S46 CONGRESSIONAL RECORD — SENATE January 6, 2009 

Mr. LEAHY, Mrs. BOXER, Mr. 

BINGAMAN, Mrs. MCCASKILL, Mr. 

LIEBERMAN, Ms. KLOBUCHAR, 

and Mr. SCHUMER): 

S. 9. A bill to strenghten the United 

States economy, provide for more effective border and employment enforcement, and for other purposes; read 

the first time. 

Mr. REID. Mr. President, I ask unanimous consent that the text of the bill 

be printed in the RECORD. 

There being no objection, the text of 

the bill was ordered to be printed in 

the RECORD, as follows: 

S. 9 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Stronger 

Economy, Stronger Borders Act of 2009’’. 

SEC. 2. SENSE OF CONGRESS. 

It is the sense of Congress that Congress 

should enact, and the President should sign, 

legislation to strengthen the economy, recognize the heritage of the United States as a 

nation of immigrants, and amend the Immigration and Nationality Act (8 U.S.C. 1101 et 

seq.) by— 

(1) providing more effective border and employment enforcement; 

(2) preventing illegal immigration; and 

(3) reforming and rationalizing avenues for 

legal immigration. 

Mr. LEAHY. Mr. Presdient, as we 

begin the 111th Congress, we will try, 

once again, to enact comprehensive immigration reforms that have eluded us 

in the past several years. With an administration that understands the critical necessity of meaningful reform 

and that understands the policy failures of the last 8 years, I am hopeful 

that the new Congress can finally 

enact legislation consistent with our 

history as a nation of immigrants. 

The majority leader has included immigration reform as among the legislative priorities for the new Congress. I 

look forward to working with him, 

Senator KENNEDY, Senator MCCAIN, 

and others interested in working toward the goal of immigration reform. 

In 2006 and 2007, Congress attempted 

to pass practical and effective reforms 

to our immigration system. In 2006, the 

Senate did its part and passed legislation, only to be thwarted by those in 

the House of Representatives who opposed dealing with the issue in a meaningful way. In 2007, the House passed 

legislation only to have it blocked in 

the Senate by Republican Members opposed to effective reform. 

If our immigration policies are to be 

effective and play a role in restoring 

America’s image around the world, we 

must reject the failed policies of the 

last 8 years. We cannot continue to 

deny asylum seekers because they have 

been forced at the point of a gun to 

provide assistance to those engaged in 

terrorist acts. We cannot continue to 

label as terrorist organizations those 

who have stood by the United States in 

armed conflict. We must not tolerate 

the tragic and needless death of a person in our custody for lack of basic 

medical care. We must ensure that 

children are not needlessly separated 

from their parents and that family 

unity is respected. 

We must move beyond the current 

policy that is focused on detaining and 

deporting those undocumented workers 

who have been abused and exploited by 

American employers but does nothing 

to change an environment that remains ripe for these abuses. We must 

protect the rights and opportunities of 

American workers and, at the same 

time, ensure that our Nation’s farmers 

and employers have the help they need. 

We should improve the opportunities 

and make more efficient the processes 

for those who seek to come to America 

with the goal of becoming new Americans, whether to invest in our communities and create jobs, to be reunited 

with loved ones, or to seek freedom and 

opportunity and a better life. We must 

also live up to the goal of family reunification in our immigration policy and 

join at least 19 other nations that provide immigration equality to same-sex 

partners of different nationalities. And 

I believe we would be wise to reconsider the effectiveness and cost of a 

wall along our southern border, which 

has adversely affected the fragile environment and vibrant cross-border culture of an entire region. Such a wall 

stands as a symbol of fear and intolerance. This is not what America is 

about and we can do better. 

Those who oppose a realistic solution 

to address the estimated millions of 

people currently living and working in 

the United States without proper documentation have offered no alternative 

solution other than harsh penalties and 

more enforcement. The policies of the 

last 8 years, which have served only to 

appease the most extreme ideologues, 

must be replaced with sensible solutions. I am confident that our country 

and our economy will be far more secure when those who are currently living in the shadows of our society are 

recognized and provided the means to 

become lawful residents, if not a path 

to citizenship. 

As President-elect Obama’s administration considers immigration issues, I 

look forward to working closely with 

them and with the Senate’s leadership 

to find the best solutions. Presidentelect Obama’s nominees to lead the Department of Homeland Security and 

the Department of Labor understand 

very well the importance of sensible 

border policies and the importance of 

workers’ rights. The American people 

look to all of us to forge a consensus 

for immigration reform that rejects 

the extreme ideology that has attended 

this issue and prevented real progress. 

By Mr. REID (for himself, Mr. 

CONRAD, Mr. LEVIN, Mr. BEGICH, 

Mr. CARPER, Mr. DURBIN, Mrs. 

BOXER, Mr. MENENDEZ, Mr. 

BINGAMAN, Ms. STABENOW, Mrs. 

MCCASKILL, Ms. KLOBUCHAR, 

Mrs. CLINTON, Mr. SCHUMER, 

and Ms. MIKULSKI): 

S. 10. A bill to restore fiscal discipline and begin to address the longterm fiscal challenges facing the 

United States, and for other purposes; 

read the first time. 

Mr. REID. Mr. President, I ask unanimous consent that the text of the bill 

be printed in the RECORD. 

There being no objection, the text of 

the bill was ordered to be printed in 

the RECORD, as follows: 

S. 10 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Fiscal Responsibility Act of 2009’’. 

SEC. 2. SENSE OF CONGRESS ON FISCAL RESPONSIBILITY. 

It is the sense of Congress that Congress 

and the President should restore fiscal discipline and begin to address the long-term 

fiscal challenges facing the United States 

through– 

(1) strong pay-as-you-go rules, to help 

block the approval of measures that would 

increase the deficit; 

(2) recognition of warnings by both the 

Government Accountability Office and the 

Congressional Budget Office that the Federal 

budget is on an unsustainable path of rising 

deficits and debt; 

(3) establishment by Congress and the 

President of a process— 

(A) to analyze— 

(i) the current and long-term actuarial financial condition of the Federal Government; and 

(ii) the gap between the projected revenues 

and expenditures of the Federal Government; 

(B) to identify factors that affect the longterm fiscal balance of the Federal Government; 

(C) to analyze potential courses of action 

to address factors that affect the long-term 

fiscal balance of the Federal Government; 

(D) to seek a bipartisan agreement, or set 

of agreements, that will— 

(i) significantly improve the Nation’s longterm fiscal imbalances and the gap between 

projected revenues and expenditures; 

(ii) ensure the economic security of the 

United States; and 

(iii) expand future prosperity and growth 

for all Americans; 

(4) a thorough review of all Federal spending and tax expenditures by the Director of 

the Office of Management and Budget, in 

consultation with the Secretary of the 

Treasury, that identifies items that are outdated, inefficient, poorly run, unnecessary, 

or otherwise undeserving of scarce Federal 

resources or that are in need of reform; and 

(5) a review of the current system of taxation of the United States to ensure that 

burdens are borne fairly and equitably. 

By Mr. REID (for himself, Mrs. 

CLINTON, Mr. AKAKA, Mr. 

INOUYE, Mr. WHITEHOUSE, Mr. 

LAUTENBERG, Mrs. MURRAY, Mr. 

MENENDEZ, Mr. LEVIN, Mr. BAUCUS, Mr. KERRY, Mrs. BOXER, 

Mr. CARPER, Mrs. FEINSTEIN, 

and Ms. STABENOW): 

S. 21. A bill to reduce unintended 

pregnancy, reduce abortions, and improve access to women’s heath care; to 

the Committee on Health, Education, 

Labor, and Pensions. 

Mr. REID. Mr. President, I ask unanimous consent that the text of the bill 

be printed in the RECORD. 


wwoods2 on PRODPC68 with SENATE
January 6, 2009 CONGRESSIONAL RECORD — SENATE S47 

There being no objection, the text of 

the bill was ordered to be printed in 

the RECORD, as follows: 

S. 21 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

(a) SHORT TITLE.—This Act may be cited as 

the ‘‘Prevention First Act’’. 

(b) TABLE OF CONTENTS.—The table of contents for this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

TITLE I—TITLE X OF PUBLIC HEALTH 

SERVICE ACT 

Sec. 101. Short title. 

Sec. 102. Authorization of appropriations. 

TITLE II—EQUITY IN PRESCRIPTION INSURANCE AND CONTRACEPTIVE COVERAGE 

Sec. 201. Short title. 

Sec. 202. Amendments to Employee Retirement Income Security Act of 

1974. 

Sec. 203. Amendments to Public Health 

Service Act relating to the 

group market. 

Sec. 204. Amendment to Public Health Service Act relating to the individual market. 

TITLE III—EMERGENCY CONTRACEPTION 

EDUCATION AND INFORMATION 

Sec. 301. Short title. 

Sec. 302. Emergency contraception education and information programs. 

TITLE IV—COMPASSIONATE ASSISTANCE 

FOR RAPE EMERGENCIES 

Sec. 401. Short title. 

