. ... Aerie .............. United Church of Christ ....................................... Cleveland ............ OH 

Rabbi .... Heather ....... Altman ........... Bet Torah .............................................................. Mt. Kisco ............. NY 

Rev. ....... David A. ..... Ames .............. Episcopal Chaplain, Brown University ................. Providence ........... RI 

Rev. ....... Wayne R. .... Anderson ........ United Methodist Church ...................................... Louisville ............. KY 

Rev. ....... Nancy L. ..... Anderson ........ Minnehaha UCC .................................................... Minneapolis ......... MN

Rev. ....... Alice V. ....... Anderson ........ The New York Ave. Presbyterian Church .............. Washington ......... DC 

Rev. Dr. Susan R. .... Andrews ......... Bradley Hills Presbyterian Church ........................ Bethesda ............. MD 

Rev. ....... Susan C. .... Armer ............. St. Matthew’s Episcopal Church .......................... Auburn ................ WA 

Rabbi .... Benjamin .... Arnold ............ ............................................................................... Amherst ............... NY 

Rev. ....... Mark E. ....... Asman ........... Trinity Episcopal Church ...................................... Santa Barbara .... CA 

Rev. ....... Theodore A. Atkinson ......... Oxford Presbyterian Church .................................. Oxford .................. PA 

Rev. ....... A.E. ............. Aurand ........... Incarnation Lutheran Church ............................... Cedarhurst .......... NY 

Rev. ....... Louisa M. ... Baer ............... Blue Ash Presbyterian Church .............................. Cincinnati ........... OH 

Rev. ....... Brian .......... Bagley-Bonner Newbury United Community Church ..................... Newbury .............. OH 

Rev. ....... David .......... Bahr ............... Archwood United Church of Christ ....................... Cleveland ............ OH 

Rev. Dr. Warner M. ... Bailey ............. Ridglea Presbyterian Church ................................ Fort Worth ........... TX 

Rev. ....... Melvin L. .... Bailey ............. Shiloh Baptist Church .......................................... Tulsa ................... OK 

Rev. ....... Darline D. ... Balm-Demmel UMC ...................................................................... Des Moines ......... IA 

General ..

Presbyter 

Philip W. ..... Barrett ........... General Presbyter-Presbytery of Des Moines ........ Des Moines ......... IA 

Rev. ....... S. John ....... Bartley ........... ............................................................................... Atlanta ................ GA 

Rabbi .... Pamela 

Frydman.

Baugh ............ Or Shalom Jewish Commuity ................................ San Francisco ..... CA 

Rev. ....... Eugene C. ... Bay ................ Byrn Mawr Presbyterian Church ........................... Bryn Mawr ........... PA 

Rev. ....... Paul ............ Beckel ............ First Universalist Unitarian Church ..................... Wausau ............... WI 

Rev. ....... Silvia R. ..... Behrend ......... First Unitarian Church of Salt Lake City ............. Salt Lake City ..... UT 

Rabbi .... Martin P. .... Beifield, Jr. .... Congregation Beth Ahabah .................................. Richmond ............ VA 

Rev. ....... Emmy Lou .. Belcher .......... Unitarian Universalist Congregation of Grand 

Traverse.

Travers City ......... MI 

Rev. Dr. Mark ........... Belletini ......... First Unitarian Universalist Church 93 W. 

Weisheimer.

Columbus ............ OH 

Rev. ....... Russell L. ... Bennett .......... Fellowship Congregational Church UCC ............... Tulsa ................... OK 

Rev. ....... Eric ............. Bentrott ......... Pilgrim Congregational Church ............................ Cleveland ............ OH 

Rev. ....... J.C. ............. Berbiglia ........ Presbyterian Church (USA) ................................... Helotes ................ TX 

Rabbi .... Peter S. ...... Berg ............... Temple Emanu-El ................................................. Dallas .................. TX 

Rev. ....... Julie ............ Bergdahl ........ Redeemer Lutheran Church .................................. Plattsburgh ......... NY 

Brother .. Clark ........... Berge ............. Society of St. Francis ........................................... Mount Sinai ........ NY 

Rabbi .... Jonathan ..... Biatch ............ Beth El Hebrew Congregations ............................. Alexandria ........... VA 

Rev. ....... Mark ........... Bigelow .......... Congregational Church of Huntington, UCC ........ Huntington .......... NY 

Rev. ....... Wes ............. Bixby .............. Smith Memorial Cong Church, UCC ..................... Hillsboro .............. NH 

Rev. ....... Kathleen A. Bishop ........... Unity Church ......................................................... Fort Lauderdale ... FL 

Rev. Dr. Nadean ....... Bishop ........... MN Religious Coalition for Reproductive Choice Minneapolis ......... MN 

Rev. ....... Cynthia L. ... Black ............. Parish Church of Christ the King at the Cathedral.Kalamazoo ........... MI 

Rev. ....... James C. .... Blackburn ...... Diocese of Maryland ............................................. Baltimore ............ MD 

Chaplain Lee .............. Blackburn ...... ............................................................................... Kansas City ......... KS 

Vicar ...... Martha ........ Blacklock ....... St. Mary the Virgin Episcopal Church .................. Keyport ................ NJ 

Rev. ....... Rebecca M. Blackwell ....... ............................................................................... Philadelphia ........ PA 

Rev. ....... Rosalee ....... Blake ............. UMC ...................................................................... Chicago ............... IL 

Rev. ....... Dallas A. .... Blanchard ...... ............................................................................... Pensacola ............ FL 

Rev. ....... David M. ..... Blanchard ...... Unitarian Universalist Association ....................... Andover ............... MA 

Rabbi .... Barry H. ...... Block .............. Temple Beth-El ..................................................... San Antonio ........ TX 

Rev. ....... Eddie .......... Blue ............... Church of the Holy Trinity (Episcopal) ................. Baltimore ............ MD 

Cantor ... Sheri ........... Blum .............. Congregation B’nai Israel ..................................... Bridgeport ........... CT 

Mr. ......... Theodore A. Blunk ............. Old Stone Presbyterian Church ............................ Cleveland ............ OH 

98

Title First and Middle Name Last Name Organization/Affiliation City State 

Rev. ....... Melinda ...... Bobo .............. St. Martin’s by the Lake Episcopal Church ......... Minnetonka Beach MN 

Rabbi .... David .......... Bockman ........ Beth Meyer Synagogue ......................................... Raleigh ................ NC 

Rev. ....... Steve .......... Bohlert ........... CPCUCC ................................................................ Comstock Park .... MI 

Rabbi .... Elizabeth .... Bolton ............ Congregation Beit Tikvak ..................................... Balitmore ............ MD 

Rev. ....... Edward K. ... Brandt ........... Red Clay Creek Pres. Church ............................... Wilmington .......... DE 

Rev. ....... Robert L. .... Brashear ........ West-Park Presbyterian Church ............................ New York ............. NY 

Rabbi .... Balfour ....... Brickner ......... Stephen Wise Free Synagogue .............................. New York ............. NY 

Rev. ....... Harlan ........ Breininger ...... United Church of Christ ....................................... Jim Thorpe .......... PA 

Rev. ....... J. Wesley ..... Brown ............ United Methodist Church ...................................... Santa Barbara .... CA 

Rev. ....... Robert O. .... Browne ........... Presbytery of Santa Fe ......................................... Albuquerque ........ NM 

Rev. ....... Ellen A. ....... Brubaker ........ United Methodist Church ...................................... Grand Rapids ...... MI 

Reverend Daniel E. H. Bryant ............ Christian Church (Disciples of Christ) ................. Eugene ................ OR 

Rev. ....... Roger .......... Buchanan ...... Carversville Christian Church .............................. Perkionmenville ... PA 

Rabbi 

Emeritus.

Gustav ........ Buchdahl ....... Temple Emanuel ................................................... Baltimore ............ MD 

Rev. ....... Kathleen ..... Buckley .......... Chaplain, St. Lawrence University ....................... Canton ................ NY 

Rev. ....... Daniel ......... Budd .............. First Unitarian Church of Cleveland .................... Shaker Heights ... OH 

Rev. ....... Cynthia S. .. Bumb ............. United Church of Christ ....................................... St. Louis .............. MO

Rev. ....... Larry V. R. .. Bunnell .......... Presbyterian Church (USA) ................................... Klamath Falls ..... OR 

Ms. ........ Angela ........ Buxton ........... UMC, Brunswick .................................................... Brunswick ........... ME 

Cantor ... Norma Bruce Byers .............. American Conference of Cantors .......................... Manchester ......... NJ 

Dean ...... John A. ....... Cairns ............ Fourth Presbyterian Church .................................. Chicago ............... IL 

Rev. Dr. Kristina ....... Campbell ....... SW Conference, United Church of Christ ............. Scottsdale ........... AZ 

Rev. ....... Steven ........ Carlson .......... Emmaus Lutheran Church .................................... Eugene ................ OR 

Rev. ....... Walter ......... Carlson .......... UMC ...................................................................... Pana .................... IL 

Cantor ... Susan ......... Caro ............... Temple Judea ........................................................ Tarzana ............... CA 

Rev. ....... Katherine L. Carpenter ....... PCUSA ................................................................... Lynchburg ........... VA 

Rev. Dr. Wayne ......... Carter ............ Trinity Episcopal Church ...................................... Pharr ................... TX 

Rev. ....... Ashli ........... Cartwrigt-Peak Little Eagle Christian Church ............................... Westfield ............. IN 

Rev. Dr. Ignacio ....... Castuera ........ St. John’s United Methodist Church ..................... Los Angeles ......... CA 

Rev. Dr. Kenneth ...... Cauthen ......... Professor of Theology ............................................ Rochester ............ NY 

Rev. ....... Barbara ...... Chaapel ......... First Presbyterian Church ..................................... Philadelphia ........ PA 

Rev. ....... Shirely M. ... Chan .............. Riverside Salem UCC ............................................ Eden .................... NY 

Rev. Dr. Gary W. ....... Charles .......... Old Presbyterian Meeting House .......................... Alexandria ........... VA 

Rabbi .... Joshua ........ Chasan .......... Ohavi Zedek Synagogue ....................................... Burlington ........... VT 

Rev. ....... Pamela C. .. Cheney ........... United Church of Christ ....................................... Cleveland ............ OH 

Rev. ....... Barbara ...... Child .............. St. John’s Unitarian Church ................................. Cincinnati ........... OH 

Rev. Dr. Bruce .......... Chilton ........... Church of St. John the Evangelist ....................... Barrytown ............ NY 

Rev. ....... Richard ....... Chrisman ....... Central Congregational Church ............................ Jamaica Plain ..... MA 

Rev. ....... Micahel O. .. Christensen ... Warwick United Church of Christ ......................... Newport News ..... VA 

Rev. Dr. Diane .......... Christopherson United Church of Christ ....................................... Ann Arbor ............ MI 

Rev. ....... Robert ......... Clark .............. ............................................................................... Denver ................. CO 

Rev. ....... Peggy C. ..... Clason ........... Unitarian Universalist Society of Cleveland ......... Cleveland Hts. .... OH 

Rev. ....... Maryell ........ Cleary ............ Unitarian Universalist Church of Greater Lansing East Lansing ....... MI 

Rev. Prof. Howard ....... Clinebell ........ ............................................................................... Santa Barbara .... CA 

Rev. ....... Charles ....... Cloughen, Jr .. ............................................................................... Sparks ................. MD 

Rev. ....... Edward A. ... Clydesdale ..... ............................................................................... Newark ................ NJ 

Pastor .... Robert C. .... Cochran ......... Lutheran Campus Ministry, ELCA ......................... Kalamazoo ........... MI 

Rev. ....... Matthew ..... Cockrum ........ First Unitarian Society of Milwaukee ................... Milwaukee ........... WI 

Rev. ....... Anne G. ...... Cohen ............ United Church of Christ ....................................... Los Angeles ......... CA 

Rev. ....... Helen Lutton Cohen ............ First Parish of Lexington ...................................... Lexington ............. MA 

Rev. ....... Ernestine B. Cole ............... Columbia Theological Seminary ........................... Decatur ............... GA 

Rev. ....... Ann Marie ... Coleman ........ University Church ................................................. Chicago ............... IL 

Rev. ....... John ............ Collins ........... NY Conference, United Methodist Church ............ New York ............. NY 

Dr. ......... Shelia ......... Collins ........... NY Conference, United Methodist Church ............ New York ............. NY 

Rev. ....... Cyril C. ....... Colonius ......... ............................................................................... Kalamazoo ........... MI 

Rev. ....... Lucretia ...... Cooksy ........... Jubilee United Methodist Church ......................... Duncanville ......... TX 

Rabbi .... Sigma ......... Coran ............. Williams College ................................................... Williamstown ....... MA 

The Rev. Sandra Lee Cordingley ...... Christ Episcopal Church ....................................... West River ........... MD 

Rev. ....... Mary Jane ... Cornell ........... ............................................................................... Atlanta ................ GA 

Rev. ....... Monica ........ Corsaro .......... Chaplain, Planned Parenthood Affiliates of 

Washington State.

