I
104TH CONGRESS
2D SESSION
H. R. 3178
To promote greater equity in the delivery of health care services to American
women through expanded research on women’s health issues and through
improved access to health care services, including preventive health
services.
IN THE HOUSE OF REPRESENTATIVES
MARCH 27, 1996
Ms. SLAUGHTER (for herself, Mrs. MORELLA, Mrs. LOWEY, Ms. EDDIE BER-
NICE JOHNSON of Texas, Ms. BROWN of Florida, Mrs. CLAYTON, Miss
COLLINS of Michigan, Mrs. COLLINS of Illinois, Ms. DELAURO, Ms.
ESHOO, Ms. FURSE, Ms. HARMAN, Ms. JACKSON-LEE of Texas, Mrs.
JOHNSON of Connecticut, Mrs. KELLY, Mrs. KENNELLY, Ms. LOFGREN,
Ms. MCKINNEY, Mrs. MALONEY, Mrs. MEEK of Florida, Mrs. MEYERS
of Kansas, Mrs. MINK of Hawaii, Ms. NORTON, Ms. PELOSI, Ms. RIV-
ERS, Mrs. ROUKEMA, Ms. ROYBAL-ALLARD, Mrs. SCHROEDER, Mrs.
THURMAN, Ms. VELA´ZQUEZ, Ms. WATERS, and Ms. WOOLSEY) intro-
duced the following bill; which was referred to the Committee on Com-
merce, and in addition to the Committees on Ways and Means, the Judi-
ciary, Agriculture, International Relations, Veterans’ Affairs, Economic
and Educational Opportunities, National Security, and Banking and Fi-
nancial Services, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall within
the jurisdiction of the committee concerned
A BILL
To promote greater equity in the delivery of health care
services to American women through expanded research
on women’s health issues and through improved access
to health care services, including preventive health
services.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Women’s Health Eq-
uity Act of 1996’’.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I
Subtitle A—Breast Cancer Research Extension Act of 1996
Sec. 1101. Short title.
Sec. 1102. Extension of program of research on breast cancer.
Subtitle B—HHS Women Scientists Employment Opportunity Act
Sec. 1151. Short title.
Sec. 1152. Women’s scientific employment.
Subtitle C—Women and AIDS Research Initiative Amendments of 1996
Sec. 1191. Short title.
Sec. 1192. Establishment of general program of research regarding women and
acquired immune deficiency syndrome.
Subtitle D—Women’s Cardiovascular Diseases Research and Prevention Act
Sec. 1201. Short title.
Sec. 1202. Findings.
Sec. 1203. Expansion and intensification of activities regarding heart attack,
stroke and other cardiovascular diseases in women.
Subtitle E—Osteoporosis and Related Bone Diseases Research Act of 1996
Sec. 1251. Short title.
Sec. 1252. Findings.
Sec. 1253. Osteoporosis research.
Subtitle F—Lupus Research Amendments of 1996
Sec. 1291. Short title.
Sec. 1292. Findings.
Sec. 1293. Expansion and intensification of activities regarding lupus.
Subtitle G—Ovarian Cancer Research and Information Amendments of 1996
Sec. 1301. Short title.
Sec. 1302. Funding for research on ovarian cancer.
Sec. 1303. Public information and education on ovarian cancer.
Subtitle H—HPV Infection and Cervical Cancer Research Resolution of 1996
Sec. 1351. Short title.
Sec. 1352. Sense of Congress.
Subtitle I—Office for Rare Disease Research Act of 1996
Sec. 1391. Short title.
Sec. 1392. Establishment of Office for Rare Disease Research.
Subtitle J—Federal Risk Assessment in Women’s Health Act of 1996
Sec. 1401. Short title.
Sec. 1402. Interagency review.
Sec. 1403. Study of research needs.
Subtitle K—Women’s Health Environmental Factors Act of 1996
Sec. 1451. Short title.
Sec. 1452. Report on effect of environmental factors on women’s health.
Subtitle L—Consumer Involvement in Breast Cancer Research Act
Sec. 1491. Short title.
Sec. 1492. Increased involvement of advocates in decision making regarding re-
search on breast cancer.
Subtitle M—Women and Alcohol Research Equity Act of 1996
Sec. 1501. Short title.
Sec. 1502. Findings.
Sec. 1503. Provisions regarding increase in amount of funds expended for re-
search on alcohol abuse and alcoholism among women.
TITLE II—SERVICES
Subtitle A—Women’s Health Office Act of 1996
Sec. 2101. Short title.
Sec. 2102. Public Health Service Office on Women’s Health.
Sec. 2103. Centers for Disease Control and Prevention Office of Women’s
Health.
Sec. 2104. Agency for Health Care Policy and Research Office of Women’s
Health.
Sec. 2105. Health Resources and Services Administration Office of Women’s
Health.
Sec. 2106. Food and Drug Administration Office of Women’s Health.
Subtitle B—Genetic Information Nondiscrimination in Health Insurance Act
of 1996
Sec. 2151. Short title.
Sec. 2152. Prohibition of health insurance discrimination on the basis of ge-
netic information.
Subtitle C—Improved Patient Access to Clinical Studies Act of 1996
Sec. 2191. Short title.
Sec. 2192. Coverage for individuals participating in approved clinical studies.
Subtitle D—Equitable Health Care for Neurobiological Disorders Act of 1996
Sec. 2201. Short title.
Sec. 2202. Findings.
Sec. 2203. Standards for nondiscriminatory treatment of neurobiological dis-
orders for employer health benefit plans.
Sec. 2204. Enforcement through excise tax.
Sec. 2205. Definitions.
Subtitle E—Victims of Abuse Insurance Protection Act
Sec. 2251. Short title.
Sec. 2252. Definitions.
Sec. 2253. Discriminatory acts prohibited.
Sec. 2254. Reasons for adverse actions.
Sec. 2255. Life insurance.
Sec. 2256. Subrogation without consent prohibited.
Sec. 2257. Enforcement.
Subtitle F—Insurance Protection for Victims of Domestic Violence Act
Sec. 2291. Short title.
Sec. 2292. Prohibition of health insurance discrimination with respect to vic-
tims of domestic violence.
Subtitle G—Domestic Violence Victims Insurance Protection Act of 1996
Sec. 2301. Short title.
Sec. 2302. Protection of domestic violence victims from health insurance dis-
crimination.
Subtitle H—Fairness to Minority Women Health Act
Sec. 2351. Short title.
Sec. 2352. Exception to AFDC income and resources attribution rule for cer-
tain battered aliens.
Sec. 2353. Amendment to the Food Stamp Act of 1977.
Sec. 2354. Requiring certain recipients of Federal financial assistance to have
personnel available who speak predominant language used in
area.
Sec. 2355. Study regarding domestic violence and latina women.
Subtitle I—Adolescent Health Demonstration Projects Act
Sec. 2391. Short title.
Sec. 2392. Establishment or support of demonstration projects.
Sec. 2393. Project requirements.
Sec. 2394. Areas to be served.
Sec. 2395. Abortion restriction.
Sec. 2396. Report.
Subtitle J—Eating Disorders Information and Education Act of 1996
Sec. 2401. Short title.
Sec. 2402. Findings.
Sec. 2403. Public information and education on eating disorders.
Subtitle K—Women’s Choice and Reproductive Health Protection Act of 1996
Sec. 2451. Short title.
Sec. 2452. Findings.
Sec. 2453. Sense of Congress with respect to certain reproductive health issues.
Sec. 2454. Family planning amendments.
Sec. 2455. Freedom of full disclosure.
Sec. 2456. Fairness in evaluation of RU–486.
Sec. 2457. Freedom of choice.
Sec. 2458. Fairness in insurance.
Sec. 2459. Abortions in facilities of the uniformed services not prohibited if not
federally funded.
Subtitle L—Women’s Right To Know Act of 1996
Sec. 2491. Short title.
Sec. 2492. First amendment rights.
Subtitle M—International Population Stabilization and Reproductive Health
Act
Sec. 2501. Short title.
Sec. 2502. Authorities relating to United States population assistance.
Sec. 2503. Authorizations of appropriations.
Sec. 2504. Oversight of multilateral development banks.
Sec. 2505. Economic and social development initiatives to stabilize world popu-
lation.
Sec. 2506. AIDS prevention and control fund.
Sec. 2507. Support for United Nations forward looking strategies for the ad-
vancement of women.
Sec. 2508. Support for the convention on the elimination of all forms of dis-
crimination against women.