Sec. 402. Survivors of sexual assault; provision by hospitals of emergency 

contraceptives without charge. 

TITLE V—AT-RISK COMMUNITIES TEEN 

PREGNANCY PREVENTION ACT 

Sec. 501. Short title. 

Sec. 502. Teen pregnancy prevention. 

Sec. 503. Research. 

Sec. 504. General requirements. 

TITLE VI—ACCURACY OF 

CONTRACEPTIVE INFORMATION 

Sec. 601. Short title. 

Sec. 602. Accuracy of contraceptive information. 

TITLE VII—UNINTENDED PREGNANCY 

REDUCTION ACT 

Sec. 701. Short title. 

Sec. 702. Medicaid; clarification of coverage 

of family planning services and 

supplies. 

Sec. 703. Expansion of family planning services. 

Sec. 704. Effective date. 

TITLE VIII—RESPONSIBLE EDUCATION 

ABOUT LIFE ACT 

Sec. 801. Short title. 

Sec. 802. Assistance to reduce teen pregnancy, HIV/AIDS, and other 

sexually transmitted diseases 

and to support healthy adolescent development. 

Sec. 803. Sense of Congress. 

Sec. 804. Evaluation of programs. 

Sec. 805. Definitions. 

Sec. 806. Appropriations. 

TITLE IX—PREVENTION THROUGH 

AFFORDABLE ACCESS 

Sec. 901. Short title. 

Sec. 902. Restoring and protecting access to 

discount drug prices for university-based and safety-net clinics. 

SEC. 2. FINDINGS. 

The Congress finds as follows: 

(1) Healthy People 2010 sets forth a reduction of unintended pregnancies as an important health objective for the Nation to 

achieve over the first decade of the new century, a goal first articulated in the 1979 Surgeon General’s Report, Healthy People, and 

reiterated in Healthy People 2000: National 

Health Promotion and Disease Prevention 

Objectives. 

(2) Although the Centers for Disease Control and Prevention (referred to in this section as the ‘‘CDC’’) included family planning 

in its published list of the Ten Great Public 

Health Achievements in the 20th Century, 

the United States still has one of the highest 

rates of unintended pregnancies among industrialized nations. 

(3) Each year, nearly half of all pregnancies in the United States are unintended, 

and nearly half of unintended pregnancies 

end in abortion. 

(4) In 2006, 36,200,000 women, more than half 

of all women of reproductive age, were in 

need of contraceptive services and supplies 

to help prevent unintended pregnancy, and 

nearly half of those were in need of public 

support for such care. 

(5) The United States has some of the highest rates of sexually transmitted infections 

(STIs) among industrialized nations. In 2006, 

there were approximately 19,000,000 new 

cases of STIs, almost half of them occurring 

in young people ages 15 to 24. According to 

the Centers for Disease Control and Prevention, in addition to the burden on public 

health, STIs impose a tremendous economic 

burden with direct medical costs as high as 

$14,700,000,000 each year in 2006 dollars. 

(6) Contraceptive use can improve overall 

health by enabling women to plan and space 

their pregnancies and has contributed to dramatic declines in maternal and infant mortality. Widespread use of contraceptives has 

been the driving force in reducing unintended pregnancies and sexually transmitted 

infections (STIs), and reducing the need for 

abortion in this nation. Contraceptive use 

also saves public health dollars. For every 

dollar spent to provide services in publicly 

funded family planning clinics, $4.02 in Medicaid expenses are saved because unintended 

births are averted. 

(7) Reducing unintended pregnancy improves maternal health and is an important 

strategy in efforts to reduce maternal mortality. Women experiencing unintended pregnancy are at greater risk for physical abuse. 

(8) A child born from an unintended pregnancy is at greater risk than a child born 

from an intended pregnancy of low birth 

weight, dying in the first year of life, being 

abused, and not receiving sufficient resources for healthy development. 

(9) The ability to control fertility allows 

couples to achieve economic stability by facilitating greater educational achievement 

and participation in the workforce. 

(10) Contraceptives are effective in preventing unintended pregnancy when used 

consistently and correctly. Without contraception, a sexually active woman has an 85 

percent chance of becoming pregnant within 

a year. 

(11) Approximately 50 percent of unintended pregnancies occur among women who 

do not use contraception. 

(12) Many poor and low-income women cannot afford to purchase contraceptive services 

and supplies on their own. The number of 

women needing subsidized services has increased by more than 1,000,000 (7 percent) 

since 2000. A poor woman in the United 

States is now nearly 4 times as likely as a 

more affluent woman to have an unplanned 

pregnancy. Between 1994 and 2001, unintended pregnancy among low-income women 

increased by 29 percent, while unintended 

pregnancy decreased by 20 percent among 

women with higher incomes. 

(13) Public health programs, such as the 

Medicaid program and family planning programs under title X of the Public Health 

Service Act, provide high-quality family 

planning services and other preventive 

health care to underinsured or uninsured individuals who may otherwise lack access to 

health care. 

(14) Medicaid has become an essential 

source of support for the provision of subsidized family planning services and supplies. It is the single largest source of public 

funds supporting these services. In 2001, the 

program provided 6 in 10 of all public dollars 

spent on family planning services. In 2006, 12 

percent of women of reproductive age 

(7,300,000 women ages 15 to 44) looked to Medicaid for their care and 37 percent of poor 

women of reproductive age rely upon Medicaid. 

(15) Approximately 1,400,000 unintended 

pregnancies and 600,000 abortions are averted 

each year because of services provided in 

publicly funded clinics. In 2006, Title X (of 

the Public Health Service Act) service providers performed more than 2,400,000 Pap 

tests, 2,400,000 breast exams, and 5,800,000 

tests for sexually transmitted diseases, including 652,426 HIV tests and 2,300,000 

Chlamydia tests. One in 4 women who obtain 

reproductive health services from a medical 

provider do so at a publicly funded clinic. 

(16) The stagnant funding for public family 

planning programs in combination with the 

increasing demand for subsidized services, 

the rising costs of contraceptive services and 

supplies, and the high cost of improved 

screening and treatment for cervical cancer 

and sexually transmitted infections has diminished the ability of clinics receiving 

funds under title X of the Public Health 

Services Act to adequately serve all those in 

need. At present, clinics are able to reach 

just 41 percent of the women needing subsidized services. Had Title X funding kept up 

with inflation since fiscal year 1980, it would 

now be funded at $759,000,000, instead of its 

fiscal year 2007 funding level of $283,000,000. 

Taking inflation into account, funding for 

Title X in constant dollars is 63 percent 

lower today than it was in fiscal year 1980. 

(17) While the Medicaid program remains 

the largest source of subsidized family planning services, States are facing significant 

budgetary pressures to cut their Medicaid 

programs, putting many women at risk of 

losing coverage for family planning services. 

(18) In addition, eligibility under the Medicaid program in many States is severely restricted, which leaves family planning services financially out of reach for many poor 

women. Many States have demonstrated tremendous success with Medicaid family planning waivers that allow States to expand access to Medicaid family planning services. 

However, the administrative burden of applying for a waiver poses a significant barrier to States that would like to expand 

their coverage of family planning programs 

through Medicaid. 

(19) As of December of 2008, 27 States offered expanded family planning benefits as a 

result of Medicaid family planning waivers. 

The cost-effectiveness of these waivers was 

affirmed by a recent evaluation funded by 

the Centers for Medicare & Medicaid Services. This evaluation of six waivers found 

that all family planning programs under 

such waivers resulted in significant savings 

to both the Federal and State governments. 

Moreover, the researchers found measurable 

reductions in unintended pregnancy. 


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S48 CONGRESSIONAL RECORD — SENATE January 6, 2009 

(20) Although employer-sponsored health 

plans have improved coverage of contraceptive services and supplies, largely in response to State contraceptive coverage laws, 

there is still significant room for improvement. The ongoing lack of coverage in health 

insurance plans, particularly in self-insured 

and individual plans, continues to place effective forms of contraception beyond the financial reach of many women. 

(21) Including contraceptive coverage in 

private health care plans saves employers 

money. Not covering contraceptives in employee health plans costs employers 15 to 17 

percent more than providing such coverage. 

(22) Approved for use by the Food and Drug 

Administration, emergency contraception is 

a safe and effective way to prevent unintended pregnancy after unprotected sex. Research confirms that easier access to emergency contraceptives does not increase sexual risk-taking or sexually transmitted diseases. 

(23) The available evidence shows that 

many women do not know about emergency 

contraception, do not know where to get it, 

or are unable to access it. Overcoming these 

obstacles could help ensure that more 

women use emergency contraception consistently and correctly. 

(24) A November 2006 study of declining 

pregnancy rates among teens concluded that 

the reduction in teen pregnancy between 1995 

and 2002 is primarily the result of increased 

use of contraceptives. As such, it is critically 

important that teens receive accurate, unbiased information about contraception. 