Seattle ................. WA 

Rev. ....... Pamela ....... Cranston ........ St. Cuthbert’s Episcopal Church .......................... Oakland ............... CA 

Rabbi .... Meryl ........... Crean ............. ............................................................................... Elkins Park .......... PA 

99

Title First and Middle Name Last Name Organization/Affiliation City State 

Rev. ....... James ......... Crowder ......... Episcopal Church .................................................. Cockeysville ......... MD 

Rev. ....... Thomas L. .. Culbertson ..... Emmanuel Episcopal Church ............................... Baltimore ............ MD 

Rev. ....... Richard A. .. Cullen ............ Auburn United Methodist Church ......................... Auburn ................ ME 

Rev. ....... Arthur E. ..... Curtis ............. Unitarian Universalist (ret.) ................................. Anchorage ........... AK 

Rev. ....... Ben ............. Dake .............. ............................................................................... Cottage Grove ..... OR 

Rev. ....... Beverly ........ Dale ............... Christian Association University of Pennsylvania Philadelphia ........ PA 

Rev. ....... Nancy C. ..... Danson .......... United Methodist Church ...................................... San Jose .............. CA 

Rev. ....... Wayne ......... Darnell ........... Inter Faith Ministry ............................................... Ft. Lauderdale ..... FL 

Rabbi .... Andrew ....... Davids ........... Union of American Hebrew Congregations ........... New York ............. NY 

Rabbi .... Josef A. ....... Davidson ........ B’nai Zion Congregation ....................................... Chattanooga ....... TN 

Rev. ....... Tom ............ Davis ............. Chair, PPFA Clergy Advisory Board ...................... Saratoga Springs NY 

Rabbi .... David .......... Davis ............. Vanderbilt University ............................................ Nashville ............. TN 

Dr. ......... Holly Haile .. Davis ............. Padoquohan Medicine Lodge; and Member of the 

Long Island Presbytery, PCUSA.

Southampton ....... NY 

Rev. ....... Virgie J. ...... Davis ............. Zion United Church of Christ ............................... Dale ..................... WI 

Ms. ........ Peggy .......... Davis-Herod ... South Haven UCC ................................................. Bedford ............... OH 

Rev. ....... Lisa W. ....... Davison .......... Christian Church (Disciples of Christ) & Lexington Theological Seminary.Lexington ............. KY 

Rev. ....... Michael ....... Davison .......... Christian Church In Kentucky .............................. Lexington ............. KY 

Rev. ....... Lorraine ...... De Armitt ....... Southold United Methodist Church ...................... Southold .............. NY 

Ms. ........ Adele .......... de Ryk ........... Parish Nurse, All Saints Episcopal Church .......... Loveland .............. CO 

Rev. ....... Michael R. .. De Vaughn ..... Carter Chapel CME Church .................................. Amarillo ............... TX 

Rev. ....... Robert C. .... Dean .............. Episcopal Church .................................................. StaffordVA.

Rev. ....... Gregory ....... Dell ................ Broadway United Methodist Church ..................... Chicago ............... IL 

Rev. ....... Robert ......... Dell ................ UCC ....................................................................... Sandwich ............ IL 

Ms. ........ Jean ............ DeVoll-Donaldson.Lutheran School of Theology at Chicago ............. Chicago ............... IL 

Rev. ....... William A. ... DeWolfe .......... Unitarian Universalist Church .............................. Damariscotta ...... ME 

Rabbi .... Barry ........... Diamond ........ Temple Emanu-El ................................................. Dallas .................. TX 

Mr. ......... Richard ....... Dickens .......... West End Collegiate Church ................................. New York ............. NY 

Rabbi .... Lucy ............ Dinner ............ ............................................................................... Raleigh ................ NC 

Rabbi .... Fred S. ........ Dobb .............. Adat Shalom Reconstructionist Congregation ...... Bethesda ............. MD 

Mr. ......... Donald F. .... Doering .......... ............................................................................... Amherst ............... NY 

Rev. ....... Roy ............. Donkin ........... Emmanuel Baptist Church ................................... Albany ................. NY

Rev. ....... Cheryl D. .... Donkin ........... Emmanuel Baptist Church ................................... Albany ................. NY 

Rev. ....... Jack ............ Donovan ......... Unitarian Universalist Fellowship ......................... Gainesville .......... FL 

Rev. ....... Randall ....... Doubet-King ... United Church of Christ ....................................... Chicago ............... IL 

Rev. ....... Nancy ......... Doughty ......... ............................................................................... Traverse City ....... MI 

Rev. ....... Elizabeth 

Morris.

Downie ........... St. Jude’s Episcopal Church ................................. Fenton ................. MI 

Rabbi .... William ....... Dreskin .......... Woodlands Community Temple ............................. White Plains ........ NY 

Ms. ........ Barbara ...... Drew .............. ............................................................................... Newton ................ PA 

Rev. ....... Sarah B. ..... Drummond ..... University Christian Ministries ............................. Milwaukee ........... WI 

Rev. ....... Karen N. ..... Dungan .......... First United Methodist Church ............................. Osage .................. IA 

Rev. Dr. Eileen ......... Dunn .............. Director of Women’s Programs, Green River 

Community College.

Auburn ................ WA 

Rev. Dr. Lyle J. ......... Dykstra .......... Limestone Presbyterian Church ............................ Wilmington .......... DE 

Ms. ........ Karen .......... Dyste .............. Central Presbyterian Church ................................ Eugene ................ OR 

Rev. ....... Rose ........... Edington ........ Unitarian Fellowship of Athens ............................ Athens ................. OH 

Rev. ....... Jan .............. Edmiston ....... Fairlington Presbyterian Church ........................... Alexandria ........... VA 

Rev. ....... Carol ........... Edwards ......... Unitarian Universalist at Live Oak ....................... Santa Barbara .... CA 

Rev. ....... Janet E. ...... Eggleston ....... UMC ...................................................................... Springfield .......... PA 

Rabbi .... Dan ............. Ehrenkrantz ... B’nai Keshet ......................................................... Montclair ............. NJ 

Rev. ....... Lauren D. ... Ekdahl ........... Trinity United Methodist ....................................... Lincoln ................ NE 

Rev. ....... Jim .............. Eller ............... All Souls UU Church ............................................. Kansas City ......... MO 

Rev. ....... Steve .......... Ellis ............... Episcopal Church of St. John the Baptist ........... Capitola .............. CA 

Rev. Dr. Marvin M. ... Ellison ............ Bangor Theological Seminary ............................... Portland .............. ME 

Rev. ....... Nancy Nelson.Elsenheimer ... United Church of Christ ....................................... Cleveland ............ OH 

Rabbi .... Sue ............. Elwell ............. Union of American Hebrew Congregations ........... Philadelphia ........ PA 

Ms. ........ Marjorie ...... Enseki ............ FCC ....................................................................... Eugene ................ OR 

Rabbi .... Rachel ........ Esserman ....... ............................................................................... Endwell ............... NY 

Rev. ....... Jon M. ......... Fancher .......... Rocky River Presbyterian Church ......................... Rocky River ......... OH 

Rev. ....... Douglas E. .. Fauth ............. The Christian Association at the University of 

Pennsylvania.

Philadelphia ........ PA 

100

Title First and Middle Name Last Name Organization/Affiliation City State 

Rabbi .... Morley T. ..... Feinstein ........ Temple Beth-El ..................................................... South Bend ......... IN 

Rabbi .... Steven M. ... Fink ................ Temple Oheb Shalom ............................................ Baltimore ............ MD 

Rev. ....... Wendy ......... Fish ................ First Unitarian Universalist Church ..................... Columbus ............ OH 

Rev. ....... John W. ....... Fisher ............. Sunnyside United Methodist Church .................... Kalamazoo ........... MI 

Pastor .... Eric ............. Fjeldal ............ Yalesville United Methodist Church ..................... Wallingford .......... CT 

Rev. ....... Ray ............. Flachmeier ..... Evangelical Lutheran Church of America ............ Richardson .......... TX 

Rev. ....... Madonna .... Flanders ......... Alton UMC ............................................................. Bangor ................ ME 

Rev. ....... Ann ............. Fontaine ......... Episcopal Church .................................................. Jackson ............... WY 

Ms. ........ Rita ............ Fossell ........... Presbysterian Women-Churchwide ........................ Lake Bluff ........... IL 

Rev. Dr. Garnett E. ... Foster ............. Louisville Presbyterian Theological Seminary ....... Louisville ............. KY 

Rev. ....... C.H. ............ Fotch .............. St. John’s Episcopal Church ................................. Ross .................... CA 

Rev. ....... Kimberly 

Buechner.

Fouse ............. Presbyterian Church (USA) ................................... Cold Spring ......... KY 

Rev. Dr. Richard E. .. Fouse ............. Doylestown Presbyterian Church .......................... Doylestown .......... PA 

Rev. ....... Anne C. ...... Fowler ............ St. John’s Episcopal Church ................................. Jamaica Plain ..... MA 

Rev. ....... Amy A. ........ Freedman ....... Channing Memorial Church .................................. Newport ............... RI 

Rabbi .... Allen I. ........ Freehling ........ University Synagogue ............................................ Los Angeles ......... CA 

Rabbi .... Gordon M. ... Freeman ......... Congregation B’nai Shalom .................................. Walnut Creek ...... CA 

Rabbi .... Jonathan B. Freirich .......... Cleveland Hillel ..................................................... Cleveland ............ OH 

Rabbi .... Ronne ......... Friedman ....... Temple Israel ........................................................ Boston ................. MA 

Rabbi .... Alan D. ....... Fuchs ............. ............................................................................... White River Junction.VT 

Rev. ....... Holly Spencer.Fuqua ............ ............................................................................... Lexington ............. KY 

Rev. Dr. George T. .... Gardner .......... College Hill United Methodist Church .................. Wichita ................ KS 

Rabbi .... David J. ...... Gelfand .......... The Jewish Center of the Hamptons .................... East Hampton ..... NY 

Rev. ....... Gretchen 

Seidler.

Gibbs ............. ............................................................................... Mill Creek ............ IN 

Rev. ....... Gordon D. ... Gibson ........... Unitarian Universalist Fellowship of Elkhart ....... Elkhart ................ IN 

Rev. ....... Lance A.B. .. Gifford ........... St. John’s Mt. Washington .................................... Baltimore ............ MD 

Rev. ....... Martha E. ... Gilbert ............ The United Methodist Church ............................... Ellenburg ............. NY 

Rev. ....... Richard S. .. Gilbert ............ First Unitarian Church .......................................... Rochester ............ NY 

Rev. ....... Christopher 

A..

Gilmore .......... Winnetka Congregational Church ......................... Winnetka ............. IL 

Rabbi .... Gail ............. Glicksman ...... ............................................................................... Haverford ............ PA 

Rabbi .... Brian .......... Glusman ........ ............................................................................... Birmingham ........ AL 

Rev. ....... Jerry ............ Goddard ......... Unitarian Universalist ........................................... Newmarket .......... NH 

Rabbi .... Irwin ........... Goldenberg .... Temple Beth Israel ............................................... York ..................... PA 

Rabbi .... Jeffrey W. .... Goldwasser .... Congregation Beth Israel ...................................... North Adams ....... MA 

Rev. ....... Thomas W. Goodhue ......... United Methodist Church of Bayshore ................. Bayshore ............. NY 

Rev. ....... Charlotte .... Gosselink ....... PA Southeast Conference UCC ............................. Collegeville .......... PA 

Rev. ....... Beth ............ Graham .......... Unitarian Universalist Fellowship ......................... Huntington .......... NY 

Rev. ....... Peter ........... Grandy ........... Asylum Hill Congregational Church ..................... Hartford ............... CT 

Rev. ....... Robert J. ..... Granger .......... Overlook United Methodist Church ....................... Woodstock ........... NY 

Cantor ... Oma T. ....... Green ............. American Conference of Cantors .......................... Teaneck ............... NJ 

Rev. Dr. W. Bradford Greeley ........... Main Line Unitarian Church ................................. New Castle .......... NH 

Rabbi .... Frederick ..... Greene ........... Congregation B’nai Israel ..................................... Bridgeport ........... CT 

Rev. Dr. Larry ........... Greenfield ...... Religious Institute for Sexual Morality, Justice 

and Healing.

Chicago ............... IL 

Rev. ....... John M. ....... Gregory-Davis Meriden Congregational Church, UCC .................. Meriden ............... NH 

Rev. ....... Susan ......... Gregory-Davis Meriden Congregational Church, UCC .................. Meriden ............... NH 

Rev. ....... Daphne ....... Grimes ........... Episcopal Church .................................................. Cody .................... WY 

Rev. Dr. Larry A. ....... Grimm ............ St. Paul Presbyterian Church ............................... Lakewood ............ CO 

Rev. Dr. J. Bennett ... Guess ............. Justice and Witness Ministries, UCC ................... Cleveland ............ OH 

Ms. ........ Debra W. .... Haffner .......... Religious Institute on Sexual Morality, Justice, 

and Healing.