Subtitle N—Federal Prohibition of Female Genital Mutilation Act of 1996
Sec. 2551. Short title.
Sec. 2552. Title 18 amendment.
Sec. 2553. Information and education regarding female genital mutilation.
Sec. 2554. Effective dates.
Subtitle O—Women and HIV Outreach and Prevention Act
Sec. 2591. Short title.
Sec. 2592. Preventive 
health 
programs 
regarding 
women 
and 
human
immunodeficiency virus.
Sec. 2593. Treatment of women for substance abuse.
Sec. 2594. Early intervention services for women.
Subtitle P—Smoking Prevention and Cessation in WIC Clinics Act
Sec. 2601. Short title.
Sec. 2602. Smoking cessation demonstration programs for WIC participants.
Subtitle Q—Comprehensive Fetal Alcohol Syndrome Prevention Act
Sec. 2651. Short title.
Sec. 2652. Prevention of fetal alcohol syndrome; program of National Institute
on Alcohol Abuse and Alcoholism.
Subtitle R—Postreproductive Health Care Act
Sec. 2691. Short title.
Sec. 2692. Establishment of program for postreproductive health care.
Subtitle S—Family Caregiver Support and Protection Act of 1996
Sec. 2701. Short title.
Sec. 2702. Coverage of respite care services under medicare.
Sec. 2703. Treatment of long-term care services as medical care.
Subtitle T—Medicare Mammography Enhancement Act of 1996
Sec. 2751. Short title.
Sec. 2752. Expanding screening mammography under the medicare program.
Subtitle U—Medicare Bone Mass Measurement Standardization Act of 1996
Sec. 2791. Short title.
Sec. 2792. Medicare coverage of bone mass measurements.
Subtitle V—Osteoporosis and Related Bone Disorders Resource Center Act of
1996
Sec. 2801. Short title.
Sec. 2802. Funding for information clearinghouse on osteoporosis, Paget’s dis-
ease, and related bone disorders.
Subtitle W—Women Veterans Health Improvement Act of 1996
Sec. 2851. Short title.
Sec. 2852. Women’s health services.
Sec. 2853. Report on women’s health care and research.
Sec. 2854. Expansion of research relating to women veterans.
Sec. 2855. Population study.
Sec. 2856. Outreach services for homeless women veterans.
Sec. 2857. Safe and effective treatment for women psychiatric patients.
Sec. 2858. Mammography quality standards.
TITLE I
Subtitle A—Breast Cancer
Research Extension Act of 1996
SEC. 1101. SHORT TITLE.
This subtitle may be cited as the ‘‘Breast Cancer Re-
search Extension Act of 1996’’.
SEC. 1102. EXTENSION OF PROGRAM OF RESEARCH ON
BREAST CANCER.
Section 417B(b)(1) of the Public Health Service Act
(42 U.S.C. 286a–8(b)(1)) is amended to read as follows:
‘‘(1) BREAST CANCER.—For the purpose of car-
rying out section 417(c), there are authorized to be
appropriated $575,000,000 for fiscal year 1997, and
such sums as may be necessary for each of the fiscal
years 1998 through 2001. Such authorizations of
appropriations are in addition to the authorizations
of appropriations established in subsection (a) with
respect to such purpose.’’.
Subtitle B—HHS Women Scientists
Employment Opportunity Act
SEC. 1151. SHORT TITLE.
This subtitle may be cited as the ‘‘HHS Women Sci-
entist Employment Opportunity Act’’.
SEC. 1152. WOMEN’S SCIENTIFIC EMPLOYMENT.
The Public Health Service Act (42 U.S.C. 281 et
seq.) is amended by adding at the end the following title:
‘‘TITLE XXVII—WOMEN’S SCIENTIFIC EMPLOY-
MENT WITH DEPARTMENT OF HEALTH
AND HUMAN SERVICES
‘‘SEC. 2701. WOMEN’S SCIENTIFIC EMPLOYMENT.
‘‘(a) IN GENERAL.—
‘‘(1) IN GENERAL.—For each agency specified
in paragraph (2), the Secretary, in collaboration
with the head of the agency, shall—
‘‘(A) establish policies for the agency on
matters relating to the employment by the
agency of women as scientists, and periodically
review and as appropriate revise such policies;
and
‘‘(B) monitor the extent of compliance with
such policies and take appropriate action in
cases in which the Secretary determines that
the policies have been violated.
‘‘(2) SPECIFIED AGENCIES.—The agencies re-
ferred to in paragraph (1) are the National Insti-
tutes of Health, the Centers for Disease Control and
Prevention, the Food and Drug Administration, and
such other agencies or offices of the Department of
Health and Human Services as the Secretary deter-
mines to be appropriate.
‘‘(b) CERTAIN FUNCTIONS.—
‘‘(1) IN GENERAL.—In carrying out subsection
(a) with respect to a specified agency, the Secretary
shall provide for the following:
‘‘(A) Determining the concerns of women
scientists employed at the agency.
‘‘(B) Developing a policy defining the
standard tenure process for employment at the
agency.
‘‘(C) Determining the reason for departure
from the agency by interviewing women and
men scientists as they leave.
‘‘(D) Distributing yearly to all employees
of the agency of the policy of the agency on
flexible family leave.
‘‘(E) Monitoring the number of women, in-
cluding minority women, included on the com-
mittees, panels, and other working groups (and
in meetings) of the agency.
‘‘(F) Making efforts to recruit minority
women, based on the small numbers of tenured
minority women scientists.
‘‘(G) Developing additional goals related to
women and minority women scientists at the
agency.
‘‘(2) AGENCY-SPECIFIC PROVISIONS.—With re-
spect to the National Institutes of Health, in carry-
ing out subsection (a), the Secretary shall (in addi-
tion to activities under paragraph (1)) provide for
the implementation of the recommendations of the
group known as the Task Force on the Status of
NIH Intramural Women Scientists.
‘‘(c) INCLUSION OF WOMEN ON INTRAMURAL AND
EXTRAMURAL CONFERENCES AND OTHER GROUPS.—
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a policy at each specified agency of requiring in-
clusion of women scientists in greater numbers on or
in conferences, workshops, meetings, international
congresses, and other groups funded or sponsored by
the agency. Such policy shall provide for the inclu-
sion of not less than one woman scientist in each
such group, except as provided in paragraph (2).
This paragraph applies whether such groups are
held for employees of the agency headquarters, for
employees of field offices, or both.
‘‘(2) EXCLUSION; WRITTEN
EXPLANATION.—
The policy established in paragraph (1) may provide
that no woman scientist will be included in a group
for purposes of such paragraph if the Secretary pro-
vides a waiver of the requirement. The Secretary
may grant such a waiver only if—
‘‘(A) the individual with the chief respon-
sibility for the group involved submits to the
Secretary a written request for the waiver and
the request provides an explanation of the rea-
sons underlying the need for the waiver; and
‘‘(B) the Secretary makes a determination
that extraordinary circumstances justify provid-
ing the waiver.
‘‘(d) STUDY ON PAY EQUITY.—
‘‘(1) IN GENERAL.—For each specified agency,
the Secretary shall provide for a study to identify
any pay differences among men and women sci-
entists employed by the agency, both tenured and
untenured. The study shall include recommendations
on measures to adjust any disparities or inequities,
and shall identify a program to communicate infor-
mation on salary ranges to all employees.
‘‘(2) REPORT.—Not later than 240 days after
the date of the enactment of the HHS Women Sci-
entist Employment Opportunity Act of 1996, the
Secretary shall complete the study required in para-
graph (1) and submit to the Committee on Com-
merce of the House of Representatives, and to the
Committee on Labor and Human Resources of the
Senate, a report describing the findings made as a
result of the study.
‘‘(e) DEFINITIONS.—For purposes of this section, the
term ‘specified agency’ means an agency specified in sub-
section (a)(2).
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there are authorized
to be appropriated such sums as may be necessary for
each of the fiscal years 1997 through 1999.’’.
Subtitle C—Women and AIDS Re-
search Initiative Amendments
of 1996
SEC. 1191. SHORT TITLE.
This subtitle may be cited as the ‘‘Women and AIDS
Research Initiative Amendments of 1996’’.
SEC. 1192. ESTABLISHMENT OF GENERAL PROGRAM OF RE-
SEARCH REGARDING WOMEN AND ACQUIRED
IMMUNE DEFICIENCY SYNDROME.
Part B of title XXIII of the Public Health Service
Act (42 U.S.C. 300cc–11 et seq.) is amended by adding
at the end the following section:
‘‘SEC. 2321. RESEARCH REGARDING WOMEN.