(25) The American Medical Association, 

the American Nurses Association, the American Academy of Pediatrics, the American 

College of Obstetricians and Gynecologists, 

the American Public Health Association, and 

the Society for Adolescent Medicine, support 

responsible sex education that includes information about both abstinence and contraception. 

(26) Teens who receive comprehensive sex 

education that includes discussion of contraception as well as abstinence are more likely 

than those who receive abstinence-only messages to delay sex, to have fewer partners, 

and to use contraceptives when they do become sexually active. 

(27) Government-funded abstinence-onlyuntil-marriage programs are precluded from 

discussing contraception except to talk 

about failure rates. An October 2006 report 

by the Government Accountability Office 

found that the Department of Health and 

Human Services does not review the materials of recipients of grants administered by 

such department for scientific accuracy and 

requires grantees to review their own materials for scientific accuracy. The GAO also 

reported on the Department’s total lack of 

appropriate and customary measurements to 

determine if funded programs are effective. 

In addition, a separate letter from the Government Accountability Office found that 

the Department of Health and Human Services is in violation of Federal law by failing 

to enforce a requirement under the Public 

Health Service Act that Federally-funded 

grantees working to address the prevention 

of sexually transmitted diseases, including 

abstinence-only-until-marriage programs, 

must provide medically accurate information about the effectiveness of condoms. 

(28) Recent scientific reports by the Institute of Medicine, the American Medical Association, and the Office on National AIDS 

Policy stress the need for sex education that 

includes messages about abstinence and provides young people with information about 

contraception for the prevention of teen 

pregnancy, HIV/AIDS, and other sexually 

transmitted diseases. 

(29) A 2006 statement from the American 

Public Health Association (‘‘APHA’’) ‘‘recognizes the importance of abstinence education, but only as part of a comprehensive 

sexuality education program ... APHA calls 

for repealing current federal funding for abstinence-only programs and replacing it with 

funding for a new Federal program to promote comprehensive sexuality education, 

combining information about abstinence 

with age-appropriate sexuality education.’’ 

(30) Comprehensive sex education programs 

respect the diversity of values and beliefs 

represented in the community and will complement and augment the sex education children receive from their families. 

(31) Over 60 percent of the 56,300 annual 

new cases of HIV infections in the United 

States occur in youth ages 13 through 24. African American and Latino youth have been 

disproportionately affected by the HIV/AIDS 

epidemic. In 2005, Blacks and Latinos accounted for 84 percent of all new HIV infections among 13 to 19 year olds and 76 percent 

of HIV infections among 20 to 24 year olds in 

the United States even though, together, 

they represent only about 32 percent of people in these ages. Teens in the United States 

contract an estimated 9,000,000 sexually 

transmitted infections each year. By age 24, 

at least 1 in 4 sexually active people between 

the ages of 15 and 24 will have contracted a 

sexually transmitted infection. 

(32) Approximately 50 young people a day, 

an average of two young people every hour of 

every day, are infected with HIV in the 

United States. 

(33) In 1990, Congress passed the Medicaid 

Anti-Discriminatory Drug Price and Patient 

Benefit Restoration Act to ensure that Medicaid receives the lowest drug prices in the 

marketplace. Congress intentionally protected the practice of pharmaceutical companies offering charitable organizations and 

clinics nominally-priced drugs. As an unintended consequence of the Deficit Reduction 

Act of 2005, birth control prices have skyrocketed for millions of women who depend 

on safety net providers for their birth control. Birth control that previously cost only 

$5 to $10 per month is now prohibitively expensive, running as much as $40 or $50 a 

month. Many family planning health centers 

have absorbed much of this price increase, 

further straining already limited resources. 

As the economic crisis worsens, women and 

their families are increasingly turning to 

health care safety net providers, such as 

family planning health centers, for a reliable 

source of care. 

TITLE I—TITLE X OF PUBLIC HEALTH 

SERVICE ACT 

SEC. 101. SHORT TITLE. 

This title may be cited as the ‘‘Title X 

Family Planning Services Act of 2009’’. 

SEC. 102. AUTHORIZATION OF APPROPRIATIONS. 

For the purpose of making grants and contracts under section 1001 of the Public 

Health Service Act, there are authorized to 

be appropriated $700,000,000 for fiscal year 

2010 and such sums as may be necessary for 

each subsequent fiscal year. 

TITLE II—EQUITY IN PRESCRIPTION INSURANCE AND CONTRACEPTIVE COVERAGE 

SEC. 201. SHORT TITLE. 

This title may be cited as the ‘‘Equity in 

Prescription Insurance and Contraceptive 

Coverage Act of 2007’’. 

SEC. 202. AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 

1974. 

(a) IN GENERAL.—Subpart B of part 7 of 

subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 

1185 et seq.) is amended by adding at the end 

the following: 

‘‘SEC. 715. STANDARDS RELATING TO BENEFITS 

FOR CONTRACEPTIVES. 

‘‘(a) REQUIREMENTS FOR COVERAGE.—A 

group health plan, and a health insurance 

issuer providing health insurance coverage 

in connection with a group health plan, may 

not— 

‘‘(1) exclude or restrict benefits for prescription contraceptive drugs or devices approved by the Food and Drug Administration, or generic equivalents approved as substitutable by the Food and Drug Administration, if such plan or coverage provides benefits for other outpatient prescription drugs 

or devices; or 

‘‘(2) exclude or restrict benefits for outpatient contraceptive services if such plan or 

coverage provides benefits for other outpatient services provided by a health care 

professional (referred to in this section as 

‘outpatient health care services’). 

‘‘(b) PROHIBITIONS.—A group health plan, 

and a health insurance issuer providing 

health insurance coverage in connection 

with a group health plan, may not— 

‘‘(1) deny to an individual eligibility, or 

continued eligibility, to enroll or to renew 

coverage under the terms of the plan because 

of the individual’s or enrollee’s use or potential use of items or services that are covered 

in accordance with the requirements of this 

section; 

‘‘(2) provide monetary payments or rebates 

to a covered individual to encourage such individual to accept less than the minimum 

protections available under this section; 

‘‘(3) penalize or otherwise reduce or limit 

the reimbursement of a health care professional because such professional prescribed 

contraceptive drugs or devices, or provided 

contraceptive services, described in subsection (a), in accordance with this section; 

or 

‘‘(4) provide incentives (monetary or otherwise) to a health care professional to induce 

such professional to withhold from a covered 

individual contraceptive drugs or devices, or 

contraceptive services, described in subsection (a). 

‘‘(c) RULES OF CONSTRUCTION.— 

‘‘(1) IN GENERAL.—Nothing in this section 

shall be construed— 

‘‘(A) as preventing a group health plan and 

a health insurance issuer providing health 

insurance coverage in connection with a 

group health plan from imposing 

deductibles, coinsurance, or other cost-sharing or limitations in relation to— 

‘‘(i) benefits for contraceptive drugs under 

the plan or coverage, except that such a deductible, coinsurance, or other cost-sharing 

or limitation for any such drug shall be consistent with those imposed for other outpatient prescription drugs otherwise covered 

under the plan or coverage; 

‘‘(ii) benefits for contraceptive devices 

under the plan or coverage, except that such 

a deductible, coinsurance, or other cost-sharing or limitation for any such device shall be 

consistent with those imposed for other outpatient prescription devices otherwise covered under the plan or coverage; and 

‘‘(iii) benefits for outpatient contraceptive 

services under the plan or coverage, except 

that such a deductible, coinsurance, or other 

cost-sharing or limitation for any such service shall be consistent with those imposed 

for other outpatient health care services otherwise covered under the plan or coverage; 

‘‘(B) as requiring a group health plan and a 

health insurance issuer providing health insurance coverage in connection with a group 

health plan to cover experimental or investigational contraceptive drugs or devices, or 

experimental or investigational contraceptive services, described in subsection (a), except to the extent that the plan or issuer 

provides coverage for other experimental or 


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January 6, 2009 CONGRESSIONAL RECORD — SENATE S49 

investigational outpatient prescription drugs 

or devices, or experimental or investigational outpatient health care services; or 

‘‘(C) as modifying, diminishing, or limiting 

the rights or protections of an individual 

under any other Federal law. 

‘‘(2) LIMITATIONS.—As used in paragraph 

(1), the term ‘limitation’ includes— 

‘‘(A) in the case of a contraceptive drug or 

device, restricting the type of health care 

professionals that may prescribe such drugs 

or devices, utilization review provisions, and 

limits on the volume of prescription drugs or 

devices that may be obtained on the basis of 

a single consultation with a professional; or 

‘‘(B) in the case of an outpatient contraceptive service, restricting the type of 

health care professionals that may provide 

such services, utilization review provisions, 

requirements relating to second opinions 

prior to the coverage of such services, and 

requirements relating to preauthorizations 

prior to the coverage of such services. 

‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.— 

The imposition of the requirements of this 

section shall be treated as a material modification in the terms of the plan described in 

section 102(a)(1), for purposes of assuring notice of such requirements under the plan, except that the summary description required 

to be provided under the last sentence of section 104(b)(1) with respect to such modification shall be provided by not later than 60 

days after the first day of the first plan year 

in which such requirements apply. 

‘‘(e) PREEMPTION.—Nothing in this section 

shall be construed to preempt any provision 

of State law to the extent that such State 

law establishes, implements, or continues in 

effect any standard or requirement that provides coverage or protections for participants or beneficiaries that are greater than 

the coverage or protections provided under 

this section. 

‘‘(f) DEFINITION.—In this section, the term 

‘outpatient contraceptive services’ means 

consultations, examinations, procedures, and 

medical services, provided on an outpatient 

basis and related to the use of contraceptive 

methods (including natural family planning) 

to prevent an unintended pregnancy.’’. 

(b) CLERICAL AMENDMENT.—The table of 

contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 

1001) is amended by inserting after the item 

relating to section 713 the following: 

‘‘Sec. 715. Standards relating to benefits for 

contraceptives.’’. 

(c) EFFECTIVE DATE.—The amendments 

made by this section shall apply with respect 

to plan years beginning on or after January 

1, 2010. 

SEC. 203. AMENDMENTS TO PUBLIC HEALTH 

SERVICE ACT RELATING TO THE 

GROUP MARKET. 

(a) IN GENERAL.—Subpart 2 of part A of 

title XXVII of the Public Health Service Act 

(42 U.S.C. 300gg–4 et seq.) is amended by adding at the end the following: 

‘‘SEC. 2708. STANDARDS RELATING TO BENEFITS 

FOR CONTRACEPTIVES. 

‘‘(a) REQUIREMENTS FOR COVERAGE.—A 

group health plan, and a health insurance 

issuer providing health insurance coverage 

in connection with a group health plan, may 

not— 

‘‘(1) exclude or restrict benefits for prescription contraceptive drugs or devices approved by the Food and Drug Administration, or generic equivalents approved as substitutable by the Food and Drug Administration, if such plan or coverage provides benefits for other outpatient prescription drugs 

or devices; or 

‘‘(2) exclude or restrict benefits for outpatient contraceptive services if such plan or 

coverage provides benefits for other outpatient services provided by a health care 

professional (referred to in this section as 

‘outpatient health care services’). 

‘‘(b) PROHIBITIONS.—A group health plan, 

and a health insurance issuer providing 

health insurance coverage in connection 

with a group health plan, may not— 

‘‘(1) deny to an individual eligibility, or 

continued eligibility, to enroll or to renew 

coverage under the terms of the plan because 

of the individual’s or enrollee’s use or potential use of items or services that are covered 

in accordance with the requirements of this 

section; 

‘‘(2) provide monetary payments or rebates 

to a covered individual to encourage such individual to accept less than the minimum 

protections available under this section; 

‘‘(3) penalize or otherwise reduce or limit 

the reimbursement of a health care professional because such professional prescribed 

contraceptive drugs or devices, or provided 

contraceptive services, described in subsection (a), in accordance with this section; 

or 

‘‘(4) provide incentives (monetary or otherwise) to a health care professional to induce 

such professional to withhold from covered 

individual contraceptive drugs or devices, or 

contraceptive services, described in subsection (a). 

‘‘(c) RULES OF CONSTRUCTION.— 

‘‘(1) IN GENERAL.—Nothing in this section 

shall be construed— 

‘‘(A) as preventing a group health plan and 

a health insurance issuer providing health 

insurance coverage in connection with a 

group health plan from imposing 

deductibles, coinsurance, or other cost-sharing or limitations in relation to— 

‘‘(i) benefits for contraceptive drugs under 

the plan or coverage, except that such a deductible, coinsurance, or other cost-sharing 

or limitation for any such drug shall be consistent with those imposed for other outpatient prescription drugs otherwise covered 

under the plan or coverage; 

‘‘(ii) benefits for contraceptive devices 

under the plan or coverage, except that such 

a deductible, coinsurance, or other cost-sharing or limitation for any such device shall be 

consistent with those imposed for other outpatient prescription devices otherwise covered under the plan or coverage; and 

‘‘(iii) benefits for outpatient contraceptive 

services under the plan or coverage, except 

that such a deductible, coinsurance, or other 

cost-sharing or limitation for any such service shall be consistent with those imposed 

for other outpatient health care services otherwise covered under the plan or coverage; 

‘‘(B) as requiring a group health plan and a 

health insurance issuer providing health insurance coverage in connection with a group 

health plan to cover experimental or investigational contraceptive drugs or devices, or 

experimental or investigational contraceptive services, described in subsection (a), except to the extent that the plan or issuer 

provides coverage for other experimental or 

investigational outpatient prescription drugs 

or devices, or experimental or investigational outpatient health care services; or 

‘‘(C) as modifying, diminishing, or limiting 

the rights or protections of an individual 

under any other Federal law. 

‘‘(2) LIMITATIONS.—As used in paragraph 

(1), the term ‘limitation’ includes— 

‘‘(A) in the case of a contraceptive drug or 

device, restricting the type of health care 

professionals that may prescribe such drugs 

or devices, utilization review provisions, and 

limits on the volume of prescription drugs or 

devices that may be obtained on the basis of 

a single consultation with a professional; or 

‘‘(B) in the case of an outpatient contraceptive service, restricting the type of 

health care professionals that may provide 

such services, utilization review provisions, 

requirements relating to second opinions 

prior to the coverage of such services, and 

requirements relating to preauthorizations 

prior to the coverage of such services. 

‘‘(d) NOTICE.—A group health plan under 

this part shall comply with the notice requirement under section 715(d) of the Employee Retirement Income Security Act of 

1974 with respect to the requirements of this 

section as if such section applied to such 

plan. 

‘‘(e) PREEMPTION.—Nothing in this section 

shall be construed to preempt any provision 

of State law to the extent that such State 

law establishes, implements, or continues in 

effect any standard or requirement that provides coverage or protections for enrollees 

that are greater than the coverage or protections provided under this section. 

‘‘(f) DEFINITION.—In this section, the term 

‘outpatient contraceptive services’ means 

consultations, examinations, procedures, and 

medical services, provided on an outpatient 

basis and related to the use of contraceptive 

methods (including natural family planning) 

to prevent an unintended pregnancy.’’. 

(b) EFFECTIVE DATE.—The amendments 

made by this section shall apply with respect 

to group health plans for plan years beginning on or after January 1, 2010. 

SEC. 204. AMENDMENT TO PUBLIC HEALTH SERVICE ACT RELATING TO THE INDIVIDUAL MARKET. 

(a) IN GENERAL.—Part B of title XXVII of 

the Public Health Service Act (42 U.S.C. 

300gg–41 et seq.) is amended— 

(1) by redesignating the first subpart 3 (relating to other requirements) as subpart 2; 

and 

(2) by adding at the end of subpart 2 the 

following: 

‘‘SEC. 2754. STANDARDS RELATING TO BENEFITS 

FOR CONTRACEPTIVES. 

‘‘The provisions of section 2708 shall apply 

to health insurance coverage offered by a 

health insurance issuer in the individual 

market in the same manner as they apply to 

health insurance coverage offered by a 

health insurance issuer in connection with a 

group health plan in the small or large group 

market.’’. 

(b) EFFECTIVE DATE.—The amendment 

made by this section shall apply with respect 

to health insurance coverage offered, sold, 

issued, renewed, in effect, or operated in the 

individual market on or after January 1, 

2008. 

TITLE III—EMERGENCY CONTRACEPTION 

EDUCATION AND INFORMATION 

SEC. 301. SHORT TITLE. 

This title may be cited as the ‘‘Emergency 

Contraception Education Act of 2009’’. 

SEC. 302. EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION PROGRAMS. 

(a) DEFINITIONS.—For purposes of this section: 

(1) EMERGENCY CONTRACEPTION.—The term 

‘‘emergency contraception’’ means a drug or 

device (as the terms are defined in section 

201 of the Federal Food, Drug, and Cosmetic 

Act (21 U.S.C. 321)) or a drug regimen that 

is— 

(A) used after sexual relations; 

(B) prevents pregnancy, by preventing ovulation, fertilization of an egg, or implantation of an egg in a uterus; and 

(C) approved by the Food and Drug Administration. 

(2) HEALTH CARE PROVIDER.—The term 

‘‘health care provider’’ means an individual 

who is licensed or certified under State law 

to provide health care services and who is 

operating within the scope of such license. 

(3) INSTITUTION OF HIGHER EDUCATION.—The 

term ‘‘institution of higher education’’ has 


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the same meaning given such term in section 

101(a) of the Higher Education Act of 1965 (20 

U.S.C. 1001(a)). 

(4) SECRETARY.—The term ‘‘Secretary’’ 

means the Secretary of Health and Human 

Services. 

(b) EMERGENCY CONTRACEPTION PUBLIC

EDUCATION PROGRAM.— 

(1) IN GENERAL.—The Secretary, acting 

through the Director of the Centers for Disease Control and Prevention, shall develop 

and disseminate to the public information on 

emergency contraception. 