Norwalk ............... CT 

Rev. ....... Bill .............. HamiltonHolway.Unitarian Universalist Church of Berkeley ........... Berkeley ............... CA 

Rev. ....... Barbara ...... HamiltonHolway.Unitarian Universalist Church of Berkeley ........... Berkeley ............... CA 

Rev. ....... Barbra M. ... Hansson ......... Unitarian Universalist ........................................... Plattsburgh ......... NY 

Rev. ....... Charles E. .. Harlow ........... UCC ....................................................................... Talent .................. OR 

Rev. ....... Cedric A. .... Harmon .......... ............................................................................... Washington ......... DC 

Rev. Dr. Marni .......... Harmony ........ First Unitarian Church .......................................... Orlando ............... FL 

Rev. ....... Allen V. ....... Harris ............. Franklin Circle Christian Church (Disciples of 

Christ).

Cleveland ............ OH 

101

Title First and Middle Name Last Name Organization/Affiliation City State 

Ms. ........ Sandra ........ Harwood ......... First Presbyterian Church-Buffalo ........................ Buffalo ................ NY 

Rev. ....... Danna Drum Hastings ........ ............................................................................... .............................

Rev. ....... Kathryn ....... Hawbaker ....... ............................................................................... Camden ............... OH 

Rev. ....... Ann L. ......... Hayman ......... Mary Magdalene Project ....................................... Reseda ................ CA 

Rev. ....... Barbara A. .. Heck ............... Rutgers Protestant Campus Ministries ................ New Brunswick ... NJ 

Rev. ....... Jane ............ Heckles .......... So. Cal. Nev. Conference, United Church of 

Christ.

Altadena .............. CA 

Rev. Dr. Joel J. ......... Heim .............. Disciples Peace Fellowship ................................... Waukesha ............ WI 

Rev. ....... Ken ............. Henry ............. Central Presbyterian Church ................................ Eugene ................ OR 

Rev. ....... Kathleen ..... Hepler ............ Unitarian Universalist Congregation of Monmouth County.Lincroft ................ NJ 

Rabbi .... Rachel ........ Hertzman ....... Hillel of Greater Baltimore ................................... Baltimore ............ MD 

Rev. ....... Jean Ellen ... Herzegh .......... PC (USA) ............................................................... Burns .................. OR 

Rev. ....... Anita C. ...... Hill ................. St. Paul Reformation Lutheran Church ................ St. Paul ............... MN 

Ms. ........ Bani ............ Hines-Hudson Director of Education-PP of Greater Louisville .... Louisville ............. KY 

Rev. ....... Allen ........... Hinman .......... St. John’s Episcopal ............................................. Passaic ............... NJ 

Rev. ....... Elaine ......... Hinnant .......... First Plymouth Congregational, UCC .................... Englewood ........... CO 

Rev. ....... Virginia C. .. Hoch .............. Goshen United Methodist Church ......................... Goshen ................ NY 

Rev. ....... Linda .......... Hoddy ............. Unitarian Universalist Congregation .................... Saratoga Springs NY 

Rev. ....... Judith M. .... Hoffhine ......... Broad St. Presbyterian Church ............................. Columbus ............ OH 

Rev. ....... David J. ...... Holden ........... United Church of Christ ....................................... Cleveland ............ OH

Rev. ....... Mark R. ...... Holland .......... Trinity UMC ........................................................... Kansas City ......... KS 

Rev. ....... George E. .... Hollingshead .. ............................................................................... Villanova ............. PA 

Rev. ....... Charles F. ... Holm .............. First Presbyterian Church ..................................... Easton ................. PA 

Rev. ....... Jean A.F. ..... Holmes ........... Nauraushaun Presbyterian Church ....................... Pearl River .......... NY 

Mr. ......... Joseph C. .... Hough, Jr. ...... Union Theological Seminary ................................. New York ............. NY 

Rev. ....... D. Scott ...... Howell ............ United Church of Christ ....................................... Cleveland ............ OH 

Rev. ....... Magaret E. Howland ......... White Plains Presbyterian Church ........................ White Plains ........ NY 

Dr. ......... Mary E. ....... Hunt ............... Women’s Alliance for Theology, Ethics and Ritual 

(WATER).

Silver Spring ....... MA 

Rev. Dr. Robert D. .... Hurlbut .......... ............................................................................... St. Paul ............... MN 

Deacon .. Nancy W. .... Huston ........... Episcopal Church .................................................. Omaha ................ NE 

Ms. ........ Betty ........... Huthcheson .... ............................................................................... Buffalo ................ NY 

Rev. ....... Randy ......... Hyvonen ......... Washington, North Idaho Conference, UCC .......... Spokane .............. WA 

Rev. ....... Michael B. .. Ide ................. Evangelical Lutheran Church in America ............ St. Louis .............. MO 

Rev. ....... William ....... Ingraham ....... Church of the Good Shepard ................................ Anne Arbor .......... MI 

Rabbi .... Lisa ............ Izes ................ Temple Sinai ......................................................... Rochester ............ NY 

Rabbi .... Andrew ....... Jacobs ............ Bet Am Shalom Synagogue .................................. White Plains ........ NY 

Rabbi .... Cheryl ......... Jacobs ............ Planned Parenthood Hudson Peconic ................... Hawthorne ........... NY 

Pastor .... Alexander M. Jacobs ............ Lutheran Campus Ministry ................................... Milwaukee ........... WI 

Rev. ....... B. Leslie ..... James ............ Macedonia African Methodist Episcopal Church Seaford ................ DE 

Rev. Dr. Mark ........... Jennings ........ First Presbyterian Church ..................................... Richland .............. MI 

Rev. ....... Madeline ..... Jervis ............. Clarendon Presbyterian Church ............................ Arlington ............. VA 

Rev. ....... Bryan T. ...... Jessup ............ The Unitarian Universalist Church of Fresno ....... Fresno ................. CA 

Rabbi .... Daniel ......... Jezer ............... Congregation Beth Sholom-Chevra Shas ............. De Witt ................ NY 

Board 

Chair.

Ann Hale .... Johnson .......... Union Theological Seminary, NYC ........................ Potomac .............. MD 

Rev. ....... Bruce .......... Johnson .......... Unitarian Universalist Church of Indianapolis .... Indianapolis ........ IN 

Rev. Dr. William R. .. Johnson .......... Wider Church Ministries, United Church of Christ Cleveland ............ OH 

Ms. ........ Janet ........... Johnson .......... ............................................................................... Concord ............... CA 

Rev. ....... Kathryn ....... Johnson .......... ............................................................................... Seattle ................. WA 

Rev. Dr. Peggy .......... Johnson .......... United Church of Christ ....................................... Santa Barbara .... CA 

Rev. ....... Anthony P. .. Johnson .......... First Unitarian Universalist Church of Essex 

County.

Orange ................ NJ 

Rev. ....... Rebecca ...... Johnston ........ Our Savior’s United Church of Christ .................. Ripon ................... WI 

Rev. ....... Charles H. .. Jorday ............ Pleasant Run UCC ................................................ Indianapolis ........ IN

Ms. ........ Kathleen ..... Kahl ............... ............................................................................... Chilton ................ WI 

Rabbi .... Mark ........... Kaiserman ..... Temple Emanu-El ................................................. Dalllas ................. TX 

Rabbi .... Jeremy ........ Kalmanofsky .. Congregation Ansche Chesed ............................... New York ............. NY 

Rabbi .... Lewis .......... Kamrass ........ ............................................................................... Cincinnati ........... OH 

Rabbi .... Gerald M. ... Kane .............. Temple Beth El ..................................................... Las Cruces .......... NM 

Rev. ....... Charles G. .. Kast ............... Community Church of Chapel Hill ....................... Chapel Hill .......... NC 

Rabbi .... Nancy ......... Kasten ........... ............................................................................... Dallas .................. TX 

Rabbi .... Alan J. ........ Katz ............... Temple Sinai ......................................................... Rochester ............ NY 

Rev. ....... Fred ............ Keip ............... Unitarian Universalist ........................................... Grants Pass ........ OR 

102

Title First and Middle Name Last Name Organization/Affiliation City State 

Rabbi .... Jonathan ..... Kendall .......... Temple Beit Hayam .............................................. Stuart .................. FL 

Rev. Dr. Andrew C. ... Kennedy ......... First Unitarian Society of Milwaukee ................... Milwaukee ........... WI 

Rev. ....... Diane .......... Kenney ........... United Ministry at USC ......................................... Los Angeles ......... CA 

Rev. ....... Thomas A. .. Kerr, Jr ........... Immanuel Church, Highlands (Episcopal) ........... Wilmington .......... DE 

Mr. ......... Amos .......... Kharma .......... Metropolitan Community Church of the Spirit ..... Harrisburg ........... PA 

Ms. ........ Katharine .... Kilpatric ......... Presbytery of Giddings Lovejoy ............................. St. Louis .............. MO 

Mr. ......... Steven F. .... Kindle ............ Clergy United, Inc. ................................................ Santa Barbara .... CA 

Rev. ....... Ruth L. ....... Kirk ................ St. Peter’s Church, Glenside ................................ Glenside .............. PA 

Rev. Dr. Ron D. ........ Kitterman ....... UMC ...................................................................... Fort Dodge .......... IA] 

Dr. ......... Joel T. ......... Klein .............. ............................................................................... Manchester ......... NH 

Rabbi .... Elliott .......... Kleinman ....... ............................................................................... Cleveland ............ OH 

Rev. ....... David .......... Knox ............... ............................................................................... Plainfield ............. IN 

Rev. ....... Tricia Dykers Koenig ............ ............................................................................... Cleveland Heights OH 

Rabbi .... Neil ............. Kominsky ....... Temple Emanuel of the Merrimack Valley ........... Lowell .................. MA 

Rabbi .... Sandford ..... Kopnick .......... The Valley Temple ................................................. Cincinnati ........... OH 

Rabbi .... Elisa ........... Koppel ............ The Community Synagogue .................................. Port Washington NY 

Rabbi .... Douglas E. .. Krantz ............ Congregation B’nai Yisrael ................................... Armonk ................ NY 

Rev. ....... Daniel H. .... Kuhn, Jr. ........ Vine Street Christian Church ............................... Nashville ............. TN 

Rev. Dr. Mary ........... Kuhns ............ ............................................................................... Louisville ............. KY 

Rev. ....... Wallace 

Ryan.

Kuroiwa .......... United Church of Christ ....................................... Cleveland ............ OH 

Rabbi .... Steven ........ Kushner ......... Temple Ner Tamid ................................................ Bloomfield ........... NJ 

Rev. ....... Peter ........... Laarman ........ Judson Memorial Church ...................................... New York ............. NY 

Rabbi .... Howard ....... Laibson .......... Temple Israel ........................................................ Long Beach ......... CA 

Rev. ....... Jeffrey ......... Lamb ............. Unitarian Universalist Church .............................. Midland ............... TX

Rev. ....... Werner ........ Lange ............. Auburn Community Church .................................. Chagrin Falls ...... OH 

Dr. ......... Edwin ......... Lasbury .......... UMC ...................................................................... Hockessin ............ DE 

Rev. ....... Debra .......... Latture ........... Presbyterian Church (U.S.A.) ................................ Snow Hill ............. MD 

Rabbi .... Michael A. .. Latz ................ Temple B’nai Torah .............................................. Bellevue .............. WA 

Rev. ....... R. Vincent .. Lavieri ............ American Apostolic Catholic Church .................... Greenville ............ MI 

Rev. ....... Clifford M. .. Lawrence Jr. .. United Church of Christ ....................................... Clearwater ........... FL 

Rev. ....... Katherine M. Lehman .......... St. Bede’s Episcopal Church ................................ Menlo Park .......... CA 

Rev. ....... Lois Robinson.Lehman .......... Pitts Creek and Beaver Dam Presbyterian 

Churches.