‘‘(a) IN GENERAL.—With respect to cases of infec-
tion with the human immunodeficiency virus, the Sec-
retary shall establish a program for the purpose of con-
ducting biomedical and behavioral research on such cases
in women, including research on the prevention of such
cases. The Secretary may conduct such research directly,
and may make grants to public and nonprofit private enti-
ties for the conduct of the research.
‘‘(b) CERTAIN FORMS OF RESEARCH.—In carrying
out subsection (a), the Secretary shall provide for research
on the following:
‘‘(1) The manner in which the human
immunodeficiency virus is transmitted to women, in-
cluding the relationship between cases of infection
with such virus and other cases of sexually transmit-
ted diseases, including clinical trials which examine
the question of how much human immunodeficiency
virus infection can be prevented by finding and
treating sexually transmitted diseases in women.
‘‘(2) Measures for the prevention of exposure to
and the transmission of such virus, including re-
search on the following:
‘‘(A) The prevention of any sexually trans-
mitted disease that may facilitate the trans-
mission of the virus.
‘‘(B) Rapid, inexpensive, easy-to-use sexu-
ally transmitted disease diagnostic tests for
women.
‘‘(C) Inexpensive single dose therapy for
treatable sexually transmitted diseases.
‘‘(D) The development of methods of pre-
vention for use by women.
‘‘(E) The development and dissemination
of prevention programs and materials whose
purpose is to reduce the incidence of substance
abuse among women.
‘‘(3) The development and progression of symp-
toms resulting from infection with such virus, in-
cluding research regarding gynecological infections
as well as breast changes, hormonal changes, and
menses and menopause changes, whose occurrence
becomes probable as a result of the deterioration of
the immune system.
‘‘(4) The treatment of cases of such infection,
including clinical research.
‘‘(5) Behavioral research on the prevention of
such cases and research on model educational pro-
grams for such prevention.
‘‘(6) Research leading to an understanding of
social, economic, and legal factors whose impact con-
tributes to an increased risk of such infection.
‘‘(7) Research leading to an understanding of
social, economic, and legal factors whose impact con-
tributes to—
‘‘(A) low levels of participation by women
in clinical trials; or
‘‘(B) inadequate access to health care serv-
ices, or inadequate utilization of such services.
‘‘(c) CLINICAL RESEARCH.—
‘‘(1) GYNECOLOGICAL EVALUATIONS.—In clini-
cal trials regarding the human immunodeficiency
virus in which women participate as subjects, the
Secretary shall ensure—
‘‘(A) that the designs of the trials include
adequate evaluation of prospective subjects
prior to enrollment, and adequate evaluation of
subjects during the course of the trials, includ-
ing evaluation of the reproductive tract, and ap-
propriate follow-up services regarding such eval-
uations; and
‘‘(B) the conduct of studies related to the
propensity for cases of infection with such virus
to cause abnormalities in the reproductive tract,
or to alter the natural history of other repro-
ductive-tract infections and diseases.
‘‘(2) STANDARD
TREATMENTS
FOR
GYNECO-
LOGICAL CONDITIONS.—The Secretary shall conduct
or support clinical trials under subsection (a) to de-
termine whether standard methods of treating gyne-
cological conditions are effective in the case of such
conditions that arise as a result of infection with the
human immunodeficiency virus.
‘‘(3) EFFECTIVENESS OF CERTAIN TREATMENT
PROTOCOLS.—With respect to cases of infection with
the human immunodeficiency virus, the Secretary
shall conduct or support clinical research under sub-
section (a) to determine the effectiveness, on such
cases in women, of approved treatment protocols.
‘‘(4) SUPPORT SERVICES.—
‘‘(A) In conducting or supporting clinical
trials regarding the human immunodeficiency
virus in which women participate as subjects,
the Secretary shall take into account factors
that can facilitate such participation, including
consideration of employment schedules and the
provision of support services. The Secretary
may provide such services accordingly, including
transportation services, child care services, med-
ical and mental health services, treatment for
drug abuse, social services (including services
addressing domestic violence), and other sup-
port services.
‘‘(B) Services under subparagraph (A)
shall include services designed to respond to the
ods that do not pose a threat to the ability
of women to conceive and bear healthy
children.
‘‘(2) EPIDEMIOLOGICAL RESEARCH.—The Sec-
retary shall conduct or support epidemiological re-
search under subsection (a) to determine the factors
of risk regarding infection with the human
immunodeficiency virus that are particular to
women, including research regarding—
‘‘(A) the use of spermicides and other con-
traceptive methods;
‘‘(B) the use of vaginal products, including
douches, tampons, and vaginal medications;
‘‘(C) the relationship between such infec-
tion and other sexually transmitted diseases;
‘‘(D) the relationship between such infec-
tion and various forms of substance abuse (in-
cluding use of the form of cocaine commonly
known as crack); and
‘‘(E) the relationship between such infec-
tion and noncoital forms of sexual activity.
‘‘(e) INTERAGENCY STUDY.—With respect to the
study (known as the Women’s Interagency HIV Study)
that, as of March 1996, is being carried out by the Sec-
retary through various agencies of the Public Health Serv-
ice for the purpose of monitoring the progression in
women of infection with the human immunodeficiency
virus, and determining whether such progression is dif-
ferent in women than in men, the following applies:
‘‘(1) The Secretary shall ensure that not less
than 2,500 women with such infection are included
in the study, and that the demographic variability of
the cohort is maintained.
‘‘(2) The Secretary shall ensure that the study
period is extended for a minimum of 5 years.
‘‘(3) With respect to markers of human
immunodeficiency virus disease progression and viral
activity (including the cells commonly known as CD4
cells and including quantitative viral load measures),
the Secretary shall ensure that the study adequately
addresses the relationship between such markers and
the development of serious illnesses in such women.
For purposes of the preceding sentence, the study
shall address gynecological conditions, and other
conditions particular to women, that are not cur-
rently included in the list of conditions arising from
such infection that, for surveillance purposes, is
maintained by the Director of the Centers for Dis-
ease Control and Prevention.
‘‘(f) DEFINITIONS.—For purposes of this section, the
term ‘human immunodeficiency virus’ means the etiologic
agent for acquired immune deficiency syndrome.
‘‘(g) AUTHORIZATIONS OF APPROPRIATIONS.—
‘‘(1) CLINICAL RESEARCH.—In addition to any
other authorizations of appropriations that are avail-
able for the following purposes:
‘‘(A) For the purpose of carrying out sub-
section (c)(1), there are authorized to be appro-
priated $20,000,000 for fiscal year 1997, and
such sums as may be necessary for each of the
fiscal years 1998 through 1999.
‘‘(B) For the purpose of carrying out sub-
section (c)(2), there are authorized to be appro-
priated $10,000,000 for fiscal year 1997, and
such sums as may be necessary for each of the
fiscal years 1998 through 1999.
‘‘(C) For the purpose of carrying out sub-
section (c)(3), there are authorized to be appro-
priated $10,000,000 for fiscal year 1997, and
such sums as may be necessary for each of the
fiscal years 1998 through 1999.
‘‘(D) For the purpose of carrying out sub-
section (c)(4), there are authorized to be appro-
priated $15,000,000 for fiscal year 1997, and
such sums as may be necessary for each of the
fiscal years 1998 and 1999.
‘‘(2) PREVENTION PROGRAMS.—In addition to
any other authorizations of appropriations that are
available for the following purposes:
‘‘(A) For the purpose of carrying out sub-
section (d)(1), there are authorized to be appro-
priated $10,000,000 for fiscal year 1997, and
such sums as may be necessary for each of the
fiscal years 1998 through 1999.
‘‘(B) For the purpose of carrying out sub-
section (d)(2), there are authorized to be appro-
priated $10,000,000 for fiscal year 1997, and
such sums as may be necessary for each of the
fiscal years 1998 through 1999.
‘‘(3) INTERAGENCY STUDY.—In addition to any
other authorizations of appropriations that are avail-
able for the purpose of carrying out subsection (e),
there are authorized to be appropriated for such
purpose $6,000,000 for fiscal year 1997, and such
sums as may be necessary for each of the fiscal
years 1998 through 1999.’’.
Subtitle 
D—Women’s 
Cardio-
vascular Diseases Research and
Prevention Act
SEC. 1201. SHORT TITLE.
This subtitle may be cited as the ‘‘Women’s Cardio-
vascular Diseases Research and Prevention Act’’.
SEC. 1202. FINDINGS.