(2) DISSEMINATION.—The Secretary may 

disseminate information under paragraph (1) 

directly or through arrangements with nonprofit organizations, consumer groups, institutions of higher education, Federal, State, 

or local agencies, clinics, and the media. 

(3) INFORMATION.—The information disseminated under paragraph (1) shall include, 

at a minimum, a description of emergency 

contraception and an explanation of the use, 

safety, efficacy, and availability of such contraception. 

(c) EMERGENCY CONTRACEPTION INFORMATION PROGRAM FOR HEALTH CARE PROVIDERS.— 

(1) IN GENERAL.—The Secretary, acting 

through the Administrator of the Health Resources and Services Administration and in 

consultation with major medical and public 

health organizations, shall develop and disseminate to health care providers information on emergency contraception. 

(2) INFORMATION.—The information disseminated under paragraph (1) shall include, 

at a minimum— 

(A) information describing the use, safety, 

efficacy, and availability of emergency contraception; 

(B) a recommendation regarding the use of 

such contraception in appropriate cases; and 

(C) information explaining how to obtain 

copies of the information developed under 

subsection (b) for distribution to the patients of the providers. 

(d) AUTHORIZATION OF APPROPRIATIONS.— 

There are authorized to be appropriated to 

carry out this section such sums as may be 

necessary for each of the fiscal years 2010 

through 2014. 

TITLE IV—COMPASSIONATE ASSISTANCE 

FOR RAPE EMERGENCIES 

SEC. 401. SHORT TITLE. 

This title may be cited as the ‘‘Compassionate Assistance for Rape Emergencies Act 

of 2009’’. 

SEC. 402. SURVIVORS OF SEXUAL ASSAULT; PROVISION BY HOSPITALS OF EMERGENCY CONTRACEPTIVES WITHOUT 

CHARGE. 

(a) IN GENERAL.—Federal funds may not be 

provided to a hospital under any health-related program, unless the hospital meets the 

conditions specified in subsection (b) in the 

case of— 

(1) any woman who presents at the hospital 

and states that she is a victim of sexual assault, or is accompanied by someone who 

states she is a victim of sexual assault; and 

(2) any woman who presents at the hospital 

whom hospital personnel have reason to believe is a victim of sexual assault. 

(b) ASSISTANCE FOR VICTIMS.—The conditions specified in this subsection regarding a 

hospital and a woman described in subsection (a) are as follows: 

(1) The hospital promptly provides the 

woman with medically and factually accurate and unbiased written and oral information about emergency contraception, including information explaining that— 

(A) emergency contraception does not 

cause an abortion; and 

(B) emergency contraception is effective in 

most cases in preventing pregnancy after unprotected sex. 

(2) The hospital promptly offers emergency 

contraception to the woman, and promptly 

provides such contraception to her on her request. 

(3) The information provided pursuant to 

paragraph (1) is in clear and concise language, is readily comprehensible, and meets 

such conditions regarding the provision of 

the information in languages other than 

English as the Secretary may establish. 

(4) The services described in paragraphs (1) 

through (3) are not denied because of the inability of the woman or her family to pay for 

the services. 

(c) DEFINITIONS.—For purposes of this section: 

(1) The term ‘‘emergency contraception’’ 

means a drug, drug regimen, or device that— 

(A) is used postcoitally; 

(B) prevents pregnancy by delaying ovulation, preventing fertilization of an egg, or 

preventing implantation of an egg in a uterus; and 

(C) is approved by the Food and Drug Administration. 

(2) The term ‘‘hospital’’ has the meanings 

given such term in title XVIII of the Social 

Security Act, including the meaning applicable in such title for purposes of making payments for emergency services to hospitals 

that do not have agreements in effect under 

such title. 

(3) The term ‘‘Secretary’’ means the Secretary of Health and Human Services. 

(4) The term ‘‘sexual assault’’ means coitus 

in which the woman involved does not consent or lacks the legal capacity to consent. 

(d) EFFECTIVE DATE; AGENCY CRITERIA.— 

This section takes effect upon the expiration 

of the 180-day period beginning on the date of 

the enactment of this Act. Not later than 30 

days prior to the expiration of such period, 

the Secretary shall publish in the Federal 

Register criteria for carrying out this section. 

TITLE V—AT-RISK COMMUNITIES TEEN 

PREGNANCY PREVENTION ACT 

SEC. 501. SHORT TITLE. 

This title may be cited as the ‘‘At-Risk 

Communities Teen Pregnancy Prevention 

Act of 2009’’. 

SEC. 502. TEENAGE PREGNANCY PREVENTION. 

Part P of title III of the Public Health 

Service Act (42 U.S.C. 280g et seq.) is amended by inserting after section 399N the following section: 

‘‘SEC. 399N–1. TEENAGE PREGNANCY PREVENTION GRANTS. 

‘‘(a) AUTHORITY.—The Secretary may 

award on a competitive basis grants to public and private entities to establish or expand teenage pregnancy prevention programs. 

‘‘(b) GRANT RECIPIENTS.—Grant recipients 

under this section may include State and 

local not-for-profit coalitions working to 

prevent teenage pregnancy, State, local, and 

tribal agencies, schools, entities that provide 

after-school programs, and community and 

faith-based groups. 

‘‘(c) PRIORITY.—In selecting grant recipients under this section, the Secretary shall 

give— 

‘‘(1) highest priority to applicants seeking 

assistance for programs targeting communities or populations in which— 

‘‘(A) teenage pregnancy or birth rates are 

higher than the corresponding State average; 

or 

‘‘(B) teenage pregnancy or birth rates are 

increasing; and 

‘‘(2) priority to applicants seeking assistance for programs that— 

‘‘(A) will benefit underserved or at-risk 

populations such as young males or immigrant youths; or 

‘‘(B) will take advantage of other available 

resources and be coordinated with other programs that serve youth, such as workforce 

development and after school programs. 

‘‘(d) USE OF FUNDS.—Funds received by an 

entity as a grant under this section shall be 

used for programs that— 

‘‘(1) replicate or substantially incorporate 

the elements of one or more teenage pregnancy prevention programs that have been 

proven (on the basis of rigorous scientific research) to delay sexual intercourse or sexual 

activity, increase condom or contraceptive 

use without increasing sexual activity, or reduce teenage pregnancy; and 

‘‘(2) incorporate one or more of the following strategies for preventing teenage 

pregnancy: encouraging teenagers to delay 

sexual activity; sex and HIV education; 

interventions for sexually active teenagers; 

preventive health services; youth development programs; service learning programs; 

and outreach or media programs. 

‘‘(e) COMPLETE INFORMATION.—Programs receiving funds under this section that choose 

to provide information on HIV/AIDS or contraception or both must provide information 

that is complete and medically accurate. 

‘‘(f) RELATION TO ABSTINENCE-ONLY PROGRAMS.—Funds under this section are not intended for use by abstinence-only education 

programs. Abstinence-only education programs that receive Federal funds through 

the Maternal and Child Health Block Grant, 

the Administration for Children and Families, the Adolescent Family Life Program, 

and any other program that uses the definition of ‘abstinence education’ found in section 510(b) of the Social Security Act are ineligible for funding. 

‘‘(g) APPLICATIONS.—Each entity seeking a 

grant under this section shall submit an application to the Secretary at such time and 

in such manner as the Secretary may require. 

‘‘(h) MATCHING FUNDS.— 

‘‘(1) IN GENERAL.—The Secretary may not 

award a grant to an applicant for a program 

under this section unless the applicant demonstrates that it will pay, from funds derived 

from non-Federal sources, at least 25 percent 

of the cost of the program. 

‘‘(2) APPLICANT’S SHARE.—The applicant’s 

share of the cost of a program shall be provided in cash or in kind. 

‘‘(i) SUPPLEMENTATION OF FUNDS.—An entity that receives funds as a grant under this 

section shall use the funds to supplement 

and not supplant funds that would otherwise 

be available to the entity for teenage pregnancy prevention. 

‘‘(j) EVALUATIONS.— 

‘‘(1) IN GENERAL.—The Secretary shall— 

‘‘(A) conduct or provide for a rigorous evaluation of 10 percent of programs for which a 

grant is awarded under this section; 

‘‘(B) collect basic data on each program for 

which a grant is awarded under this section; 

and 

‘‘(C) upon completion of the evaluations 

referred to in subparagraph (A), submit to 

the Congress a report that includes a detailed statement on the effectiveness of 

grants under this section. 

‘‘(2) COOPERATION BY GRANTEES.—Each 

grant recipient under this section shall provide such information and cooperation as 

may be required for an evaluation under 

paragraph (1). 

‘‘(k) DEFINITION.—For purposes of this section, the term ‘rigorous scientific research’ 

means based on a program evaluation that: 

‘‘(1) Measured impact on sexual or contraceptive behavior, pregnancy or childbearing. 