Pocomoke City ..... MD 

Rev. ....... Susan ......... Leo ................. Bridgeport United Church of Christ ..................... Portland .............. OR 

Rev. ....... William ....... Levering ......... Summit Presbyterian Church ................................ Philadelphia ........ PA 

Rabbi .... Amy ............ Levin .............. Congregation B’nai Israel ..................................... Gainesville .......... FL 

Mr. ......... Harry H. ...... Levy ............... Temple Beth-El ..................................................... San Antonio ........ TX 

Rabbi .... Eugene H. ... Levy ............... Congregational B’nai Israel .................................. Little Rock ........... AK 

Rabbi .... Janet ........... Liss ................ ............................................................................... Glen Cove ............ NY 

Rabbi .... Mark G. ...... Loeb ............... Beth El Congregation ........................................... Baltimore ............ MD

Rabbi .... Robert H. .... Loewy ............. ............................................................................... Metaire ................ LA 

Rabbi .... Alan David Londy ............. Temple Beth Shalom ............................................ Smithtown ........... NY 

Rev. ....... Daniel M. .... Long ............... Lutheran Church ................................................... Lancaster ............ PA 

Rev. ....... David .......... Lorenzen ........ First United Church of Christ ............................... Tipton .................. IA 

Rabbi .... Steven Stark Lowenstein ..... Temple Sholom of Chicago ................................... Chicago ............... IL 

Rev. Dr. Doyle A. ...... Luckenbaugh UCC ....................................................................... Massillon ............. OH 

Rev. ....... Douglas ...... Maben ............ Green Mountain Presbyterian Church ................... Lakewood ............ CO 

Rev. ....... W. Stewart .. MacColl .......... Northwoods Presbyterian Church .......................... Houston ............... TX 

Rev. ....... Gene ........... Mace .............. United Methodist .................................................. West Peoria ......... IL 

Rev. ....... Vilma M. ..... MachinVazquez.United Church of Christ ....................................... Cleveland ............ OH 

Rabbi .... Dana ........... Magat ............ Temple Emanu-El ................................................. San Jose .............. CA 

Rev. ....... Robert J. ..... Magliula ........ Christ the King Church ........................................ Stone Ridge ........ NY 

Dr. ......... Daniel ......... Maguire ......... Prof. Of Moral Theology, Marquette University ..... Milwaukee ........... WI 

Rev. ....... Lea A. ......... Mahan ........... United Methodist Church ...................................... Peninsula ............ OH 

Rabbi .... Jonathan ..... Malamy .......... B’nai Vail Congregation ....................................... Vail ...................... CO 

Cantor ... Bruce .......... Malin ............. American Conference of Cantors .......................... Marstons Mills .... MA 

Rev. ....... Ron ............. Manclaw ........ HIV/AIDS Pastoral Care Network ........................... Fort Lauderdale ... FL 

Rabbi .... Rosalin ....... Mandelberg .... Baltimore Hebrew Congregation ........................... Baltimore ............ MD 

Rev. ....... Francis ....... Manly ............. Unitarian Universalist ........................................... Buffalo ................ NY 

Rabbi .... Jeffrey M. .... Marker ........... ............................................................................... Brooklyn .............. NY 

Ms. ........ Doriene D. .. Marshall ........ Director of Christian Education, Cottonwood 

Presbyterian Church.

Salt Lake City ..... UT 

Rev. ....... Christopher 

S..

Martin ............ St. Mary’s Episcopal Church ................................ Green Cove 

Springs.

FL 

103

Title First and Middle Name Last Name Organization/Affiliation City State 

Dr. ......... Allen ........... Maruyama ...... Heritage Presbyterian Church ............................... Olathe ................. KS 

Rev. ....... James S. ..... Massie, Jr. ..... The Episcopal Church ........................................... Olcott .................. NY 

Rev. ....... Stephen J. .. Mather ........... Member, PPFA Board of Directors ........................ Anaheim .............. CA 

Mr. ......... Neal ............ Matson ........... Church of Christ ................................................... Fairbanks ............ AK 

Rev. ....... Nancy H. ..... McCarthy ....... Episcopal Church .................................................. Delray Beach ....... FL 

Rev. Dr. James ......... McDonald ....... ............................................................................... Washington ......... DC 

Rev. Dr. Elizabeth .... McDonald ....... ............................................................................... Washington ......... DC 

Rev. ....... Timothy ....... McDonald ....... First Iconium Baptist Church ............................... Atlanta ................ GA 

Rev. ....... David .......... McFarlane ...... The Presbyterian Church, Sewickley ..................... Sewickley ............. PA 

Rev. ....... Deborah A. McKinley ........ Third, Scots and Mariners Presbyterian Church .. Philadelphia ........ PA 

Rev. ....... Bethany ...... McLemore ...... Pastoral Counseling Center .................................. Roanoke .............. VA 

Rev. ....... Laurie A. ..... McNeill ........... Glenwood Landing ................................................ NY.

Ms. ........ Carolyn ....... Meagher ......... First Congregational Church ................................ Indianapolis ........ IN 

Rabbi .... Batsheva .... Meiri .............. Temple Emanuel ................................................... Reisterstown ....... MD 

Rev. ....... Sarah J. ...... Melcher .......... Presbytery of Cincinnati ....................................... Cincinnati ........... OH 

Rev. Dr. Robert H. .... Meneilly ......... ............................................................................... Prairie View ......... KS 

Rev. ....... David W. ..... Meredith ........ Broad St. United Methodist Church ..................... Columbus ............ OH 

Rabbi .... Andrea ........ Merow ............ Temple Sholom ..................................................... Philadelphia ........ PA 

Rabbi .... Barbara ...... Metzinger ....... ............................................................................... Beaumont ............ TX 

Rabbi .... James R. .... Michaels ........ Congregation Beth Israel ...................................... Flint ..................... MI

Rabbi .... Mathew D. .. Michaels ........ Congregation Jewish Community North ................ Spring ................. TX 

Rev. ....... Gary L. ........ Miller ............. ............................................................................... Hartford ............... CT 

Rev. ....... William P. ... Miller ............. United Methodist Church ...................................... Whittier ............... CA 

Rabbi .... Rachel L. .... Miller ............. Congregation B’nai Shalom .................................. Walnut Creek ...... CA 

Rev. ....... Pamela M. .. Miller ............. Episcopal Church .................................................. Big Rapids .......... MI 

Rabbi .... Jonathan ..... Miller ............. Temple Emanu-El ................................................. Birmingham ........ AL 

Rev. ....... Melanie ....... Miller ............. First Congregational Church ................................ Chappaqua ......... NY 

Rev. ....... Joel ............. Miller ............. Unitarian Universalist Church .............................. Buffalo ................ NY 

Rev. ....... Charles S. .. Milligan ......... Prof. Emeritus, Iliff School of Theology ................ Denver ................. CO 

Rev. ....... Linda 

Penrod.

Million ............ United Methodist Church ...................................... Louisville ............. KY 

Rev. ....... Margaret ..... Mills ............... West Reserve Assoc., UCC .................................... Cleveland ............ OH

Rev. ....... Susan A. ..... Minasian ........ Disciples United Community Church .................... Lancaster ............ PA 

Rev. ....... Irene K. ....... Mitchell .......... ............................................................................... Spokane .............. WA 

Cantor ... Alberto ........ Mizrahi ........... Anshe Emet Synagogue ........................................ Chicago ............... IL 

Rabbi .... Jack ............ Moline ............ Agudas Achim Congregation ................................ Alexandria ........... VA 

Rabbi .... Diana .......... Monheit .......... The Temple ........................................................... Atlanta ................ GA 

Rev. ....... Karen A. ..... Monk .............. United Methodist Church ...................................... Kingston .............. NY

Rev. ....... Kenneth ...... Moore ............. Christian Church in Nebraska .............................. Lincoln ................ NE 

Rev. ....... Rob ............. Moore ............. Evangelical Lutheran Church of America ............ Houston ............... TX 

Rev. ....... Mary Katherine.Morn .............. First Unitarian Universalist Church ..................... Nashville ............. TN 

Ms. ........ SarahLee .... Morris ............ Covenant Presbyterian Church ............................. Lubbock ............... TX 

Rabbi .... Joel ............. Mosbacher ..... Beth Haverim Congregation ................................. MahwahN ............ J 

Pastor .... R.W.W. ........ Mueckenheim United Methodist Church of Hempstead .............. Hempstead .......... NY 

Rev. ....... Martha L. ... Munson .......... Unitarian Universalist Church of East Aurora ..... Elba ..................... NY 

Rev. ....... John A. ....... Nelson ............ The Dover Church ................................................. Dover ................... MA 

Rev. ....... Culver H. .... Nelson ............ Church of the Beatitudes (UCC) .......................... Phoenix ................ AZ 

Rev. ....... Gustav ........ Nelson ............ Presbytery of Des Moines ..................................... Des Moines ......... IA 

Rev. ....... Stacey ......... Nicholas ......... Immanuel UMC ..................................................... Canton ................ MO 

Rev. ....... Johanna ...... Nichols ........... Champlain Valley Unitarian Universalist Society Middlebury .......... VT 

Rev. ....... Sala ............ Nolan ............. United Church of Christ ....................................... Cleveland ............ OH 

Rev. ....... Eileen ......... Norrington ...... United Church of Christ ....................................... Cleveland ............ OH

Mr. ......... Robert ......... Ohl ................. Old York Road Temple-Beth Am ........................... Abington .............. PA 

Rev. ....... C. Bunny .... Oliver ............. First Presbyterian Church ..................................... Ashland ............... OR 

Rev. ....... Erick ........... Olsen ............. First Church Congregational ................................ Fairfield ............... CT 

Rev. ....... Melanie ....... Oommen ........ First Congregational UCC ..................................... Eugene ................ OR 

Rabbi .... Michael ....... Oppenheimer Suburban Temple-Kol Ami .................................... Beachwood .......... OH 

Rev. ....... Charles 

Blustein.

Ortman .......... Unitarian Church .................................................. Montclair ............. NJ 

Rev. ....... Marilyn ....... Pagan ............ ............................................................................... Chicago ............... IL 

Rev. ....... Archie M. .... Palmer Jr. ...... Episcopal Diocese of Newark ............................... Glen Ridge .......... NJ 

Rev. ....... Ann ............. Palmerton ...... Broad Street Presbyterian Church ........................ Columbus ............ OH 

Rev. ....... Sandra ........ Paran ............. Hospice of MI ........................................................ Detroit ................. MI 

Rev. ....... Richard S. .. Parker ............ United Methodist Church ...................................... Babylon ............... NY 

104

Title First and Middle Name Last Name Organization/Affiliation City State 

Rev. ....... R. Wayne .... Parrish ........... Loveland Presbyterian Church .............................. Loveland .............. OH 

Rev. ....... Stephen J. .. Patterson ....... Theological Seminary ............................................ St. Louis .............. MO 

Rev. Dr. Sheron ........ Patterson ....... St. Paul United Methodist Church ....................... Dallas .................. TX 

Rev. ....... Mark R. ...... Pawlowski ...... Planned Parenthood of South Central Michigan .. Kalamazoo ........... MI 

Rev. ....... Ron R. ........ Payson ........... Unitarian Universalist ........................................... Worcester ............ MA 

Rev. ....... Edgar .......... Peara ............. Unitarian Universalist ........................................... Eugene ................ OR 

Rev. ....... Frederic ...... Pease ............. UCC ....................................................................... Dresden ............... ME 

Rev. ....... Guy R. ........ Peek ............... RCRC, Western New York ..................................... Niagara Falls ...... NY 

Rev. Dr. John C. ....... Peiper ............ St. Christopher Episcopal Church ........................ Linthicum Heights MD 

Rev. ....... Barbara ...... Pekich ............ ............................................................................... Grand Rapids ...... MI 

Rev. ....... Clare L. ...... Petersberger .. Towson Unitarian Universalist Church ................. Lutherville ........... MD 

Rev. ....... Kerri ............ Peterson-Davis Presbyterian Church (USA) ................................... Duluth ................. GA 

Rev. ....... Thomas ....... Philipp ........... Long Island United Campus Ministries ................ Merrick ................ NY 

Rev. ....... Jeffrey ......... Phillips .......... Community United Church of Christ .................... Champaign ......... IL 

Rev. ....... John B. ....... Pierce ............. Westminster Presbyterian Church ........................ Eugene ................ OR 

Rev. ....... Deborah ...... Pitney ............. First UMC .............................................................. Eugene ................ OR 

Rev. ....... Gayland ...... Pool ................ ............................................................................... Fort Worth ........... TX 

Rev. ....... Lois M. ....... Powell ............ United Church of Christ ....................................... Cleveland ............ OH 

Bishop ... Neff ............ Powell ............ Episcopal Diocese of Southwestern Virginia ........ Roanoke .............. VA 

Rabbi .... Sally J. ........ Priesand ........ Monmouth Reform Temple .................................... Tinton Falls ......... NJ 

Rabbi .... James ......... Prosnit ........... Congregation B’nai Israel ..................................... Bridgeport ........... CT 

Rev. ....... Stephen D. Quill ............... New Hope Lutheran Church .................................. Missouri City ....... TX 

Ms. ........ Marlene ...... Quinn ............. Limestone Presbyterian Church ............................ Wilmington .......... DE 

Rev. ....... Jennifer L. .. Rake-Marona Group Health Cooperative ..................................... Tacoma ............... WA 

Rev. ....... James C. .... Ransom ......... Trinity Episcopal Church ...................................... Towson ................ MD 

Rev. ....... Anita ........... Rayburn ......... Tod Ave UMC ........................................................ Warren ................. OH 

Ms. ........ Anita ........... Redding ......... UCC ....................................................................... Cleveland ............ OH 

Rev. ....... Willard T. .... Reece ............. Kansas Religious Leaders for Choice ................... Wichita ................ KS 

Rev. ....... George F. .... Regas ............ The Regas Institute .............................................. Pasadena ............ CA 

Rev. ....... Nelson R. .... Reppert .......... University United Methodist Church ..................... Syracuse .............. NY 

Rev. ....... Ernesto ....... Reyes ............. UCC ....................................................................... Los Angeles ......... CA 

Ms. ........ Marlene ...... Richardson .... ............................................................................... Greenville ............ PA 

Rabbi .... Leah ........... Richman ........ Oheb Zedeck Synagogue Center ........................... Pottsville ............. PA 

Rev. ....... Tim ............. Riss ............... United Methodist Church ...................................... Smithtown ........... NY 

Rev. ....... Paul B. ....... Robinson ........ Medford Congregational UCC ............................... Medford ............... OR 

Rev. ....... T. Michael .. Rock ............... Central, United Church of Christ ......................... Providence ........... RI 

Mr. ......... Dave ........... Rockafellow ... Unitarian Universal Fellowship of Bozeman ........ Bozeman ............. MT 

Mrs. ....... Rachel ........ Rockafellow ... Unitarian Universal Fellowship of Bozeman ........ Bozeman ............. MT 

Ms. ........ Judith E. ..... Rogers ........... Unitarian Universalist Church at Washington 

Crossing.