The Congress finds as follows with respect to women
in the United States:
(1) Heart attack, stroke, and other cardio-
vascular diseases are the leading causes of death in
women.
(2) Heart attacks and strokes are leading
causes of disability in women.
(3) Cardiovascular diseases claim the lives of
more women each year than does cancer. Each year
more than 479,000 females die of cardiovascular dis-
eases, while approximately 246,000 females die of
cancer. Heart attack kills more than 5 times as
many females as breast cancer. Stroke kills twice as
many females as breast cancer.
(4) One in 5 females has some form of cardio-
vascular disease. Of females under age 65, each year
more than 20,000 die of heart attacks. In the case
of African-American women, from ages 35 to 74 the
women than in men. Of individuals who die from a
stroke, each year approximately 61 percent are fe-
males. In 1992, 87,124 females died from strokes.
Women have unrecognized heart attacks more fre-
quently than men. Of women who died suddenly
from heart attack, 63 percent had no previous evi-
dence of disease.
(8) More than half of the annual health care
costs that are related to cardiovascular diseases are
attributable to the occurrence of the diseases in
women, each year costing this nation hundreds of
billions of dollars in health care costs and lost pro-
ductivity.
SEC. 1203. EXPANSION AND INTENSIFICATION OF ACTIVI-
TIES REGARDING HEART ATTACK, STROKE
AND OTHER CARDIOVASCULAR DISEASES IN
WOMEN.
Subpart 2 of part C of title IV of the Public Health
Service Act (42 U.S.C. 285b et seq.) is amended by insert-
ing after section 424 the following section:
‘‘HEART ATTACK, STROKE, AND OTHER CARDIOVASCULAR
DISEASES IN WOMEN
‘‘SEC. 424A. (a) IN GENERAL.—The Director of the
Institute shall expand, intensify, and coordinate research
and related activities of the Institute with respect to heart
attack, stroke, and other cardiovascular diseases in
women.
‘‘(b) COORDINATION WITH OTHER INSTITUTES.—
The Director of the Institute shall coordinate activities
under subsection (a) with similar activities conducted by
the other national research institutes and agencies of the
National Institutes of Health to the extent that such Insti-
tutes and agencies have responsibilities that are related
to heart attack, stroke, and other cardiovascular diseases
in women.
‘‘(c) CERTAIN PROGRAMS.—In carrying out sub-
section (a), the Director of the Institute shall conduct or
support research to expand the understanding of the
causes of, and to develop methods for preventing, cardio-
vascular diseases in women. Activities under such sub-
section shall include conducting and supporting the follow-
ing:
‘‘(1) Research to determine the reasons under-
lying the prevalence of heart attack, stroke, and
other cardiovascular diseases in women, including
African-American women and other women who are
members of racial or ethnic minority groups.
‘‘(2) Basic research concerning the etiology and
causes of cardiovascular diseases in women.
‘‘(3) Epidemiological studies to address the fre-
quency and natural history of such diseases and the
differences among men and women, and among ra-
cial and ethnic groups, with respect to such diseases.
‘‘(4) The development of safe, efficient, and
cost-effective diagnostic approaches to evaluating
women with suspected ischemic heart disease.
‘‘(5) Clinical research for the development and
evaluation of new treatments for women, including
rehabilitation.
‘‘(6) Studies to gain a better understanding of
methods of preventing cardiovascular diseases in
women, including applications of effective methods
for the control of blood pressure, lipids, and obesity.
‘‘(7) Information and education programs for
patients and health care providers on risk factors as-
sociated with heart attack, stroke, and other cardio-
vascular diseases in women, and on the importance
of the prevention or control of such risk factors and
timely referral with appropriate diagnosis and treat-
ment. Such programs shall include information and
education on health-related behaviors that can im-
prove such important risk factors as smoking, obe-
sity, high blood cholesterol, and lack of exercise.
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there are authorized
to be appropriated $140,000,000 for fiscal year 1997, and
such sums as may be necessary for each of the fiscal years
1998 and 1999. The authorization of appropriations es-
tablished in the preceding sentence is in addition to any
other authorization of appropriation that is available for
such purpose.’’.
Subtitle E—Osteoporosis and Re-
lated Bone Diseases Research
Act of 1996
SEC. 1251. SHORT TITLE.
This subtitle may be cited as the ‘‘Osteoporosis and
Related Bone Diseases Research Act of 1996’’.
SEC. 1252. FINDINGS.
The Congress finds that—
(1) osteoporosis, or porous bone, is a condition
characterized by an excessive loss of bone tissue and
an increased susceptibility to fractures of the hip,
spine, and wrist;
(2) osteoporosis is a threat to an estimated
25,000,000 Americans, 80 percent of whom are
women, many of whose cases go undiagnosed be-
cause the condition develops without symptoms until
a strain, bump, or fall causes a fracture;
(3) between 3 and 4 million Americans have
Paget’s 
disease, 
osteogenesis 
imperfecta,
hyperparathyroidism, and other related metabolic
bone diseases;
(4) osteoporosis is responsible for 1,500,000
bone fractures annually, including more than
250,000 hip fractures, 500,000 vertebral fractures,
200,000 fractures of the wrist, and the remaining
fractures at other limb sites;
(5) 1 of every 2 women and 1 of every 8 men
over age 50 will develop fractures associated with
osteoporosis;
(6) direct medical costs of osteoporosis are esti-
mated to be $10,000,000,000 annually for the Unit-
ed States, not including the costs of family care and
lost work for caregivers;
(7) direct medical costs of osteoporosis are ex-
pected to increase precipitously because the propor-
tion of the population comprised of older persons is
expanding and each generation of older persons
tends to have a higher incidence of osteoporosis than
preceding generations;
(8) technology now exists, and new technology
is developing, that will permit early diagnosis and
prevention of osteoporosis as well as management of
the condition once it has developed;
(9) funding for research on osteoporosis and re-
lated bone diseases is severely constrained at key re-
search institutes, including the National Institute of
Arthritis and Musculoskeletal and Skin Diseases, the
National Institute on Aging, the National Institute
of Diabetes and Digestive and Kidney Diseases, the
National Institute of Dental Research, and the Na-
tional Institute of Child Health and Human Devel-
opment;
(10) further research is needed to improve med-
ical knowledge concerning—
(A) cellular mechanisms related to the
processes of bone resorption and bone forma-
tion, and the effect of different agents on bone
remodeling;
(B) risk factors for osteoporosis, including
newly discovered risk factors, risk factors relat-
ed to groups not ordinarily studied (such as
men and minorities), risk factors related to
genes that help to control skeletal metabolism,
and risk factors relating to the relationship of
aging 
processes 
to 
the 
development 
of
osteoporosis;
(C) bone mass measurement technology,
including more widespread and cost-effective
techniques for making more precise measure-
ments and for interpreting measurements;
(D) calcium (including bioavailability, in-
take requirements, and the role of calcium in
building heavier and denser skeletons), and vi-
tamin D and its role as an essential vitamin in
adults;
(E) prevention and treatment, including
the efficacy of current therapies, alternative
drug therapies for prevention and treatment,
and the role of exercise; and
(F) rehabilitation; and
(11) further educational efforts are needed to
increase public and professional knowledge of the
causes of, methods for avoiding, and treatment of
osteoporosis.
SEC. 1253. OSTEOPOROSIS RESEARCH.
Subpart 4 of part C of title IV of the Public Health
Service Act (42 U.S.C. 285d et seq.) is amended by adding
at the end the following new section:
Institute of Diabetes and Digestive and Kidney Diseases,
$4,000,000 for the National Institute of Dental Research,
and $3,000,000 for the National Institute of Child Health
and Human Development for each of the fiscal years 1997
through 1999, and such sums as may be necessary for
subsequent fiscal years. These funds are in addition to
amounts authorized to be appropriated for biomedical re-
search relating to osteoporosis and related bone diseases
under any other provision of law.
‘‘(d) RELATED BONE DISEASES DEFINED.—As used
in this section, the term ‘related bone diseases’ includes—
‘‘(1) Paget’s disease, a bone disease character-
ized by enlargement and loss of density with bowing
and deformity of the bones;
‘‘(2) osteogenesis imperfecta, a familial disease
marked by extreme brittleness of the long bones;
‘‘(3) hyperparathyroidism, a condition charac-
terized by the presence of excess parathormone in
the body resulting in disturbance of calcium metabo-
lism with loss of calcium from bone and renal dam-
age;
‘‘(4) hypoparathyroidism, a condition character-
ized by the absence of parathormone resulting in
disturbances of calcium metabolism;
‘‘(5) renal bone disease, a disease characterized
by metabolic disturbances from dialysis, renal trans-
plants, or other renal disturbances;
‘‘(6) primary or postmenopausal osteoporosis
and secondary osteoporosis, such as that induced by
corticosteroids; and
‘‘(7) other general diseases of bone and mineral
metabolism including abnormalities of vitamin D.’’.