‘‘(2) Employed an experimental or quasiexperimental design with well-constructed 

and appropriate comparison groups. 

‘‘(3) Had a sample size large enough (at 

least 100 in the combined treatment and control group) and a follow-up interval long 


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enough (at least six months) to draw valid 

conclusions about impact. 

‘‘(l) AUTHORIZATION OF APPROPRIATIONS.— 

There are authorized to be appropriated to 

carry out this section such sums as may be 

necessary for fiscal year 2010 and each subsequent fiscal year.’’. 

SEC. 503. RESEARCH. 

(a) IN GENERAL.—The Secretary of Health 

and Human Services, acting through the Director of the Centers for Disease Control and 

Prevention, shall make grants to public or 

nonprofit private entities to conduct, support, and coordinate research on the prevention of teen pregnancy in eligible communities, including research on the factors contributing to the disproportionate rates of 

teen pregnancy in such communities. 

(b) RESEARCH.—In carrying out subsection 

(a), the Secretary of Health and Human 

Services shall support research that— 

(1) investigates and determines the incidence and prevalence of teen pregnancy in 

communities described in such subsection; 

(2) examines— 

(A) the extent of the impact of teen pregnancy on— 

(i) the health and well-being of teenagers 

in the communities; and 

(ii) the scholastic achievement of such 

teenagers; 

(B) the variance in the rates of teen pregnancy by— 

(i) location (such as inner cities, inner suburbs, and outer suburbs); 

(ii) population subgroup (such as Hispanic, 

Asian-Pacific Islander, African-American, 

Native American); and 

(iii) level of acculturation; 

(C) the importance of the physical and social environment as a factor in placing communities at risk of increased rates of teen 

pregnancy; and 

(D) the importance of aspirations as a factor affecting young women’s risk of teen 

pregnancy; and 

(3) is used to develop— 

(A) measures to address race, ethnicity, socioeconomic status, environment, and educational attainment and the relationship to 

the incidence and prevalence of teen pregnancy; and 

(B) efforts to link the measures to relevant 

databases, including health databases. 

(c) PRIORITY.—In making grants under subsection (a), the Secretary of Health and 

Human Services shall give priority to research that incorporates— 

(1) interdisciplinary approaches; or 

(2) a strong emphasis on community-based 

participatory research. 

(d) AUTHORIZATION OF APPROPRIATIONS.— 

For the purpose of carrying out this section, 

there is authorized to be appropriated such 

sums as may be necessary for each of the fiscal years 2010 through 2014. 

SEC. 504. GENERAL REQUIREMENTS. 

(a) MEDICALLY ACCURATE INFORMATION.—A 

grant may be made under this title only if 

the applicant involved agrees that all information provided pursuant to the grant will 

be age-appropriate, factually and medically 

accurate and complete, and scientifically 

based. 

(b) CULTURAL CONTEXT OF SERVICES.—A 

grant may be made under this title only if 

the applicant involved agrees that information, activities, and services under the grant 

that are directed toward a particular population group will be provided in the language 

and cultural context that is most appropriate for individuals in such group. 

(c) APPLICATION FOR GRANT.—A grant may 

be made under this title only if an application for the grant is submitted to the Secretary of Health and Human Services and the 

application is in such form, is made in such 

manner, and contains such agreements, assurances, and information as the Secretary 

of Health and Human Services determines to 

be necessary to carry out the program involved. 

TITLE VI—ACCURACY OF 

CONTRACEPTIVE INFORMATION 

SEC. 601. SHORT TITLE. 

This title may be cited as the ‘‘Truth in 

Contraception Act of 2009’’. 

SEC. 602. ACCURACY OF CONTRACEPTIVE INFORMATION. 

Notwithstanding any other provision of 

law, any information concerning the use of a 

contraceptive provided through any federally funded sex education, family life education, abstinence education, comprehensive 

health education, or character education 

program shall be medically accurate and 

shall include health benefits and failure 

rates relating to the use of such contraceptive. 

TITLE VII—UNINTENDED PREGNANCY 

REDUCTION ACT 

SEC. 701. SHORT TITLE. 

This title may be cited as the ‘‘Unintended 

Pregnancy Reduction Act of 2009’’. 

SEC. 702. MEDICAID; CLARIFICATION OF COVERAGE OF FAMILY PLANNING SERVICES AND SUPPLIES. 

Section 1937(b) of the Social Security Act 

(42 U.S.C. 1396u–7(b)) is amended by adding at 

the end the following: 

‘‘(5) COVERAGE OF FAMILY PLANNING SERVICES AND SUPPLIES.—Notwithstanding the 

previous provisions of this section, a State 

may not provide for medical assistance 

through enrollment of an individual with 

benchmark coverage or benchmark-equivalent coverage under this section unless such 

coverage includes for any individual described in section 1905(a)(4)(C), medical assistance for family planning services and 

supplies in accordance with such section.’’. 

SEC. 703. EXPANSION OF FAMILY PLANNING 

SERVICES. 

(a) COVERAGE AS MANDATORY CATEGORICALLY NEEDY GROUP.— 

(1) IN GENERAL.—Section 1902(a)(10)(A)(i) of 

the Social Security Act (42 U.S.C. 

1396a(a)(10)(A)(i)) is amended— 

(A) in subclause (VI), by striking ‘‘or’’ at 

the end; 

(B) in subclause (VII), by adding ‘‘or’’ at 

the end; and 

(C) by adding at the end the following new 

subclause: 

‘‘(VIII) who are described in subsection (dd) 

(relating to individuals who meet the income 

standards for pregnant women);’’. 

(2) GROUP DESCRIBED.—Section 1902 of the 

Social Security Act (42 U.S.C. 1396a) is 

amended by adding at the end the following 

new subsection: 

‘‘(dd)(1) Individuals described in this subsection are individuals— 

‘‘(A) meet at least the income eligibility 

standards established under the State plan 

as of January 1, 2009, for pregnant women or 

such higher income eligibility standard for 

such women as the State may establish; and 

‘‘(B) are not pregnant. 

‘‘(2) At the option of a State, individuals 

described in this subsection may include individuals who are determined to meet the income eligibility standards referred to in 

paragraph (1)(A) under the terms and conditions applicable to making eligibility determinations for medical assistance under this 

title under a waiver to provide the benefits 

described in clause (XV) of the matter following subparagraph (G) of section 1902(a)(10) 

granted to the State under section 1115 as of 

January 1, 2007.’’. 

(3) LIMITATION ON BENEFITS.—Section 

1902(a)(10) of the Social Security Act (42 

U.S.C. 1396a(a)(10)) is amended in the matter 

following subparagraph (G)— 

(A) by striking ‘‘and (XIV)’’ and inserting 

‘‘(XIV)’’; and 

(B) by inserting ‘‘, and (XV) the medical 

assistance made available to an individual 

described in subsection (dd) shall be limited 

to family planning services and supplies described in 1905(a)(4)(C) including medical diagnosis and treatment services that are provided pursuant to a family planning service 

in a family planning setting;’’ after ‘‘cervical 

cancer’’. 

(4) CONFORMING AMENDMENTS.—Section 

1905(a) of the Social Security Act (42 U.S.C. 

1396d(a)) is amended in the matter preceding 

paragraph (1)— 

(A) in clause (xii), by striking ‘‘or’’ at the 

end; 

(B) in clause (xii), by adding ‘‘or’’ at the 

end; and 

(C) by inserting after clause (xiii) the following: 

‘‘(xiv) individuals described in section 

1902(dd),’’. 

(b) PRESUMPTIVE ELIGIBILITY.— 

(1) IN GENERAL.—Title XIX of the Social 

Security Act (42 U.S.C. 1396 et seq.) is 

amended by inserting after section 1920B the 

following: 

‘‘PRESUMPTIVE ELIGIBILITY FOR FAMILY

PLANNING SERVICES

‘‘SEC. 1920C. (a) STATE OPTION.—A State 

plan approved under section 1902 may provide for making medical assistance available 

to an individual described in section 1902(dd) 

(relating to individuals who meet certain income eligibility standards) during a presumptive eligibility period. In the case of an 

individual described in section 1902(dd)), such 

medical assistance shall be limited to family 

planning services and supplies described in 

1905(a)(4)(C) including medical diagnosis and 

treatment services that are provided pursuant to a family planning service in a family 

planning setting. 

‘‘(b) DEFINITIONS.—For purposes of this section: 

‘‘(1) PRESUMPTIVE ELIGIBILITY PERIOD.—The 

term ‘presumptive eligibility period’ means, 

with respect to an individual described in 

subsection (a), the period that— 

‘‘(A) begins with the date on which a qualified entity determines, on the basis of preliminary information, that the individual is 

described in section 1902(dd); and 

‘‘(B) ends with (and includes) the earlier 

of— 

‘‘(i) the day on which a determination is 

made with respect to the eligibility of such 

individual for services under the State plan; 

or 

‘‘(ii) in the case of such an individual who 

does not file an application by the last day of 

the month following the month during which 

the entity makes the determination referred 

to in subparagraph (A), such last day. 