Titusville ............. NJ 

Rev. ....... Cally ........... Rogers-Witte .. Southwest Conference, United Church of Christ Phoenix ................ AZ 

Rabbi .... Liz ............... Rolle .............. Temple Sinai ......................................................... Stamford ............. CT 

Rev. ....... Brooke ........ Rolston .......... Campus Christian Ministry ................................... Seattle ................. WA 

Mr. ......... Gary ............ Rooney ........... Presbyterian Women Churchwide Coordinating 

Team.

Minneola ............. KS 

Rev. Dr. Dan ............. Rosemergy ..... Brookmeade Congregational Church, UCC ........... Nashville ............. TN 

Rabbi .... Tracee L. .... Rosen ............. Valley Beth Shalom .............................................. Encino ................. CA 

Ms. ........ Ellen Y. ....... Rosenberg ...... Women of Reform Judaism, The Federation of 

Temple Sisterhoods.

New York ............. NY 

Rabbi .... David .......... Rosenn ........... The Jewish Service Corps ..................................... New York ............. NY 

Bishop ... Catherine S. Roskam .......... ............................................................................... Dobbs Ferry ......... NY 

Rev. ....... Eugene ....... Ross ............... Central Pacific Conference—UMC ....................... Portland .............. OR 

Ms. ........ Gloria .......... Rothhaas ....... Lakewood Congregational Church ........................ Lakewood ............ OH 

Rev. ....... Richard F. .. Rouquie, Jr. ... Hillwood Presbyterian Church ............................... Nashville ............. TN 

Cantor ... Lori ............. Salzman ......... Temple Beth Shalom ............................................ Needham ............. MA 

Rev. ....... David .......... Sammons ....... Mt. Diablo Unitarian Universalist Church ............ Walnut Creek ...... CA 

Rev. ....... Jason W. ..... Samuel .......... Transfiguration Episcopal Church ........................ Lake St. Louis ..... MO 

Rabbi .... Marna ......... Sapowitz ........ Temple Beth Hatfiloh ............................................ Olympia ............... WA

Rev. ....... Jill Job ........ Saxby ............. Maine Interfaith Council for Reproductive 

Choices and Unitarian Universalist Association.

Cape Elizabeth .... ME 

Rev. ....... Anna Clock Saxon ............. Westminster Presbyterian Church ........................ Peoria .................. IL 

Ms. ........ Marilyn ....... Scarpa ........... ............................................................................... Newton ................ PA 

Cantor ... Hollis Suzanne.Schachner ...... Temple Shir Tikva ................................................. Wayland .............. MA 

105

Title First and Middle Name Last Name Organization/Affiliation City State 

Rev. ....... James W. .... Schaefer ........ UCC ....................................................................... Decorah ............... IA 

Rev. ....... Donna ......... Schaper ......... Coral Gables Cong. Church .................................. Coral Gables ....... FL 

Cantor ... Jodi M. ........ Schechtman ... Temple Beth Am ................................................... Framingham ........ MA 

Rabbi .... Amy R. ........ Scheinerman .. Beth Shalom Congregation of Carroll County ...... Taylorsville .......... MA 

Cantor ... Robert S. .... Scherr ............ Temple Israel ........................................................ Natick .................. MA 

Rev. Dr. Robert ......... Schiesler ........ St. Luke’s Episcopal Church ................................ Montclair ............. NJ 

Mr. ......... Brian .......... Schofield-Bodt Golden Hill United Methodist Church ................... Bridgeport ........... CT 

Rev. ....... Christopher Schooley ......... Christians Presbyterian Church ............................ Newark ................ DE 

Rev. ....... William C. .. Schram .......... Presbyterian Church ............................................. Fort Myers ........... FL 

Rev. ....... Gilbert ........ Schroerlucke .. UM Clergy ............................................................. Louisville ............. KY 

Rev. ....... Mike ............ Schuenemeyer Diamond Bar Congregational UCC ....................... Diamond Bar ....... CA 

Ms. ........ Helen .......... Sears ............. Churchwide Coordinating Team Presby. Women .. Owensboro ........... KY 

Rev. ....... David .......... Selzer ............. Episcopal Church of the Good Sheperd ............... Buffalo ................ NY 

Rev. Dr. Robert ......... Senghas ......... Unitarian Universalist ........................................... Burlington ........... VT

Cantor ... Judith ......... Seplowin ........ Temple Beth-El ..................................................... Providence ........... RI 

Rev. ....... John S. ....... Setterlund ...... Lutheran Church ................................................... Champaign ......... IL

Rev. ....... Arthur G. .... Severance ...... First Unitarian Universalist Church of San Antonio.San Antonio ........ TX 

Rev. Dr. David M. ..... Seymour ......... United Church of Christ/Presbyterian Church USA Tulsa ................... OK 

Rev. ....... Robert E. .... Seymour ......... American Baptist .................................................. Chapel Hill .......... CA 

Rabbi .... Richard ....... Shapiro .......... Congregation B’nai B’rith ..................................... Santa Barbara .... CA 

Rabbi .... Alan ............ ShavitLonstein.Tri-City Jewish Center ........................................... Rock Island ......... IL 

Rabbi .... Randy ......... Sheinberg ...... Congregation Rodeph Sholom .............................. New York ............. NY 

Ms. ........ Patricia ....... Shepherd ....... ............................................................................... Des Moines ......... IA 

Rabbi .... Alan ............ Sherman ........ ............................................................................... West Palm Beach FL 

Rev. ....... Mary E. ....... Shields ........... Trinity Lutheran Seminary .................................... Columbus ............ OH 

Rev. ....... Martha M. .. Shiverick ........ Presbytery of the Western Reserve ....................... Cleveland ............ OH 

Cantor ... Linda .......... Shivers ........... Congregation Neveh Shalom ................................ Portland .............. OR 

Rabbi .... Marion ........ Shulevitz ........ Rabbinical Assembly ............................................ New York ............. NY 

Rabbi .... Robert A. .... Silvers ............ Congregation B’nai Israel ..................................... Boca Raton ......... FL 

Rev. ....... Lib Mcgregor Simmons ........ University Presbyterian Church ............................ San Antonio ........ TX 

Rev. ....... Elisabeth K. Simpson ......... First Presbyterian Church ..................................... Glen Cove ............ NY 

Rev. ....... William G. .. Sinkford ......... President, Unitarian Universalist Association ...... Boston ................. MA 

Rabbi .... Steven ........ Sirbu .............. North Shore Synagogue ........................................ Syosset ................ NY 

Rev. Dr. Joanne ........ Sizoo .............. Presbyterian Church USA ...................................... Cincinnati ........... OH 

Rev. ....... Jeremy ........ Skaggs ........... Fellowship Congregational Church ....................... Tulsa ................... OK 

Rev. ....... Angela 

Maddalone.

Skinner .......... First Presbyterian Church of Yorktown ................. Yorktown Heights NY 

Chaplain Donald ........ Skinner .......... Living Enrichment Center ..................................... Wilsonville ........... OR 

Rev. ....... Stanely E. ... Skinner .......... Emmanuel/Friedens Church .................................. Schenectady ........ NY 

Rev. ....... Joseph Andrew.Slane ............. Southminster Presbyterian Church ....................... Birmingham ........ AL 

Rev. Dr. Michael D. .. Smith ............. First Presbyterian Church ..................................... Grinnell ............... IA 

Ms. ........ Mary Elva ... Smith ............. Presbyterian Church (USA) ................................... Louisville ............. KY 

Rabbi .... Ronald B. ... Sobel .............. Congregation Emanu-El of the City of New York New York ............. NY 

Rev. ....... Richard ....... Sparrow ......... United Church of Christ ....................................... Cleveland ............ OH 

Ms. ........ Kerith .......... Spencer-Shapiro.Hebrew Union College-Jewish Institute of Religion.New York ............. NY 

Rev. ....... David W. ..... Spollett .......... First Church, UCC ................................................. Fairfield ............... CT 

Rev. ....... E. Kyle ........ St. Claire ....... St. Philip’s Episcopal Church ............................... New Hope ............ PA 

Rev. ....... Lynn ............ Stanton-Hoyle Clifton Presbyterian Church ................................. Clifton ................. VA

Rabbi .... Sonya .......... Starr .............. Columbia Jewish Congregation ............................ Columbia ............. MD 

Rev. Dr. William R. .. Stayton .......... Widener University ................................................ Chester ................ PA 

Cantor ... Debra .......... Stein .............. The Jewish Center of the Hamptons .................... East Hampton ..... NY 

Rev. Dr. Elizabeth .... Stein .............. ELCA; New Hope Lutheran Church ....................... Missouri City ....... TX 

Rabbi .... Margot ........ Stein .............. Jewish Reconstructionist Federation .................... Elkins Park .......... PA 

Rabbi .... Jonathan A. Stein .............. ............................................................................... New York ............. NY 

Rabbi .... David E. ..... Stern .............. Temple Emanu-El ................................................. Dallas .................. TX 

Cantor ... Ellen ........... Stettner .......... Stephen Wise Free Synagogue .............................. New York ............. NY 

Rev. ....... Jerald M. .... Stinson .......... First Congregational Church ................................ Long Beach ......... CA 

Rev. ....... Nathan L. ... Stone ............. Unitarian Universalist Fellowship of Waco .......... Waco ................... TX 

Rabbi .... Susan B. .... Stone ............. Temple Beth Shalom ............................................ Hudson ................ OH 

Rev. ....... Robert J. ..... Stout .............. UMC ...................................................................... Horse Cave .......... KY 

106

Title First and Middle Name Last Name Organization/Affiliation City State 

Rabbi .... David .......... Straus ............ Main Line Reform Temple Beth Elohim ............... Wynnewood .......... PA 

Rev. Dr. Charles H. .. Straut, Jr. ...... UMC ...................................................................... Brooklyn .............. NY 

Rev. ....... Victoria I. ... Streiff-Fraser Unitarian Universalist Congregation of Columbus, In.Columbus ............ IN 

Rev. ....... Elwood ........ Sturtevant ...... Thomas Jefferson Unitarian Church ..................... Louisville ............. KY 

Cantor ... Jodi L.Sufrin Temple Beth 

Elohim.

Wellesley ............................................................... MA.