Subtitle F—Lupus Research
Amendments of 1996
SEC. 1291. SHORT TITLE.
This subtitle may be cited as the ‘‘Lupus Research
Amendments of 1996’’.
SEC. 1292. FINDINGS.
The Congress finds that—
(1) lupus is a serious, complex, inflammatory,
autoimmune disease of particular concern to women;
(2) lupus affects women 9 times more often
than men;
(3) there are 3 main types of lupus: systemic
lupus, a serious form of the disease that affects
many parts of the body; discoid lupus, a form of the
disease that affects mainly the skin; and drug-in-
duced lupus caused by certain medications;
(4) lupus can be fatal if not detected and treat-
ed early;
(5) the disease can simultaneously affect var-
ious areas of the body, such as the skin, joints, kid-
neys, and brain, and can be difficult to diagnose be-
cause the symptoms of lupus are similar to those of
many other diseases;
(6) lupus disproportionately affects African-
American women, as the prevalence of the disease
among such women is 3 times the prevalence among
white women, and an estimated 1 in 250 African-
American women between the ages of 15 and 65 de-
velops the disease;
(7) it has been estimated that over 500,000
Americans have been diagnosed with the disease,
and that many more have undiagnosed cases;
(8) current treatments for the disease can be
effective, but may lead to damaging side effects; and
(9) many victims of the disease suffer debilitat-
ing pain and fatigue, making it difficult to maintain
employment and lead normal lives.
SEC. 1293. EXPANSION AND INTENSIFICATION OF ACTIVI-
TIES REGARDING LUPUS.
Subpart 4 of part C of title IV of the Public Health
Service Act (42 U.S.C. 285d et seq.) is amended by insert-
ing after section 441 the following section:
‘‘LUPUS
‘‘SEC. 441A. (a) IN GENERAL.—The Director of the
Institute shall expand and intensify research and related
activities of the Institute with respect to lupus.
‘‘(b) COORDINATION WITH OTHER INSTITUTES.—
The Director of the Institute shall coordinate the activities
of the Director under subsection (a) with similar activities
conducted by the other national research institutes and
agencies of the National Institutes of Health to the extent
that such Institutes and agencies have responsibilities that
are related to lupus.
‘‘(c) PROGRAMS FOR LUPUS.—In carrying out sub-
section (a), the Director of the Institute shall conduct or
support research to expand the understanding of the
causes of, and to find a cure for, lupus. Activities under
such subsection shall include conducting and supporting
the following:
‘‘(1) Research to determine the reasons under-
lying the elevated prevalence of lupus in women, in-
cluding African-American women.
‘‘(2) Basic research concerning the etiology and
causes of the disease.
‘‘(3) Epidemiological studies to address the fre-
quency and natural history of the disease and the
differences among the sexes and among racial and
ethnic groups with respect to the disease.
‘‘(4) The development of improved screening
techniques.
‘‘(5) Clinical research for the development and
evaluation of new treatments, including new biologi-
cal agents.
‘‘(6) Information and education programs for
health care professionals and the public.
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there are authorized
to be appropriated $20,000,000 for fiscal year 1997, and
such sums as may be necessary for each of the fiscal years
1998 and 1999. The authorization of appropriations es-
tablished in the preceding sentence is in addition to any
other authorization of appropriations that is available for
such purpose.’’.
Subtitle 
G—Ovarian 
Cancer
Research 
and 
Information
Amendments of 1996
SEC. 1301. SHORT TITLE.
This subtitle may be cited as the ‘‘Ovarian Cancer
Research and Information Amendments of 1996’’.
SEC. 1302. FUNDING FOR RESEARCH ON OVARIAN CANCER.
Section 417B(b)(2) of the Public Health Service Act
is amended—
(1) by striking ‘‘CANCERS.—For the purpose
of’’ and all that follows through ‘‘417,’’ and insert-
ing the following: ‘‘CANCERS.—
‘‘(A) For the purpose of carrying out sec-
tion 417(d),’’; and
(2) by adding at the end the following subpara-
graph:
‘‘(B)(i) For the purpose of carrying out re-
search under section 417(d) on ovarian cancer,
there 
are 
authorized 
to 
be 
appropriated
$90,000,000 for fiscal year 1997, and such
sums as may be necessary for each of the fiscal
years 1998 and 1999. With respect to such pur-
pose, such authorizations of appropriations are
in addition to the authorizations of appropria-
tions established in subparagraph (A) and in
subsection (a).
‘‘(ii) Of the amounts appropriated under
clause (i), the Director of the Institute shall re-
serve 50 percent for research described in such
clause that does not involve treatment or clini-
cal trials, and 50 percent for research described
in such clause that does involve treatment and
clinical trials.
‘‘(iii) In expending the amounts reserved
under clause (ii), the Director of the Institute
shall ensure that 1 or more programs of re-
search on ovarian cancer are carried out under
the programs designated by the Director as the
Specialized Programs of Research Excellence.’’.
SEC. 1303. PUBLIC INFORMATION AND EDUCATION ON
OVARIAN CANCER.
Section 417(d)(4) of the Public Health Service Act
is amended by striking ‘‘section 413; and’’ and inserting
the following: ‘‘section 413, which programs shall include
programs on ovarian cancer that (subject to changes in
the applicable facts) provide information and education re-
garding—
‘‘(A) screening procedures for such cancer,
including the fact that there is not a procedure
that reliably provides for the early detection of
such cancer;
‘‘(B) the fact that there may be a genetic
basis to such cancer;
‘‘(C) factors indicating a substantial risk
of such cancer; and
‘‘(D) the various treatments for such can-
cer and the extent to which the treatments are
effective; and’’.
Subtitle H—HPV Infection and Cer-
vical Cancer Research Resolu-
tion of 1996
SEC. 1351. SHORT TITLE.
This subtitle may be cited as the ‘‘HPV Infection and
Cervical Cancer Research Resolution of 1996’’.
SEC. 1352. SENSE OF CONGRESS.
It is the sense of the Congress that in conducting re-
search relating to the prevention and detection of cervical
cancer, the Director of the National Cancer Institute and
the Director of the National Institute of Allergy and Infec-
tious Diseases should collaborate in sponsoring basic and
clinical research on human papillomavirus diagnosis and
prevention as a risk of cervical cancer, and as applicable,
develop screening techniques accordingly.
Subtitle I—Office for Rare Disease
Research Act of 1996
SEC. 1391. SHORT TITLE.
This subtitle may be cited as the ‘‘Office for Rare
Disease Research Act of 1996’’.
SEC. 1392. ESTABLISHMENT OF OFFICE FOR RARE DISEASE
RESEARCH.
Part A of title IV of the Public Health Service Act
(42 U.S.C. 281 et seq.) is amended by adding at the end
thereof the following new section:
‘‘SEC. 404F. OFFICE FOR RARE DISEASE RESEARCH.
‘‘(a) ESTABLISHMENT.—There is established within
the Office of the Director of the National Institutes of
Health an office to be known as the Office for Rare Dis-
ease Research (in this section referred to as the ‘Office’).
The Office shall be headed by a director, who shall be ap-
pointed by the Director of the National Institutes of
Health.
‘‘(b) PURPOSE.—The purpose of the Office is to pro-
mote and coordinate the conduct of research on rare dis-
eases through a strategic research plan and to establish
and manage a rare disease research clinical database.
‘‘(c) ADVISORY COUNCIL.—The Secretary shall es-
tablish an advisory council for the purpose of providing
advice to the director of the Office concerning carrying
out the strategic research plan and other duties under this
section. Section 222 shall apply to such council to the
same extent and in the same manner as such section ap-
plies to committees or councils established under such sec-
tion.
‘‘(d) DUTIES.—In carrying out subsection (b), the di-
rector of the Office shall—
‘‘(1) develop a comprehensive plan for the con-
duct and support of research on rare diseases;
‘‘(2) coordinate and disseminate information
among the institutes and the public on rare diseases;
‘‘(3) support research training and encourage
the participation of a diversity of individuals in the
conduct of rare disease research;
‘‘(4) identify projects or research on rare dis-
eases that should be conducted or supported by the
National Institutes of Health;
‘‘(5) develop and maintain a central database
on current government sponsored clinical research
projects for rare diseases;
‘‘(6) determine the need for registries of re-
search subjects and epidemiological studies of rare
disease populations; and
‘‘(7) prepare biennial reports on the activities
carried out or to be carried out by the Office and
submit such reports to the Secretary and the Con-
gress.’’.