‘‘(2) QUALIFIED ENTITY.— 

‘‘(A) IN GENERAL.—Subject to subparagraph 

(B), the term ‘qualified entity’ means any 

entity that— 

‘‘(i) is eligible for payments under a State 

plan approved under this title; and 

‘‘(ii) is determined by the State agency to 

be capable of making determinations of the 

type described in paragraph (1)(A). 

‘‘(B) RULE OF CONSTRUCTION.—Nothing in 

this paragraph shall be construed as preventing a State from limiting the classes of 

entities that may become qualified entities. 

‘‘(c) ADMINISTRATION.— 

‘‘(1) IN GENERAL.—The State agency shall 

provide qualified entities with— 

‘‘(A) such forms as are necessary for an application to be made by an individual described in subsection (a) for medical assistance under the State plan; and 


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‘‘(B) information on how to assist such individuals in completing and filing such 

forms. 

‘‘(2) NOTIFICATION REQUIREMENTS.—A qualified entity that determines under subsection 

(b)(1)(A) that an individual described in subsection (a) is presumptively eligible for medical assistance under a State plan shall— 

‘‘(A) notify the State agency of the determination within 5 working days after the 

date on which determination is made; and 

‘‘(B) inform such individual at the time the 

determination is made that an application 

for medical assistance is required to be made 

by not later than the last day of the month 

following the month during which the determination is made. 

‘‘(3) APPLICATION FOR MEDICAL ASSISTANCE.—In the case of an individual described 

in subsection (a) who is determined by a 

qualified entity to be presumptively eligible 

for medical assistance under a State plan, 

the individual shall apply for medical assistance by not later than the last day of the 

month following the month during which the 

determination is made. 

‘‘(d) PAYMENT.—Notwithstanding any other 

provision of this title, medical assistance 

that— 

‘‘(1) is furnished to an individual described 

in subsection (a)— 

‘‘(A) during a presumptive eligibility period; 

‘‘(B) by a entity that is eligible for payments under the State plan; and 

‘‘(2) is included in the care and services 

covered by the State plan, shall be treated as 

medical assistance provided by such plan for 

purposes of clause (4) of the first sentence of 

section 1905(b).’’. 

(2) CONFORMING AMENDMENTS.— 

(A) Section 1902(a)(47) of the Social Security Act (42 U.S.C. 1396a(a)(47)) is amended by 

inserting before the semicolon at the end the 

following: ‘‘and provide for making medical 

assistance available to individuals described 

in subsection (a) of section 1920C during a 

presumptive eligibility period in accordance 

with such section.’’. 

(B) Section 1903(u)(1)(D)(v) of such Act (42 

U.S.C. 1396b(u)(1)(D)(v)) is amended— 

(i) by striking ‘‘or for’’ and inserting ‘‘, 

for’’; and 

(ii) by inserting before the period the following: ‘‘, or for medical assistance provided 

to an individual described in subsection (a) 

of section 1920C during a presumptive eligibility period under such section’’. 

SEC. 704. EFFECTIVE DATE. 

(a) IN GENERAL.—Except as provided in 

paragraph (2), the amendments made by this 

title take effect on October 1, 2009. 

(b) EXTENSION OF EFFECTIVE DATE FOR

STATE LAW AMENDMENT.—In the case of a 

State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which the 

Secretary of Health and Human Services determines requires State legislation in order 

for the plan to meet the additional requirements imposed by the amendments made by 

this title, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its 

failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of 

the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that 

has a 2-year legislative session, each year of 

the session is considered to be a separate 

regular session of the State legislature. 

TITLE VIII—RESPONSIBLE EDUCATION 

ABOUT LIFE ACT 

SEC. 801. SHORT TITLE. 

This title may be cited as the ‘‘Responsible 

Education About Life Act of 2009’’. 

SEC. 802. ASSISTANCE TO REDUCE TEEN PREGNANCY, HIV/AIDS, AND OTHER SEXUALLY TRANSMITTED DISEASES AND 

TO SUPPORT HEALTHY ADOLESCENT DEVELOPMENT. 

(a) IN GENERAL.—Each eligible State shall 

be eligible to receive from the Secretary of 

Health and Human Services, for each of the 

fiscal years 2010 through 2014, a grant to conduct programs of family life education, including education on both abstinence and 

contraception for the prevention of teenage 

pregnancy and sexually transmitted diseases, including HIV/AIDS. 

(b) REQUIREMENTS FOR FAMILY LIFE PROGRAMS.—For purposes of this title, a program 

of family life education is a program that— 

(1) is age-appropriate and medically accurate; 

(2) does not teach or promote religion; 

(3) teaches that abstinence is the only sure 

way to avoid pregnancy or sexually transmitted diseases; 

(4) stresses the value of abstinence while 

not ignoring those young people who have 

had or are having sexual intercourse; 

(5) provides information about the health 

benefits and side effects of all contraceptives 

and barrier methods as a means to prevent 

pregnancy and reduce the risk of contracting 

sexually transmitted diseases, including 

HIV/AIDS; 

(6) encourages family communication between parent and child about sexuality; 

(7) teaches young people the skills to make 

responsible decisions about sexuality, including how to avoid unwanted verbal, physical, and sexual advances; and 

(8) teaches young people how alcohol and 

drug use can effect responsible decision making. 

(c) ADDITIONAL ACTIVITIES.—In carrying 

out a program of family life education, a 

State may expend a grant under subsection 

(a) to carry out educational and motivational activities that help young people— 

(1) gain knowledge about the physical, 

emotional, biological, and hormonal changes 

of adolescence and subsequent stages of 

human maturation; 

(2) develop the knowledge and skills necessary to ensure and protect their sexual and 

reproductive health from unintended pregnancy and sexually transmitted disease, including HIV/AIDS throughout their lifespan; 

(3) gain knowledge about the specific involvement and responsibility of males in sexual decision making; 

(4) develop healthy attitudes and values 

about adolescent growth and development, 

body image, racial and ethnic diversity, and 

other related subjects; 

(5) develop and practice healthy life skills, 

including goal-setting, decision making, negotiation, communication, and stress management; 

(6) develop healthy relationships, including 

the prevention of dating and relationship violence; 

(7) promote self-esteem and positive interpersonal skills focusing on relationship dynamics, including friendships, dating, romantic involvement, marriage and family 

interactions; and 

(8) prepare for the adult world by focusing 

on educational and career success, including 

developing skills for employment preparation, job seeking, independent living, financial self-sufficiency, and workplace productivity. 

SEC. 803. SENSE OF CONGRESS. 

It is the sense of Congress that while 

States are not required under this title to 

provide matching funds, with respect to 

grants authorized under section 802(a), they 

are encouraged to do so. 

SEC. 804. EVALUATION OF PROGRAMS. 

(a) IN GENERAL.—For the purpose of evaluating the effectiveness of programs of family 

life education carried out with a grant under 

section 802, evaluations of such program 

shall be carried out in accordance with subsections (b) and (c). 

(b) NATIONAL EVALUATION.— 

(1) IN GENERAL.—The Secretary shall provide for a national evaluation of a representative sample of programs of family life education carried out with grants under section 

802. A condition for the receipt of such a 

grant is that the State involved agree to cooperate with the evaluation. The purposes of 

the national evaluation shall be the determination of— 

(A) the effectiveness of such programs in 

helping to delay the initiation of sexual 

intercourse and other high-risk behaviors; 

(B) the effectiveness of such programs in 

preventing adolescent pregnancy; 

(C) the effectiveness of such programs in 

preventing sexually transmitted disease, including HIV/AIDS; 

(D) the effectiveness of such programs in 

increasing contraceptive knowledge and contraceptive behaviors when sexual intercourse 

occurs; and 

(E) a list of best practices based upon essential programmatic components of evaluated programs that have led to success in 

subparagraphs (A) through (D). 

(2) REPORT.—A final report providing the 

results of the national evaluation under 

paragraph (1) shall be submitted to Congress 

not later than March 31, 2015, with an interim report provided on an annual basis at 

the end of each fiscal year under section 

802(a). 

(c) INDIVIDUAL STATE EVALUATIONS.— 

(1) IN GENERAL.—A condition for the receipt of a grant under section 802 is that the 

State involved agree to provide for the evaluation of the programs of family education 

carried out with the grant in accordance 

with the following: 

(A) The evaluation will be conducted by an 

external, independent entity. 

(B) The purposes of the evaluation will be 

the determination of— 

(i) the effectiveness of such programs in 

helping to delay the initiation of sexual 

intercourse and other high-risk behaviors; 

(ii) the effectiveness of such programs in 

preventing adolescent pregnancy; 

(iii) the effectiveness of such programs in 

preventing sexually transmitted disease, including HIV/AIDS; and 

(iv) the effectiveness of such programs in 

increasing contraceptive knowledge and contraceptive behaviors when sexual intercourse 

occurs. 