Rabbi .... Brooks R. .... Susman ......... Temple Shaari Emeth/PPCNJ ................................ Manalapan .......... NJ 

Rev. ....... Helen .......... Svoboda-Barber.Episcopal .............................................................. Topeka ................. KS 

Rev. ....... M. Thomas Swantner ....... ............................................................................... Pana .................... IL 

Rev. ....... Gail ............. Tapscott ......... Unitarian Universalist Church of Ft. Lauderdale Ft. Launderdale ... FL 

Rev. ....... Arch B. ....... Taylor ............. Presbyterian Church ............................................. Louisville ............. KY 

Rabbi .... David H. ..... Teitelbaum ..... Board of Rabbis of Northern California ............... San Francisco ..... CA 

Mr. ......... Jeffery L. ..... Termini .......... ............................................................................... Tonawanda .......... NY 

Rev. ....... Eugene ....... TeSelle ........... Vanderbilt Divinity School .................................... Nashville ............. TN 

Rev. ....... Bob ............. Thaden ........... United Congregational Church UCC ..................... Butte ................... MT 

Rev. ....... Jane ............ Thickstun ....... UU Fellowship of Midland, MI .............................. Midland ............... MI 

Rev. ....... Tim ............. Tiffany ........... First Christian Church .......................................... Medford ............... OR 

Rev. ....... George Ayer Tigh ............... UMC ...................................................................... Lansdale ............. PA 

Rev. ....... Edward ....... Tourangeau .... St. John’s Episcopal Church ................................. Lafayette ............. IN 

Rev. ....... Larry E. ....... Treece ............ Evansville United Church of Christ ...................... Evansville ............ WI 

Cantor ... Louise ......... Treitman ........ Temple Beth David ............................................... Westwood ............ MA 

Rev. ....... Thomas R. .. Uphaus .......... United Church of Christ ....................................... Clinton ................ MI 

Rev. ....... David L. ...... Van Arsdale ... First Presbyterian Church ..................................... Kalamazoo ........... MI 

Rev. ....... Doug ........... Van Doren ...... Plymouth Congregational UCC ............................. Grand Rapids ...... MI 

Rev. ....... Jane W. ....... Van Zandt ..... Episcopal Diocese of Maryland ............................ Baltimore ............ MD 

Rev. ....... Ernest F. ..... VanderKruik ... United Methodist Church ...................................... Warwick ............... NY 

Rev. ....... Karen .......... Vannoy ........... United Methodist Church ...................................... San Antonio ........ TX 

Rev. ....... Heidi ........... Vardeman ...... Macalester Plymouth United Church .................... St. Paul ............... MN 

Rev. ....... Jessica ........ Vazquez ......... Christian Church (Disciples of Christ) ................. Indianapolis ........ IN 

Rev. ....... Ross ........... Walters .......... Eureka Christian Church ...................................... Eureka ................. IL 

Rev. ....... Paul Reynolds.Warren ........... St. Paul’s UCC ...................................................... Schulenburg ........ TX 

Rev. ....... Penelope M. Warren ........... Episcopal Church .................................................. San Francisco ..... CA 

Rev. ....... Mary Ellen .. Waychoff ........ Macon County Larger Parish-Presbyterian ........... New Cambria ...... MO 

Rev. ....... Theodore A. Webb .............. Unitarian Universalist ........................................... Sacramento ......... CA

Rev. ....... Gloria .......... Weber ............. Evangelical Lutheran Church of America ............ St. Louis .............. MO 

Rabbi .... Elyse ........... Wechterman ... Congregation Agudas Achim ................................ Attleboro .............. MA 

Rev. ....... Cynthia D. .. Weems ........... United Methodist Church ...................................... Kansas City ......... KA 

Rev. ....... Victoria ....... Weinstein ....... Channing Memorial Church, Unitarian Universalist.Columbia ............. MD 

Rev. ....... Lauren M. ... Welch ............. Episcopal Diocese of Maryland ............................ Baltimore ............ MD 

Rev. ....... Jonathan N. Weldon ........... Episcopal Church of the Resurrection ................. Eugene ................ OR 

Rev. ....... Clarence E. 

Ken.

Whitwer .......... United Church of Christ ....................................... Grand Rapids ...... MI 

Rabbi .... David S. ..... Widzer ............ Temple Shalom of Newton .................................... Newton ................ MA 

Rev. ....... Bets ............ Wienecke ........ Live Oak Unitarian Universalist Congregation ..... Goleta .................. CA 

Rev. ....... Susan 

Anslow.

Williams ......... RCRC ..................................................................... Jamestown .......... NY 

Rev. ....... Clark ........... Wills ............... Episcopal Church .................................................. Seattle ................. WA 

Rev. ....... Dennis ........ Winkelback .... New York Conference—United Methodist Church Newburgh ............ NY 

Rev. ....... Karyn L. ...... Wiseman ........ Grandview UMC .................................................... Kansas City ......... KS

Rev. Dr. J. Philip ...... Wogaman ....... Foundry United Methodist Church ........................ Washington ......... DC 

Rev. ....... William 

James.

Wood .............. St. John’s Episcopal Church ................................. Wichita ................ KS 

Rev. ....... Hillary ......... Wright ............ ............................................................................... Kansas City ......... MO 

Rev. ....... Michael G. .. Young ............ First Unitarian Church of Honolulu ...................... Honolulu .............. HI 

Rev. Dr. Robert D. .... Young ............ Presbyterian USA .................................................. West Chester ....... PA 

Ms. ........ Judith D. ..... Zelson ............ Temple Beth-El ..................................................... Northbrook ........... IL 

Rev. ....... Craig D. ...... Zimmerman ... St. Paul’s United Church of Christ ...................... Ringtown ............. PA 

The 1,700-member Central Conference of American Rabbis and the Justice and Witness Ministries of the United Church of Christ have also 

endorsed this statement. 

107

Mr. BILIRAKIS. Ladies and gentlemen, thank you so very much. 

It was a great hearing and you made it such and we have learned 

an awful lot. I trust we can all do the right thing tomorrow. 

Thank you. God bless you. 

[Whereupon, at 5:22 p.m., the hearing was adjourned.] 

[Additional material submitted for the record follows:]

PREPARED STATEMENT OF THE AMERICAN CIVIL LIBERTIES UNION

I. INTRODUCTION

The American Civil Liberties Union, a nationwide, non-partisan organization with 

nearly 300,000 members dedicated to protecting the individual liberties and freedoms guaranteed by the Constitution and laws of the United States, respectfully 

submits this testimony to the House of Representatives Committee on Energy and 

Commerce regarding abstinence-only-until-marriage education programs. As the 

Committee considers H.R. 4122, which would reauthorize the abstinence-only-untilmarriage education program contained in Section 510 of the Social Security Act 

through the year 2007, the ACLU urges the Committee to weigh the serious civil 

liberties and public health concerns posed by these programs. 

While the ACLU believes that discussion of abstinence is an important component 

of any educational program about human sexuality, we oppose programs, such as 

the one outlined in Section 510, that focus exclusively on abstinence and censor 

other valuable information that can help young people to make responsible and safe 

decisions about sexual activity and reproduction. Moreover, in addition to their restrictions on free speech, abstinence-only-until-marriage programs endanger the 

health of young people, create a hostile environment for lesbian and gay youth, and 

dangerously entangle the government with religion. 

II. ABSTINENCE-ONLY PROGRAMS CONSTITUTE GOVERNMENT-SPONSORED CENSORSHIP. 

The current Section 510 language permits federal funds to be used only for programs that have as their ‘‘exclusive purpose,’’ teaching the benefits of abstinence. 

See 42 U.S.C. § 710. In addition, recipients of these funds may not provide a participating adolescent with any other information regarding sexual conduct in the same 

setting as the abstinence program. Thus, recipients of federal abstinence-only funds 

operate under a federally imposed gag order that prohibits them from providing information in a funded program on preventing sexually transmitted diseases or pregnancy through the use of recognized methods of contraception, even when they are 

asked directly for this information by a young person participating in the program. 

As the Supreme Court said in Board of Education v. Pico, 457 U.S. 853, 867 (1982), 

when addressing censorship in a school context, ‘‘We have recognized that the State 

may not, consistently with the spirit of the First Amendment, contract the spectrum 

of available knowledge. In keeping with this principle, we have held that in a variety of contexts the Constitution protects the right to receive information and ideas.’’

(citations omitted). 

Because more comprehensive sexuality information cannot be provided in a federally funded abstinence-only program, the result of these programs is that teachers 

are censored and students are denied critical information. Material on contraception, sexually transmitted diseases, and sexual orientation has literally been ripped 

out of textbooks used in such programs. Some teachers have been disciplined or 

threatened with lawsuits for speaking frankly in the classroom about matters of sexuality or for answering direct questions from students. The fear of such recrimination chills important speech in our schools. ‘‘[T]he First Amendment... does not tolerate laws that cast a pall of orthodoxy over the classroom.’’ Keyishian v. Board of 

Regents, 385 U.S.589, 603 (1967). 

The Section 510 abstinence-only program thus infringes on constitutional rights 

of free expression by censoring the transmission of vitally needed information about 

human sexuality and reproduction. Section 510 not only suppresses a particular 

viewpoint on sexuality, which is the most egregious form of speech regulation, cf. 

Rosenberger v. Rectors & Vistors of the Univ. of Virginia, 515 U.S. 819, 829 (1995), 

it suppresses the very information about sexuality that is most critical to teens. Section 510 leaves grantees no choice but to omit any mention of topics such as contraception, abortion, homosexuality, and AIDS or to present these subjects in a nonscientific, inaccurate or incomplete fashion. 

108

II. ABSTINENCE-ONLY PROGRAMS ARE INEFFECTIVE AND ENDANGER YOUNG PEOPLE’S

HEALTH. 

There is no compelling data that demonstrate that abstinence-only programs 

funded under Section 510 are effective in helping to delay sexual initiation or in reducing risk-taking behaviors among young people. In fact, the overwhelming weight 

of evidence suggests that programs that include messages about both abstinence 

and contraception are most effective in delaying the onset of sex among young people, reducing the number of sexual partners they have, and in making them better 

users of contraception when they do become sexually active. 

Far from being concerned about ‘‘mixed messages,’’ parents support comprehensive sexuality education that includes information about abstinence and about contraception. Studies show that parents want other trained adults to provide accurate 

and forthright information about sex to their children. See Tina Hoff et al., Sex Education in the Classroom 30-33 (2000). 

Evidence also suggests that the availability of federal abstinence-only dollars is 

steering schools away from teaching comprehensive sexuality education altogether, 

even in their non-restricted (i.e. non-federally funded) programs. There are several 

causes of this phenomenon. First, schools have limited curricular time to devote to 

sexuality instruction. If they are paid by the federal government to devote that instructional time to abstinence, they are unlikely to set aside additional time for comprehensive sex education. Second, because federal abstinence dollars are matching 

dollars, state funds for sex education are being diverted into these programs and 

there is little state funding left for more comprehensive programs. According to one 

study, as of 1999, one-third of the nation’s high schools were promoting abstinenceonly education, while excluding information about contraception and safer sex. See

Adam Sonfield and Rachael Benson Gold, States’ Implementation of the Section 510 

Abstinence Education Program, FY 1999, 33(4) Family Planning Perspectives 166 

(2001). Thus, abstinence-only money is reducing the availability of information that 

young people—many of whom are already sexually active—need to protect their 

health and to prevent unintended pregnancies. 

Abstinence-only programs also undermine efforts to stop the spread of HIV and 

other sexually transmitted diseases. These programs often provide inaccurate information about the effectiveness of condoms in preventing the transmission of HIV 

and exaggerate the data on condom failure rates. Such misleading information poses 

grave risks to young people’s health. 

IV. ABSTINENCE-ONLY PROGRAMS CREATE A HOSTILE ENVIRONMENT FOR LESBIAN AND

GAY TEENS AND POSE PARTICULAR RISKS TO THE HEALTH OF THESE TEENS. 

Abstinence-only programs are particularly harmful to lesbian and gay youth. By 

excluding information about safer sex practices and teaching about sex only in the 

context of marriage, abstinence-only programs stigmatize gay and lesbian teens and 

undermine efforts to educate those teens about HIV and STD prevention. 

Abstinence-only programs also create a hostile environment for lesbian and gay 

youth. These programs rely on fear and shame and address same-sex sexuality only 

as a context for HIV transmission. At least two widely used abstinence-only curricula—‘‘Clue 2000’’ and ‘‘Facing Reality’’—are overtly hostile to lesbians and gay 

men. Moreover, section 510 requires that all federally funded programs teach that 

‘‘a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity’’ and that ‘‘sexual activity outside the context of marriage is likely to have harmful psychological and physical effects.’’ See 

42 U.S.C. § 710. In a society that generally denies gays and lesbians the right to 

marry, these programs thus essentially reject the idea of sexual intimacy for lesbian 

and gay youth and even deny their very humanity. Such clear hostility violates the 

rights of lesbian and gay youth to attend school free of discrimination. 

V. ABSTINENCE-ONLY PROGRAMS DANGEROUSLY ENTANGLE THE GOVERNMENT WITH

RELIGION. 

Many abstinence-only curricula contain religious prescriptions for proper behavior 

and values, in violation of the First Amendment’s guarantee of the separation of 

church and state. A popular abstinence-only curriculum called ‘‘Sex Respect,’’ for example, was originally designed for parochial school use. While it now uses the term 

‘‘nature’’ in place of ‘‘God,’’ it still has strong religious undertones and cites religious 

publications as its reference sources. 