Subtitle J—Federal Risk Assess-
ment in Women’s Health Act of
1996
SEC. 1401. SHORT TITLE.
This subtitle may be cited as the ‘‘Federal Risk As-
sessment in Women’s Health Act of 1996’’.
SEC. 1402. INTERAGENCY REVIEW.
The Office of Science and Technology Policy, through
the Federal Coordinating Council for Science, Engineer-
ing, and Technology, and in consultation with the Office
of Women’s Health of the Public Health Service and with
the Office of Research on Women’s Health of the National
Institutes of Health, shall conduct a review of all Federal
programs that assess or mitigate the risks to women’s
health from environmental exposures, including programs
setting standards for exposure to various pollutants, toxic
substances, pesticide use, and pesticide residues. The re-
sults of such review, including recommendations for ensur-
ing that women’s health needs are addressed by Federal
programs and policies, shall be transmitted to the Con-
gress within 6 months after the date of enactment of this
Act.
SEC. 1403. STUDY OF RESEARCH NEEDS.
The National Institute of Environmental Health
Sciences shall enter into a contract with the National Re-
search Council of the National Academy of Sciences for
the carrying out by such Council, in consultation with the
Office of Women’s Health of the Public Health Service
and with the Office of Research on Women’s Health of
the National Institutes of Health, for a study to determine
the status of the science base and needs of the Federal
Government for research relating to the risks to women’s
health from environmental exposures, for the purpose of
assessing and mitigating such risks. The results of such
study shall be transmitted to the Congress within one year
after the date of enactment of this Act.
Subtitle K—Women’s Health
Environmental Factors Act of 1996
SEC. 1451. SHORT TITLE.
This subtitle may be cited as the ‘‘Women’s Health
Environmental Factors Act of 1996’’.
SEC. 1452. REPORT ON EFFECT OF ENVIRONMENTAL FAC-
TORS ON WOMEN’S HEALTH.
(a) IN GENERAL.—The Secretary of Health and
Human Services, acting through the Director of the Na-
tional Institute of Environmental Health Sciences, shall
submit to the Congress a report in accordance with the
following:
(1) The report shall summarize the body of sci-
entific knowledge on the effects that environmental
factors have on women’s health. The report shall in-
clude descriptions of the known effects of environ-
mental factors on breast cancer, on immune dys-
function, and on compounds that mimic human es-
trogen.
(2) The report shall specify an agenda for the
conduct and support of research by such Director on
the effects that environmental factors have on wom-
en’s health. The agenda shall specify the categories
of research that should receive priority. In the devel-
opment of the agenda, the summary prepared under
paragraph (1) shall be considered, including consid-
eration of areas of research identified by the sum-
mary as having received insufficient study.
(b) DATE FOR SUBMISSION OF REPORT.—The report
under subsection (a) shall be submitted to the Congress
not later than one year after the date of the enactment
of this Act.
Subtitle L—Consumer Involvement
in Breast Cancer Research Act
SEC. 1491. SHORT TITLE.
This subtitle may be cited as the ‘‘Consumer Involve-
ment in Breast Cancer Research Act’’.
SEC. 1492. INCREASED INVOLVEMENT OF ADVOCATES IN
DECISION MAKING REGARDING RESEARCH
ON BREAST CANCER.
Section 417(c) of the Public Health Service Act (42
U.S.C. 285a–6(c)) is amended by adding at the end the
following paragraph:
‘‘(3) INVOLVEMENT
OF
ADVOCATES
IN
DECI-
SION MAKING.—
‘‘(A) The Director of the Institute shall, to
the extent practicable, provide for the increased
involvement (relative to fiscal year 1996) of ad-
vocates in decision making at the Institute re-
garding research on breast cancer.
‘‘(B) For purposes of this paragraph, the
term ‘advocate’ means an individual who is ac-
countable to, represents, and reports back to
organizations that represent those affected by
breast cancer.
‘‘(C) The Director of the Institute shall
prepare a report on the manner in which sub-
paragraph (A) has been carried out. The report
shall be included in the first report under sec-
tion 407 that the Director submits after the ex-
piration of the one-year period beginning on the
date of the enactment of the Consumer Involve-
ment in Breast Cancer Research Act.’’.
Subtitle M—Women and Alcohol
Research Equity Act of 1996
SEC. 1501. SHORT TITLE.
This subtitle may be cited as the ‘‘Women and Alco-
hol Research Equity Act of 1996’’.
SEC. 1502. FINDINGS.
The Congress finds as follows with respect to the
United States:
(1) One of every 4 alcoholics receiving treat-
ment is a woman.
(2) In fiscal year 1995, the National Institute
on Alcohol Abuse and Alcoholism had a total re-
search budget of $191,186,000, and $43,997,080 of
the budget (approximately 23 percent) was available
for research on alcohol abuse and alcoholism among
women. There are selected areas where alcohol con-
tributes to a more rapid and severe development of
disease in women than in men, and research on
women exclusively in these areas is important.
(3) According to data collected during the years
1980 through 1993 (in the survey known as the Na-
tional Drug and Alcoholism Treatment Unit Sur-
vey), women represent approximately 30 percent of
the clients presenting for alcohol problems in tradi-
tional public treatment facilities. A recent study has
shown that women are more likely than men to use
nontraditional health care systems for alcohol-related
problems. No data exists to count women in non-
traditional treatment settings; therefore, it is not
possible to know whether women are overrepresented
or underrepresented in all treatment settings in pro-
portion to their numbers (30 percent).
(4) Alcohol use by pregnant women is the lead-
ing known cause of mental retardation in newborns.
Fetal alcohol syndrome (FAS), which is marked by
dysfunction of the central nervous system and by
prenatal and postnatal growth deficiency and facial
malformations, strikes 1 to 3 out of every 1,000
newborns, or 3,600 to 10,000 babies a year, depend-
ing upon the national birth-rate. The incidence of
less severe fetal alcohol effects (FAE) is at least 3
times that of fetal alcohol syndrome. For Black
Americans, the risk of FAS remains about sevenfold
higher than for whites, even after adjustment for the
frequency of maternal alcohol intake, occurrence of
chronic alcohol problems, and parity. Among Native
Americans, the incidence of FAS varies among dif-
ferent cultures; some are similar to the overall U.S.
population, while a much higher prevalence is re-
ported for others. Research is also needed on the
male contribution to birth abnormalities related to
alcohol.
(5) Most treatment programs do not provide
child care or adequate alternatives for women enter-
ing treatment.
(6) The death rate of female alcoholics is 50 to
100 percent higher than for male alcoholics. Propor-
tionately more alcoholic women die of cirrhosis of
the liver than do alcoholic men. Additionally, the
combined effects of estrogen and alcohol may impact
not only liver damage but osteoporosis as well.
(7) The interval between onset of drinking-re-
lated problems and entry into treatment appears to
be shorter for women than for men. Further, studies
of women alcoholics in treatment suggest that they
often experience greater physiological impairment
earlier in their drinking careers, despite having
consumed less alcohol than men. These findings sug-
gest that the development of consequences associated
with heavy drinking may be accelerated or ‘‘tele-
scoped’’ in women.
(8) Women become intoxicated faster than men.
This may be due to a different enzyme and hor-
monal activity in women than in men.
(9) Chronic, heavy drinking contributes to men-
strual disorders, fertility problems, and premature
menopause.
(10) Alcohol use may be associated with an in-
creased risk of breast cancer. Research indicates
that the incidence of breast cancer increases when a
woman consumes 1 ounce or more of absolute alco-
hol daily.
(11) The National Institute on Alcohol Abuse
and Alcoholism has identified areas for future re-
search on alcohol abuse and alcoholism among
women. As a result of stimulating research applica-
tions during the years 1993 through 1995, such In-
stitute’s portfolio on women and children has in-
creased by $17,997,000, or more than 69 percent,
over the fiscal year 1992 base of $26,000,000.
SEC. 1503. PROVISIONS REGARDING INCREASE IN AMOUNT
OF FUNDS EXPENDED FOR RESEARCH ON AL-
COHOL ABUSE AND ALCOHOLISM AMONG
WOMEN.