(2) USE OF GRANT.—A condition for the receipt of a grant under section 802 is that the 

State involved agree that not more than 10 

percent of the grant will be expended for the 

evaluation under paragraph (1). 

SEC. 805. DEFINITIONS. 

For purposes of this title: 

(1) The term ‘‘eligible State’’ means a 

State that submits to the Secretary an application for a grant under section 802 that is 

in such form, is made in such manner, and 

contains such agreements, assurances, and 

information as the Secretary determines to 

be necessary to carry out this title. 

(2) The term ‘‘HIV/AIDS’’ means the 

human immunodeficiency virus, and includes 

acquired immune deficiency syndrome. 

(3) The term ‘‘medically accurate’’, with 

respect to information, means information 

that is supported by research, recognized as 

accurate and objective by leading medical, 

psychological, psychiatric, and public health 

organizations and agencies, and where relevant, published in peer review journals. 

(4) The term ‘‘Secretary’’ means the Secretary of Health and Human Services. 


wwoods2 on PRODPC68 with SENATE
January 6, 2009 CONGRESSIONAL RECORD — SENATE S53 

SEC. 806. APPROPRIATIONS. 

(a) IN GENERAL.—For the purpose of carrying out this title, there are authorized to 

be appropriated such sums as may be necessary for each of the fiscal years 2010 

through 2014. 

(b) ALLOCATIONS.—Of the amounts appropriated under subsection (a) for a fiscal 

year— 

(1) not more than 7 percent may be used for 

the administrative expenses of the Secretary 

in carrying out this title for that fiscal year; 

and 

(2) not more than 10 percent may be used 

for the national evaluation under section 

804(b). 

TITLE IX—PREVENTION THROUGH 

AFFORDABLE ACCESS 

SEC. 901. SHORT TITLE. 

This title may be cited as the ‘‘Prevention 

Through Affordable Access Act’’. 

SEC. 902. RESTORING AND PROTECTING ACCESS 

TO DISCOUNT DRUG PRICES FOR 

UNIVERSITY-BASED AND SAFETYNET CLINICS. 

(a) RESTORING NOMINAL PRICING.—Section 

1927(c)(1)(D)(i) of the Social Security Act (42 

U.S.C. 1396r–8(c)(1)(D)(i)) is amended— 

(1) by redesignating subclause (IV) as subclause (VI); and 

(2) by inserting after subclause (III) the following new subclauses: 

‘‘(IV) An entity that is operated by a 

health center of an institution of higher education, the primary purpose of which is to 

provide health services to students of that 

institution. 

‘‘(V) An entity that is a public or private 

nonprofit entity that provides a service or 

services described under section 1001(a) of 

the Public Health Service Act.’’. 

(b) EFFECTIVE DATE.—The amendments 

made by this section shall be effective as of 

the date of the enactment of this Act. 

By Mrs. HUTCHISON (for herself, 

Mr. ALEXANDER, Mr. ENSIGN, 

Mr. CORNYN, and Mr. MARTINEZ): 

S. 35. A bill to provide a permanent 

deduction for State and local general 

sales taxes; to the Committee on Finance. 

Mrs. HUTCHISON. Mr. President, I 

am pleased to introduce a bill to permanently correct an injustice in the 

tax code that has harmed citizens in 

many States of this great Nation. 

State and local governments have 

various alternatives for raising revenue. Some levy income taxes, some 

use sales taxes, and others use a combination of the two. The citizens who 

pay State and local income taxes have 

been able to offset some of their federal 

income taxes by receiving a deduction 

for those State and local income taxes. 

Before 1986, taxpayers also had the 

ability to deduct their sales taxes. 

The philosophy behind these deductions is simple: people should not have 

to pay taxes on their taxes. The money 

that people must give to one level of 

government should not also be taxed 

by another level of government. 

Unfortunately, citizens of some 

States were treated differently after 

1986 when the deduction for State and 

local sales taxes was eliminated. This 

discriminated against those living in 

States, such as my home State of 

Texas, with no income taxes. It is important to remember the lack of an income tax does not mean citizens in 

these States do not pay State taxes; 

revenues are simply collected differently. 

It is unfair to give citizens from some 

States a deduction for the revenue they 

provide their State and local governments, while not doing the same for 

citizens from other States. Federal tax 

law should not treat people differently 

on the basis of State residence and differing tax collection methods, and it 

should not provide an incentive for 

States to establish income taxes over 

sales taxes. 

This discrepancy has a significant 

impact on Texas. According to the 

Texas Comptroller, extending the deduction would save Texans a projected 

$1.2 billion a year, or an average of $520 

per filer claiming the deduction. The 

Texas Comptroller also estimates continuing the deduction is associated 

with 15,700 to 25,700 Texas jobs and $1.1 

billion to $1.4 billion in gross State 

product. 

Recognizing the inequity in the tax 

code, Congress reinstated the sales tax 

deduction in 2004 and authorized it for 

2 years. In 2006 Congress extended the 

sales tax deduction for an additional 2 

years. Last year, Congress extended 

the deduction for 2 more years. Unfortunately, the deduction is only in effect through 2009, and we must act to 

prevent the inequity from returning. 

The legislation I am offering today 

will fix this problem for good by making the State and local sales tax deduction permanent. This will permanently 

end the discrimination suffered by my 

fellow Texans and citizens of other 

States who do not have the option of 

an income tax deduction. 

This legislation is about reestablishing equity to the tax code and defending the important principle of 

eliminating taxes on taxes. I hope my 

fellow Senators will support this effort 

and pass this legislation. 

Mr. President, I ask unanimous consent that the text of the bill be printed 

in the RECORD. 

There being no objection, the text of 

the bill was ordered to be printed in 

the RECORD, as follows: 

S. 35 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. PERMANENT EXTENSION OF DEDUCTION OF STATE AND LOCAL GENERAL SALES TAXES. 

(a) IN GENERAL.—Subparagraph (I) of section 164(b)(5) of the Internal Revenue Code of 

1986, as amended by section 201 of the Tax 

Extenders and Minimum Tax Relief Act of 

2008, is amended by striking ‘‘, and before 

January 1, 2010’’. 

(b) EFFECTIVE DATE.—The amendment 

made by this section shall apply to taxable 

years beginning after December 31, 2009. 

By Mr. MCCAIN (for himself and 

Mr. ENSIGN): 

S. 36. A bill to repeat the perimeter 

rule for Ronald Reagan Washington 

National Airport, and for other purposes; to the Committee on Commerce, 

Science, and Transportation. 

Mr. MCCAIN. Mr. President, I am 

pleased to be joined by Senator ENSIGN

in introducing the Abolishing Aviation 

Barriers Act of 2009. This bill would remove the arbitrary restrictions that 

prevent Americans from having an 

array of options for non-stop air travel 

between airports in Western states and 

LaGuardia International Airport and 

Ronald Reagan Washington National 

Airport. 

LaGuardia restricts the departure or 

arrival of non-stop flights to or from 

airports that are farther then 1,500 

miles from LaGuardia. Washington National has a similar restriction for nonstop flights to or from airports 1,250 

miles from Washington National. These 

restrictions are commonly referred to 

as the ‘‘perimeter rule.’’ This bill 

would abolish these archaic limitations 

that reduce consumers’ options for convenient flights and competitive fares. 

The original purpose of the perimeter 

rule was to promote LaGuardia and 

Washington National as airports for 

business travelers flying to and from 

East Coast and Midwest cities and to 

promote traffic to other airports by diverting long haul flights to Newark 

and Kennedy airports in the New York 

area and the Dulles airport in the 

Washington area. However, over the 

years, Congress has granted numerous 

exceptions to the perimeter rule because the air traveling public is eager 

for options. Today, exceptions are 

made for nonstop flights between 

LaGuardia and Denver and between 

Washington National and Denver, Las 

Vegas, Los Angeles, Phoenix, Salt 

Lake City and Seattle. Rather then 

continuing to take a piecemeal approach to promoting consumer choice, 

I urge Congress to take this opportunity once and for all to do away with 

this outdated rule. 

I continue to believe that Americans 

should have access to air travel at the 

lowest possible cost and with the most 

convenience for their schedule. Therefore, I have always advocated for the 

removal of any artificial barrier that 

prevents free market competition. In 

2004, I co-sponsored legislation to repeal the Wright Amendment which prohibited flights from Dallas’ Love Field 

airport to 43 states. This year, I am 

proud to once again join with my colleagues to eliminate another unnecessary restraint through the Abolishing 

Aviation Barriers Act of 2009. 

A 1999 study by the Transportation 

Research Board, the most recent available, stated that perimeter rules ‘‘no 

longer serve their original purpose and 

have produced too many adverse side 

effects, including barriers to competition . . . The rules arbitrarily prevent 

some airlines from extending their networks to these airports; they discourage competition among the airports in 

the region and among the airlines that 

use these airports; and they are subject 

to chronic attempts by special interest 

groups to obtain exemptions.’’ That 

same year, the Government Accountability Office, GAO, stated that the 


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