Although federal guidelines do not permit abstinence-only grant recipients to convey religious messages and to impose religious viewpoints on participants, in practice, many of these programs do precisely that. In one example, a program that reVerDate 0ct 02 2002 09:18 Oct 05, 2002 Jkt 010199 PO 00000 Frm 00112 Fmt 6633 Sfmt 6621 W:\DISC\79467 79467
109

ceived federal abstinence-only funds submitted as part of its grant proposal a request for $750 to buy Bibles for each participant in the program and to engrave the 

participants’ names on the Bibles. Another program that received federal abstinence-only funds submitted a sample skit as part of its funding request in which 

Jesus was a main character and in which the narrator explained that ‘‘Christ can 

forgive any sins in our lives.’’ This is an inappropriate and unnecessary entanglement of government with religion. The rigidity of the federal abstinence-only requirements make it more likely that such entanglement will occur because it skews 

funding toward more ideological perspectives and away from more medical and scientific perspectives. 

VI. CONCLUSION

The ACLU urges the Committee to weigh these serious civil liberties concerns 

when considering H.R. 4122. 

AMERICAN HOSPITAL ASSOCIATION

April 19, 2002

DEAR ENERGY AND COMMERCE COMMITTEE MEMBER: 

On behalf of the American Hospital Association (AHA) and our nearly 5,000 member hospitals, health systems, and networks of care, I am writing to express support 

for two pressing legislative matters that should be included in your mark up of legislation reauthorizing the Temporary Assistance to Needy Families (TANF) program: Medicaid and SCHIP eligibility for legal immigrants and a longer extension 

of the Transitional Medical Assistance (TMA) program. 

AHA supports legislation that would allow states to cover legal immigrants under 

Medicaid and SCHIP, such as the Immigrant Children’s Health Improvement Act 

(H.R. 1143). It is important that lawfully present pregnant women and children receive health care at the appropriate time, otherwise, they risk developing health 

complications that could have been prevented. Hospital emergency room services 

should not be the sole source of health care for poor immigrants. From an economic 

and health perspective, the benefits of investing in preventive services for these lawfully present persons are well established. 

AHA also supports a full extension of Medicaid services for families making their 

way from welfare to work. There already is wide bipartisan agreement that continued access to health care is a key factor in helping families stay in the workforce. 

TMA should be extended permanently or for the full period of this reauthorization 

bill and measures to simplify enrollment and retention of such families should be 

included. 

Thank you for your consideration of these important matters. 

Sincerely, 

RICK POLLACK

Executive Vice President 

PREPARED STATEMENT OF JOHN R. DIGGS, JR. 

Ladies and gentlemen of the Committee: With great pleasure we advocate for the 

reauthorization of Title V for a full five-year period. 

I am a board certified Internal Medicine specialist well versed in the literature 

and clinical aspects of sexually transmitted diseases and unmarried teenage pregnancy. 

We have learned that the ability to freely choose is a characteristic that Americans highly value. Until the advent of Title V through the Welfare Reform Act of 

1996, Americans had very little choice in the method in which their children were 

instructed in schools on the issue of sex education. 

Finally, the paradigm shifted from sexual know-how to the new emphasis on character development and the renewal of the emphasis on marriage. Finally it was recognized that Title X, devoted to family planning, was unable to bring about a reduction in unmarried teenage pregnancy or STD rates. 

While there was never a provision for actually testing the effectiveness of Title 

X, its budget continued to grow without significant oversight or evidence of efficacy. 

Not only that but it turns out that most of the indicators of sexual chaos worsened 

during the unopposed reign of the ‘‘comprehensive sex education’’ school of thought 

and teaching. 

110

The most reliable STD statistic is that from NHANES regarding the frequency of 

genital herpes. The findings are remarkable. The series of studies show that the 

herpes rate climbed at the same time that condom promotion was at full tilt. The 

sexual revolution had already been established. AIDS had transformed from a 

phrase meaning ‘‘help’’ to a deadly, big disease with a little name. During the tenyear period between 1980 and 1990, herpes positivity rose by a third. The most recent NHANES study says that fully 20 percent of Americans over the age of 12 are 

permanently infected with Herpes 2, the causative agent of genital herpes. 

Clearly something comprehensive sex education and condom utilization failed to 

slow the epidemic—au contraire, herpes rates increased. 

True understanding of the problem was achieved with the release of a document 

from the National Institutes of Health entitled ‘‘Scientific Evidence of Condom Effectiveness in Preventing Transmission of Sexually transmitted Diseases. The conclusions of the panel after extensive literature review were that scientific proof of 

condom effectiveness in preventing herpes transmission was lacking. However, this 

ten-month year old report has not had the expected effect of correcting the erroneous information about so-called ‘safe sex’ that has dominated the educational platform of the last twenty years. The call for consistent condom use rings out in quarters from Planned Parenthood to a variety of other organizations interested in 

condom promotion. Unfortunately, it is still considered optional to tell the public the 

simple truth. Despite the dramatic increase in condom usage, the herpes epidemic 

continues unabated due to the startlingly obvious factor that condoms don’t stop 

herpes transmission. 

The case of herpes and lack of condom effectiveness is only one example of the 

legerdemain that dominates the philosophy of ‘‘comprehensive sex education.’’ Even 

the name itself is a misnomer. The most comprehensive aspect of the education is 

the complete denial that the cornerstone of the approach—condoms—has been found 

to be inefficacious, not by abstinence-until-marriage ideologues seeking supporting 

data from obscure journals, but by distinguished panel of experts who reviewed copious data to reach their conclusions. 

Of eight diseases, the panel could only find scientific evidence of condom effectiveness for one and a half. These results should compel wholesale changes in any program that touts itself as comprehensive. Parents, teachers and doctors should be 

scrambling to apologize to the offspring, students and patients for relying on outdated misinformation. This misinformation leads adolescents across the country to 

into a false sense of security not seen since the embarking of the Titanic. For decades, youth have been told to protect themselves with condoms. It turns out that 

such protection is no more effective than a newspaper protecting a fancy hairdo in 

a monsoon. 

For an educational philosophy that calls itself ‘‘comprehensive’’ to leave out this 

key piece of information is so ironic that one would think it intentionally sarcastic. 

Another example is a series of programs that the Centers for Disease Control and 

Prevention have labeled ‘‘Programs That Work.’’ If there ever was a misnomer, this 

is it. If a program can be firmly classified as working by a scientific organization, 

then it should decrease teen pregnancy and STD rates significantly and repeatedly. 

However, that is not the criteria by which these programs were christened. Instead, 

all they showed was an increase in condom usage and a delay in first sexual experience measured in mere weeks. Having established that condoms have severely limited proof effectiveness, programs that increase condom use actually increase the 

utilization of a defective methodology. More of something that doesn’t work is more 

failure. The programs should be properly titled, ‘‘Programs that wished they 

worked.’’ Multiply numbers less than one leads to smaller and smaller numbers, not 

better outcomes. 

The CDC admits that 65 million Americans have an incurable sexually transmitted disease. This information, combined with the NIH findings on scientific evidence of condom effectiveness, is an irrefutable indictment of the comprehensive sex 

methodology. It has not worked and it cannot work. Furthermore, there is no theoretical foundation to expect success of the condom-based protection in the future. 

The result has been that we daily expose our youth to incurable disease. Most notable among these is human papilloma virus, HPV. The American Cancer society 

agrees that HPV is the causative agent of cervical cancer, a malady that kills more 

women in the USA than AIDS. 

The good news is that Health and Human Services, under the guidance of the 

Welfare Reform Act, invested in a new approach that has several important characteristics that distinguish it from the failed and simplistic ‘‘Just Say Condom’’ campaigns of the last two decades. Not only are the characteristics distinct but also the 

tone is distinct. 

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Abstinence-until-marriage education is directive. It does not abandon teens to a 

panoply of complex choices where the most troublesome choices are also the most 

attractive. It does what any good teaching does—spotlights the best choice and presents it as the expected selection. Students respond to high expectations better than 

low common denominators. 

Abstinence-until-marriage education is modest. It does not violate the natural 

modesty of children by having an authority figure direct them to mimic handling 

mockups of male organs to demonstrate efficiency in handling prophylactics. There 

are two major problems. First, efficient handling of an inefficient product results in 

more STD exposure, not less. Second, it is degrading, especially for girls to publicly, 

in the name of academic education, practice private adult behavior. Condom games 

in the classroom game trivialize the marital act. While such trivialization is the staple of pornographers and other media exploiters, it degrades the classroom. The 

classroom should train our youth to compete academically in a hostile world. What 

can be more embarrassing than to discover that American kids can handle condoms 

but not the Pythagorean theorem? Such misplaced priorities are a recipe for disaster 

in terms of national security, national economic status, the ongoing development of 

superior educational systems and students. The most tragic victim is the national 

moral standard. 

Alex de Tocqueville said two centuries ago that, ‘‘America is great because America is good.’’ He did not say, ‘‘America is great because their young ’uns can whip 

on condoms like no one in Europe!’’ Abstinence-until-marriage builds character and self-control. Unlike slapping on a 

condom, self-control must be cultivated over time. It is not a momentary act to master. When properly developed, it will help teens become adults that are effective, resistant to corruption, long-range planners, and considerate of others. On the other 

hand, condom-focused mentality thinks only of pleasing self. It demands immediate 

and compulsive satisfaction. Just as self-control bleeds into areas of life other than 

the sexual, likewise does the practice of immediate gratification. 

If society seeks an answer to the upward spiral of sexual assault of children and 

by children, look no further than the mantra of low expectations pedaled to youth, 

‘‘Kids are going to have sex anyway.’’ If that notion, confirmed by adults, is accepted 

by the teens, having sex ‘‘anyway’’ can include even if the other person says ‘‘no.’’ The character building associated with abstinence-until-marriage will benefit 

other areas of life. Several high-profile financial scandals, cheating at prestigious 

universities and public officials lying under oath point to the need to reinstate good 

character as a virtue rather than a stigma. 

Slowly but surely, it is becoming common knowledge that it is true: Abstinenceuntil-marriage and faithfulness within marriage are the only 100 percent effective 

ways to avoid unmarried parenthood and STDs. Begrudgingly, even abstinence opponents admit this. They were, of course, encouraged to do so because there was 

a money stream attached to accepting such statements. Indeed, a number of parties 

affiliated with Planned Parenthood applied for Title V grants despite publicly denigrating the concepts. 

Their reluctantly offered endorsement is accepted. 

But there is something more important that comes with the Title V authorization. 

It is something that is usually prized by the most vocal opponents to Title V. That 

is ‘‘choice.’’

Parents should have a choice of how to educate their children. Ideally, education 

on these issues should be issues for home and not for school. There has not been 

much choice in the last two decades. Coarse and graphic treatment of sex has been 

imposed by those who felt that the crisis was so urgent that we should bypass the 

usual precautions. Those precautions protect minors from sexual and age-inappropriate images, inappropriate classroom discussion, and degrading and embarrassing 

classroom demonstrations. 

This was done in the name of eliminating a crisis but appears, instead, to have 

perpetuated a crisis. 

Much was made of a decision by the American Medical Association to endorse 

condom distribution in schools instead of abstinence. The AMA, in that same statement admitted that the decision was not based on the weight of the evidence. They 

wrote, ‘‘condom distribution shows promise.’’ About abstinence they wrote, ‘‘needs 

more study.’’ Each of these phrases mean the same thing—data is lacking to come 

to a scientific conclusion. Rather than plainly stating that, a small body of a few 

more than a dozen persons leveraged the entire organization of 350,000 physicians 

to supposedly support this position. I applaud the honesty of the drafters in not 

overstating their findings. Indeed, data does not exist to make a scientific conclusion. Therefore, the AMA was reduced to endorsing a position despite a lack data 

to do so. 

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An intelligent reading of the AMA’s resolution reveals that we still have ‘‘choice.’’ Yes, parents and educators can legitimately challenge and even reject the failed 

comprehensive sex paradigm. 

Indeed, they have done so in droves. Hundreds of people and organizations have 

applied for funding provided by Title V. The government seed money has served to 

bring hope, modesty and respect to a position that ALL parties admit is the only 

one with 100 percent success in stopping the STD epidemic and unmarried teenage 

pregnancy. It only fails when people choose not to use it. 

Title V funding has brought about the development of new curricula and programs that bring hope, smiles, dignity and future orientation to a generation that 

has been hijacked into the existential wasteland of immediate gratification. The new 

programs serve to offer all teens a better way, a path with clear direction, solid 

principles and respect for the dignity of the individual. Most of all, important truths 

are revealed, finally magnifying the fine print of on condom efficiency. The fine print 

reads ‘‘All you have heard about condoms as protection has been greatly exaggerated. More condom usage has only resulted in more STD transmission.’’

The reauthorization should be for the full five years. I have studied the questionnaire that is expected to offer ‘‘the final word’’ on abstinence-until-marriage. The 

questionnaire could not possibly answer the question, ‘‘Does abstinence-until-marriage work?’’ It reads more like a sex survey. The most astute parents will not permit their children to answer such invasive questions. The programs that understand 

the importance that modesty plays in a person maintaining integrity will also reject 

invasive questions. Therefore, the only persons who will consent are those who have 

an impaired sense of modesty. This produces selection bias that decreases the validity of such a questionnaire. 