Section 464H(d) of the Public Health Service Act (42
U.S.C. 285n(d)) is amended by adding at the end the fol-
lowing paragraph:
‘‘(3) WOMEN’S HEALTH.—
‘‘(A) For fiscal year 1997, of the first
$191,186,000 appropriated under paragraph
(1), the Director of the Institute shall obligate
not less than $43,997,080 for the purpose of
carrying out under this subpart projects of re-
search on alcohol abuse and alcoholism among
women.
‘‘(B) In addition to the authorization of
appropriations established in paragraph (1),
there are authorized to be appropriated for car-
rying out the purpose specified in subparagraph
(A) $25,000,000 for fiscal year 1997, and such
sums as may be necessary for each of the fiscal
years 1998 and 1999.’’.
TITLE II—SERVICES
Subtitle A—Women’s Health Office
Act of 1996
SEC. 2101. SHORT TITLE.
This subtitle may be cited as the ‘‘Women’s Health
Office Act of 1996’’.
SEC. 2102. PUBLIC HEALTH SERVICE OFFICE ON WOMEN’S
HEALTH.
Title XVII of the Public Health Service Act (42
U.S.C. 300u et seq.) is amended by adding at the end
the following section:
‘‘OFFICE ON WOMEN’S HEALTH
‘‘SEC. 1710. (a) ESTABLISHMENT
OF OFFICE.—
There is established an Office on Women’s Health (here-
after referred to in this section as the ‘Office’) within the
Office of the Assistant Secretary for Health.
‘‘(b) ASSISTANT SECRETARY.—There shall be in the
Department of Health and Human Services a Deputy As-
sistant Secretary for Women’s Health, who shall be the
head of the Office. The Secretary, acting through such
Deputy Assistant Secretary, shall carry out this section.
‘‘(c) DUTIES.—The Secretary, acting through the Of-
fice, shall, with respect to women’s health conditions—
‘‘(1) advise the Assistant Secretary for Health
concerning scientific, legal, ethical, and policy issues
relating to women’s health;
‘‘(2) establish short-range and long-range goals
and objectives and coordinate all other activities
within the Department of Health and Human Serv-
ices that relate to disease prevention, health pro-
motion, service delivery, and research concerning
women;
‘‘(3) enter into interagency agreements with
other agencies of the Service to increase the partici-
pation of women in health service and promotion
programs;
‘‘(4) support research, demonstrations and eval-
uations to test new and innovative models, to in-
crease knowledge and understanding of health risk
factors, to develop mechanisms that support better
information dissemination, education, prevention,
and service delivery for women, and to support ini-
tiatives for the promotion of women with respect to
careers in the health professions and research;
‘‘(5) monitor Public Health Service agency and
regional activities regarding women’s health, and co-
ordinate activities of such agency Offices of Wom-
en’s Health;
‘‘(6) establish a women’s health resource center
to facilitate the exchange of information regarding
matters relating to health information and health
promotion, preventive health services, and education
in the appropriate use of health care, to facilitate ac-
cess to such information, to assist in the analysis of
issues and problems relating to such matters, and to
provide technical assistance with respect to the ex-
change of such information (including facilitating
the development of materials for such technical as-
sistance); and
‘‘(7) coordinate efforts to promote women’s
health programs and policies in the voluntary and
corporate sectors.
‘‘(d) COORDINATING COMMITTEE.—The Secretary
shall provide for the operation of a committee composed
of the heads of the agencies of the Public Health Service
(or the designees of the agency heads), which committee
shall be chaired by the Deputy Assistant Secretary for
Women’s Health. With respect to women’s health condi-
tions, such committee shall assist the Deputy Assistant
Secretary in identifying the needs for programs regarding
the conditions, and in making an estimate each fiscal year
of the funds needed to adequately support the programs;
identifying needs regarding the coordination of programs;
and encouraging the agencies of the Public Health Service
to conduct and support programs.
‘‘(e) ADVISORY COMMITTEE.—The Secretary shall
provide for the operation of an advisory committee regard-
ing the duties of the Office. Such committee shall be com-
posed of 15 voting members, appointed from among indi-
viduals who have expertise in women’s health and who are
not officers or employees of the Federal Government, and
the term of office for such members shall be four years.
The membership of the committee shall include as
nonvoting members each of the individuals serving as
nonvoting members of the Coordinating Committee under
subsection (d), and shall include such other Federal offi-
cials or employees as the Secretary determines to be ap-
propriate. The committee shall be chaired by the Deputy
Assistant Secretary for Women’s Health, and shall meet
at the call of the Chair, but not less than once each fiscal
year.
‘‘(f) REPORTS.—Not later than January 31, 1997,
and January 31 of each second year thereafter, the Sec-
retary shall prepare and submit to the appropriate com-
mittees of Congress a report describing the activities car-
ried out under this section during the preceding 2 fiscal
years.
‘‘(g) DEFINITION.—For purposes of this section, the
term ‘women’s health conditions’, with respect to women
of all age, ethnic, and racial groups, means all diseases,
disorders, and conditions—
‘‘(1) unique to, more serious, or more prevalent
in women; and
‘‘(2) for which the factors of medical risk or
type of medical intervention are different for women,
or for which it is unknown whether such factors or
types are different for women.
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there are authorized
to be appropriated $6,000,000 for fiscal year 1997, and
such sums as may be necessary for each of the fiscal years
1998 and 1999.’’.
SEC. 2103. CENTERS FOR DISEASE CONTROL AND PREVEN-
TION OFFICE OF WOMEN’S HEALTH.
Part B of title III of the Public Health Service Act
(42 U.S.C. 243 et seq.) is amended by inserting after sec-
tion 317F the following section:
‘‘CENTERS FOR DISEASE CONTROL AND PREVENTION
OFFICE OF WOMEN’S HEALTH
‘‘SEC. 317G. (a) ESTABLISHMENT.—There is estab-
lished within the Office of the Director of the Centers for
Disease Control and Prevention an office to be known as
the Office of Women’s Health (hereafter referred to in this
section as the ‘Office’). The Office shall be headed by a
director who shall be appointed by the Director of the
Centers.
‘‘(b) PURPOSE.—The Director of the Office shall—
‘‘(1) determine the current level of the Centers
activity regarding women’s health conditions, across
age, biological, and sociocultural contexts, in all as-
pects of the Centers work, including prevention pro-
grams, public and professional education, services,
and treatment;
‘‘(2) establish short-range and long-range goals
and objectives for women’s health and coordinate all
other activities within the Centers that relate to pre-
vention, research, education and training, service de-
livery, and policy development;
‘‘(3) identify projects in women’s health that
should be conducted or supported by the National
Centers;
‘‘(4) consult with health professionals, non-gov-
ernmental organizations, consumer organizations,
women’s health professionals, and other individuals
and groups, as appropriate, on the policy of the Cen-
ters with regard to women; and
‘‘(5) coordinate agency activities on women’s
health with the Public Health Service Office on
Women’s Health established under section 1710.
‘‘(c) COORDINATING COMMITTEE.—
‘‘(1) ESTABLISHMENT.—In carrying out sub-
section (b), the Director of the Office shall establish
a committee to be known as the Coordinating Com-
mittee on Research on Women’s Health (hereafter
referred to in this subsection as the ‘Coordinating
Committee’).
‘‘(2) COMPOSITION.—The Coordinating Com-
mittee shall be composed of the Directors of the
National Centers.
‘‘(3) CHAIRPERSON.—The Director of the Of-
fice shall serve as the chairperson of the Coordinat-
ing Committee.
‘‘(4) DUTIES.—With respect to women’s health,
the Coordinating Committee shall assist the Director
of the Office in—
‘‘(A) identifying the need for programs and
activities that focus on women’s health;
‘‘(B) identifying needs regarding the co-
ordination of activities, including intramural
and extramural multidisciplinary activities; and
‘‘(C) making recommendations to the Di-
rector of the Centers for Disease Control and
Prevention concerning findings made under
subparagraphs (A) and (B).
‘‘(d) REPORTS.—Not later than January 31, 1997,
and January 31 of each second year thereafter, the Direc-
tor shall prepare and submit to the Director of the Public
Health Service Office of Women’s Health, a report de-
scribing the activities carried out under this section during
the preceding 2 fiscal years.
‘‘(e) DEFINITION.—As used in this section the term
‘women’s health conditions’, with respect to women of all
age, ethnic, and racial groups, means all diseases, dis-
orders, and conditions—
‘‘(1) unique to, more serious, or more prevalent
in women; and
‘‘(2) for which the factors of medical risk or
type of medical intervention are different for women,
or for which it is unknown whether such factors or
types are different for women.’’.