The other major problems with this questionnaire are beyond the scope of this testimony but can be obtained by writing the Committee for Sound Evaluation at PO 

Box 45, South Hadley, MA 01075. 

With this tightly woven logical compendium of facts, it is a basic call to ‘‘choice’’

to allow parents and programs to continue the maturing of abstinence-until-marriage as the alternative to disastrous legacy of ‘‘comprehensive sex education’’ and 

its misnamed clone, ‘‘Abstinence Plus.’’

I offer this testimony with honesty and simplicity, as a physician that diagnoses 

and treats people who have grown up knowing nothing but ‘‘safe sex.’’ If it were 

truly safe, I would not have to treat them. 

Please permit American families to continue to have a choice in this matter. If 

they don’t want it, they can reject it at the state level by not matching the federal 

funds. Thus far, 49 of 50 states have seen fit to match the federal funds. That 

speaks volumes. 

Authorize Title V Abstinence-until-marriage for another five years. Choice is not 

dependent upon the results of a seriously flawed evaluation. 

PREPARED STATEMENT OF ALMA L. GOLDEN, MEDICAL DIRECTOR AND CAROL J. 

RAND, SAGE ADVICE COUNCIL, INC. 

The casualties of war are many and are strewn all around us. They are not the 

wounded, maimed and dead of terrorist attacks. They are the cancer-stricken, infertile and mortally wounded of sexually transmitted diseases. Most of their wounds 

were initially inflicted during adolescence. Deceived into believing that they were 

fully armed and protected, these youth launched into the fray of the ongoing sexual 

revolution. However, as P. J. O’Roarke has said, ‘‘The germs won.’’’

Each year, three million of the STDs contracted occur among adolescents. Consequences of these infections range from quickly curable to lethal. Bacterial infections such as chlamydia and gonorrhea can be cured but, if left untreated in the 

female adolescent, they lead to pelvic inflammatory disease which scars reproductive 

organs and greatly increases the probability of infertility. Viral infections such as 

herpes simplex, human papilloma virus (HPV), and HIV have lifelong and potentially fatal consequences. Eruptions of herpes simplex can be randomly reactivated 

throughout life, causing not only pain and discomfort to the individual but also the 

possibility of transmission to the sexual partner. HPV infects about 30% of the sexually active teens, though rates between 45% and 51% have been found among female 

army recruits. Since HPV is associated with 93% or more of the cases of cervical 

cancer, and approximately 10% of those infected will progress to dysplasia, health 

ramifications for the next generation are enormous. Finally, though HIV is the least 

infectious of these STDs, its transmissibility is increased two to five times by the 

presence of other STDs. Currently, in developed countries, HIV has almost reached 

a ‘‘chronic illness’’ status. However, when treatment fails, it is fatal. 

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Additional casualties of this war come from unintended pregnancies. Lives of adolescents and their offspring are forever changed. Young women who choose to terminate these pregnancies often struggle emotionally with the results of that choice for 

the rest of their lives. Young women who carry these pregnancies full term encounter a host of difficulties—many ensuing from aborted schooling. (Only 64% of teen 

mothers complete high school or get a GED as compared to 94% of their female 

peers who did not give birth.) Lower maternal educational level segues into 80% of 

teen mothers eventually going onto welfare. Subsequently, the single teen mother’s 

incomplete education and limited job opportunities make her children ten times 

more likely to be poor than those of a married high school graduate who was at 

least 20 years old at the birth of her first child. 

Surrounded by these walking wounded from the most recent campaigns of the 

sexual revolution, the commanding officers must analyze the current strategy, 

evaluate its effectiveness and plan a new assault. For the past thirty years, the 

strategy has been to advocate condom and contraceptive use as the best protection 

for naturally risk-taking teens. 

Just how well has this plan worked? Have millions of American adolescents 

marched into the heat of battle (pun intended), believing themselves to be more 

than adequately defended, only to find themselves shot down by ‘‘friendly fire’’? 

Young people across the nation are taught that proper use of condoms will protect 

them against pregnancies and all STDs. The truth is not so benevolent. 

In fact, condoms, even when correctly and consistently used, have a 14% failure 

rate against pregnancies. When the joint report from NIAID and NIH was released 

in July 2001, the results of a review of 138 studies were not reassuring. No conclusive evidence could be found for condom effectiveness against any STDs except for 

up to 85% protection against HIV and for female to male transmission of gonorrhea. 

Additionally, in January, 1998, this statement appeared in Family Planning Perspectives, ‘‘After years of increased condom usage, reports show that STD rates are 

higher than ever.’’

Even if condoms had been documented to be completely protective, as many teenagers believe, the reality of adolescent condom use was revealed by the American 

Academy of Pediatrics Committee on Adolescence in June 2001: ‘‘Only 45% of adolescent males report condom use for every act of intercourse,’’ and ‘‘condom use actually decreases with age when comparing males age 15-17 with males 18-19.’’ Not 

only are these young warriors equipped with defective defense weapons, but they 

don’t even use them. (That could be related to the sixteen steps of correct condom 

use which pediatricians are encouraged to review with their adolescent patients.) 

If the previous defense weaponry hasn’t worked, what can? Recent legislation, the 

Welfare Reform Act of 1996, has funded abstinence-only education for adolescents. 

Though these are relatively recent programs, ten scientific evaluations have been 

done. All conclude that statistically significant decreases in rates of sexual activity 

and of teen pregnancy occurred in the communities where these programs were implemented. 

Rather than emphasizing the mechanics of sexual intercourse and of proper 

condom use, these programs stress the importance of strong character and family 

communication. Through the successful curricula, young people are taught to value 

fidelity and to resist negative peer pressure. Parents are the essential support personnel which this education brings into the war. Their powerful influence in guiding 

adolescents toward the healthiest choice (abstinence until marriage) is deliberately 

sought, rather than excluded. Once adolescents have the necessary skills in building 

loving, enduring relationships and have the support of their families, they can successfully avoid risk behaviors, such as sexual activity, which can sabotage their mission to become confident, capable and committed adults. 

The growing field of abstinence education affords great promise for America’s 

young people—a future of optimal physical health (free of pregnancies and STDs), 

of optimal emotional health (free of guilt and regret) and of optimal spiritual health 

(full of a strong character and positive choices). Continued expansion of abstinenceuntil-marriage programs will also provide sufficient evaluation data to document its 

effectiveness in protecting adolescents. 

There is no need to send more ill-equipped American teenagers into the fierce battles of the sexual revolution. It is time for the commanding officers to assume proper 

responsibility, choose the most effective strategy and lead their troops to the healthiest possible future. 

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May 1, 2002

Committee on Energy and Commerce 

Subcommittee on Health 

2125 Rayburn House Office Building 

Washington, DC 20515-6115

DEAR MR. CHAIRMAN: On behalf of The Alan Guttmacher Institute (AGI), a notfor-profit corporation specializing in research, policy analysis, and public education 

on issues related to sexual and reproductive health, I appreciate the opportunity to 

submit written testimony for the official record of the hearing held on April 23, 

2002, before the Subcommittee on Health of the Energy and Commerce Committee, 

entitled ‘‘Welfare Reform: A Review of Abstinence Education and Transitional Medical Assistance.’’ In recent years, AGI has conducted extensive research on matters that have a direct bearing on current policy discussions around abstinence promotion and sexuality education. This research includes nationally representative surveys of local 

public school district superintendents as well as public school teachers in grades 5-

6 and 7-12; an analysis of the factors responsible for recent declines in teenage pregnancy; and a cross-country comparison of teenage sexual and reproductive behavior. 

Much of this research appeared in the peer reviewed journal, Family Planning Perspectives, between 1999 and 2001. 

More recently, AGI summarized many of the Institute’s research findings along 

with key research findings of other experts in the field in three articles published 

in The Guttmacher Report on Public Policy. These articles, which are attached for 

inclusion in the record, include: ‘‘Sex Education: Politicians, Parents, Teachers and 

Teens’’ (February 2001); ‘‘Teen Pregnancy: Trends and Lessons Learned,’’ (February 

2002); and ‘‘Abstinence Promotion and Teen Family Planning: The Misguided Drive 

for Equal Funding’’ (February 2002). Several of the research findings summarized 

in these articles include:

• Abstinence education is already widely taught in schools across the nation: Fully 

half (51%) of school districts with a policy to teach sexuality education require 

that abstinence be promoted to students as the preferred option but also permit 

discussion of contraception; another third (35%) require that abstinence be taught 

as the only option for unmarried people, while either prohibiting the discussion 

of contraception altogether or limiting discussion to contraceptive failure rates. 

Only 14% teach about both abstinence and contraception as part of a broader program designed to prepare adolescents to become sexually healthy adults. 

• Teachers are increasingly providing abstinence-only education in the classroom, 

but many believe they are not meeting their students’ need for information. The 

proportion of public school teachers who report that they teach abstinence as the 

only way of preventing pregnancies and sexually transmitted diseases rose dramatically between 1988 and 1999—from 2% to 23%. Despite the fact that more 

than nine in 10 teachers believe that students should be taught about contraception, one in four say they are instructed not to teach the subject. One in four 

teachers also say that they believe they are not meeting their students’ need for 

information. 

• The vast majority of American parents favor broader sex education programs over 

those that teach abstinence exclusively. Almost two-thirds of parents (65%) believe 

that sex education should encourage young people to delay sexual activity and 

also prepare them to use birth control when they do become sexually active. Moreover, among the one-third who say that adolescents should be told ‘‘only to have 

sex when they are married,’’ an overwhelming majority also say that schools 

should teach adolescents how to use condoms and where to get and how to use 

other birth control methods. 

• Research shows that more comprehensive sexuality education can be effective in reducing teenage pregnancy and promoting healthy behaviors. Meta-evaluations of 

teenage pregnancy prevention programs, including those that teach sexuality education, indicate that programs that discuss both abstinence and contraception can 

help young people to postpone sexual intercourse, and to reduce the frequency of 

sex and increase contraceptive use among sexually active teens. In contrast, these 

meta-evaluations conclude that there is no reliable evidence to date supporting 

the effectiveness of abstinence-only education. 

• New research is also beginning to show that abstinence-only education and strategies may have harmful health consequences for teens by deterring contraceptive use 

among those who are sexually active. The one national study available shows that 

programs that encourage students to take a virginity pledge promising to abstain 

from sex until marriage helped delay the initiation of intercourse in some teens, 

but teens who broke their pledge were one-third less likely than non-pledgers to 

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use contraceptives once they became sexually active. Similarly, sexually active 

teens who received abstinence-only messages were found to be less likely to use 

condoms than those who received safer-sex information designed to reduce the 

risk for HIV infection. 

• Recent declines in teen pregnancy can be attributed to both abstinence and contraception—but in different proportions. Approximately one-quarter of the decline in 

teenage pregnancy in this country between 1988 and 1995 was due to increased 

abstinence, while approximately three-quarters of the drop resulted from improved contraceptive use among sexually active teens. (AGI’s methodology follows 

the consensus of a group that was convened by the National Institute of Child 

Health and Human Development to examine measurement issues regarding teen 

sexual activity and contraceptive use, which included researchers from AGI, the 

National Center for Health Statistics, The Urban Institute, Child Trends and the 

National Campaign to Prevent Teenage Pregnancy.) 

• Clearer messages about the importance of contraceptive use in other Western industrialized nations contribute to their lower rates of teenage pregnancy. Teenagers in 

the United States continue to experience substantially higher pregnancy rates and 

birthrates than do teens in other Western industrialized countries. This is not because they have higher rates of sexual activity but because they are less likely 

to use any contraceptive method and especially less likely to use high effective 

hormonal methods. Moreover, sexuality education and other communication efforts in these other countries clearly and unambiguously stress the importance of 

contraceptive use for sexually active people who are not actively seeking pregnancy and that childbearing belongs in adulthood. 

Based on this information, AGI strongly believes that the restrictive definition of 

abstinence education contained in PRWORA and reauthorized by H.R. 4122—which 

requires the exclusive promotion of abstinence and which prohibits any discussion 

of the value of contraception—ignores what is largely responsible for recent declines 

in teenage pregnancy, is out of step with the desires of teachers and parents, prevents states from using federal dollars to implement sexuality education programs 

that have been proven to be effective, and may in fact place young people at risk 

by denying them the information they need to protect themselves against unintended pregnancy and sexually transmitted diseases. We therefore urge you instead 

to consider funding proven programs that encourage young people to delay sexual 

activity while teaching them about the importance and value of contraceptive use 

for people who are sexually active. 

We hope that this research and analysis will prove useful as the House of Representatives considers the reauthorization of section 510. Thank you for the opportunity to present this information and to express our views. 

Sincerely, 

CORY L. RICHARDS

Senior Vice President, Vice President for Public Policy

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