SEC. 2104. AGENCY FOR HEALTH CARE POLICY AND RE-
SEARCH OFFICE OF WOMEN’S HEALTH.
Part C of title IX of the Public Health Service Act
(42 U.S.C. 299c et seq.) is amended—
(1) by redesignating section 927 as section 928;
and
(2) by inserting after section 926 the following
section:
‘‘SEC. 927. OFFICE OF WOMEN’S HEALTH.
‘‘(a) ESTABLISHMENT.—There is established within
the Office of the Director of the Agency for Health Care
Policy and Research an office to be known as the Office
of Women’s Health (hereafter referred to in this section
as the ‘Office’). The Office shall be headed by a Director
who shall be appointed by the Director of the Agency.
‘‘(b) PURPOSE.—The Director of the Office shall—
‘‘(1) determine the current Agency level of ac-
tivity regarding women’s health, across age, biologi-
cal, and sociocultural contexts, in all aspects of
Agency work, including drafting clinical practice
guidelines, and conducting research into patient out-
comes, delivery of health care services, and access to
health care;
‘‘(2) establish short-range and long-range goals
and objectives for research important to women’s
health and coordinate all other activities within the
Agency that relate to health services and medical
effectiveness research;
‘‘(3) identify projects in women’s health that
should be conducted or supported by the Agency;
‘‘(4) consult with health professionals, non-gov-
ernmental organizations, consumer organizations,
women’s health professionals, and other individuals
and groups, as appropriate, on Agency policy with
regard to women; and
‘‘(5) coordinate agency activities on women’s
health with the Public Health Service Office on
Women’s Health established under section 1710.
‘‘(c) COORDINATING COMMITTEE.—
‘‘(1) ESTABLISHMENT.—In carrying out sub-
section (b), the Director of the Office shall establish
a committee to be known as the Coordinating Com-
mittee on Research on Women’s Health (hereafter
referred to in this subsection as the ‘Coordinating
Committee’).
‘‘(2) COMPOSITION.—The Coordinating Com-
mittee shall be composed of the Directors of the
Offices.
‘‘(3) CHAIRPERSON.—The Director of the Of-
fice shall serve as the chairperson of the Coordinat-
ing Committee.
‘‘(4) DUTIES.—With respect to research on
women’s health, the Coordinating Committee shall
assist the Director of the Office in—
‘‘(A) identifying the need for such re-
search, and making an estimate each fiscal year
of the funds needed to adequately support the
research;
‘‘(B) identifying needs regarding the co-
ordination of research activities, including in-
tramural and extramural multidisciplinary ac-
tivities; and
‘‘(C) making recommendations to the Di-
rector of the Agency for Health Care Policy and
Research concerning findings made under sub-
paragraphs (A) and (B).
‘‘(d) REPORTS.—Not later than January 31, 1997,
and January 31 of each second year thereafter, the Direc-
tor shall prepare and submit to the Director of the Public
Health Service Office of Women’s Health, a report de-
scribing the activities carried out under this section during
the preceding 2 fiscal years.’’.
SEC. 2105. HEALTH RESOURCES AND SERVICES ADMINIS-
TRATION OFFICE OF WOMEN’S HEALTH.
Part D of title III of the Public Health Service Act
(42 U.S.C. 254b et seq.) is amended—
(1) by redesignating section 340D as section
340E; and
(2) by inserting before section 340E (as so re-
designated) the following:
‘‘Subpart IX—Miscellaneous Provisions
‘‘OFFICE OF WOMEN’S HEALTH
‘‘SEC. 340D. (a) ESTABLISHMENT.—There is estab-
lished within the Office of the Administrator of the Health
Resources and Services Administration an office to be
known as the Office of Women’s Health (hereafter re-
ferred to in this section as the ‘Office’). The Office shall
be headed by a director who shall be appointed by the Di-
rector of the Administration.
‘‘(b) PURPOSE.—The Director of the Office shall—
‘‘(1) determine the current agency level of activ-
ity regarding women’s health across age, biological,
and sociocultural contexts;
‘‘(2) establish short-range and long-range goals
and objectives for women’s health and coordinate all
other activities within the agency that relate to
health care provider training, health service delivery,
research, and demonstration projects;
‘‘(3) identify projects in women’s health that
should be conducted or supported by the Bureaus;
‘‘(4) consult with health professionals, non-gov-
ernmental organizations, consumer organizations,
women’s health professionals, and other individuals
and groups, as appropriate, on agency policy with
regard to women; and
‘‘(5) coordinate agency activities on women’s
health with the Public Health Service Office on
Women’s Health established under section 1710.
‘‘(c) COORDINATING COMMITTEE.—
‘‘(1) ESTABLISHMENT.—In carrying out sub-
section (b), the Director of the Office shall establish
a committee to be known as the Coordinating Com-
mittee on Research on Women’s Health (hereafter
referred to in this subsection as the ‘Coordinating
Committee’).
‘‘(2) COMPOSITION.—The Coordinating Com-
mittee shall be composed of the Directors of the
Bureaus.
‘‘(3) CHAIRPERSON.—The Director of the Of-
fice shall serve as the Chairperson of the Coordinat-
ing Committee.
‘‘(4) DUTIES.—With respect to research on
women’s health, the Coordinating Committee shall
assist the Director of the Office in—
‘‘(A) identifying the need for programs and
activities that focus on women’s health;
‘‘(B) identifying needs regarding the co-
ordination of activities, including intramural
and extramural multidisciplinary activities; and
‘‘(C) making recommendations to the Di-
rector of the Centers for Disease Control and
Prevention concerning findings made under
subparagraphs (A) and (B).
‘‘(d) REPORTS.—Not later than January 31, 1997,
and January 31 of each second year thereafter, the Direc-
tor of the Office shall prepare and submit to the Director
of the Public Health Service Office of Women’s Health,
a report describing the activities carried out under this
section during the preceding 2 fiscal years.’’.
SEC. 2106. FOOD AND DRUG ADMINISTRATION OFFICE OF
WOMEN’S HEALTH.
Chapter IX of the Federal Food, Drug, and Cosmetic
Act (21 U.S.C. 391 et seq.) is amended by adding at the
end the following section:
‘‘SEC. 906. OFFICE OF WOMEN’S HEALTH.
‘‘(a) ESTABLISHMENT.—There is established within
the Office of the Commissioner of the Food and Drug Ad-
ministration an office to be known as the Office of Wom-
en’s Health (hereafter referred to in this section as the
‘Office’). The Office shall be headed by a Director who
shall be appointed by the Commissioner of the Administra-
tion.
‘‘(b) PURPOSE.—The Director of the Office shall—
‘‘(1) determine current Commission levels of ac-
tivity regarding women’s participation in clinical
trials the study of gender differences in the testing
of drugs, medical devices, and biological products,
across, age, sociocultural, and, where deemed appro-
priate, biological contexts;
‘‘(2) establish short-range and long-range goals
and objectives for adequate inclusion of women in all
Commission protocols and policies;
‘‘(3) provide guidance or criteria for drug and
device manufacturers to use in determining the ex-
tent and sufficiency of female representation in clini-
cal trials;
‘‘(4) consult with pharmaceutical manufactur-
ers, health professionals with expertise in women’s
issues, consumer organizations, and women’s health
professionals on Commission policy with regard to
women;
‘‘(5) make annual estimates of funds needed to
monitor clinical trials in accordance with needs that
are identified; and
‘‘(6) coordinate Commission activities on wom-
en’s health with the Public Health Service Office on
Women’s Health established under section 1710 of
the Public Health Service Act.
‘‘(c) COORDINATING COMMITTEE.—
‘‘(1) ESTABLISHMENT.—In carrying out sub-
section (b), the Director of the Office shall establish
a committee to be known as the Coordinating Com-
mittee on Women’s Health (hereafter referred to in
this subsection as the ‘Coordinating Committee’).
‘‘(2) COMPOSITION.—The Coordinating Com-
mittee shall be composed of the Directors of the
Food and Drug Administration Centers.
‘‘(3) CHAIRPERSON.—The Director of the Of-
fice shall serve as the Chairperson of the Coordinat-
ing Committee.
‘‘(4) DUTIES.—With respect to studies on wom-
en’s health, the Coordinating Committee shall assist
the Director of the Office in—
‘‘(A) identifying the need for further stud-
ies in specific areas of women’s health that fall
within the mission of the Commission, and de-
veloping strategies to foster such studies;
‘‘(B) identifying needs regarding the co-
ordination of Commission activities, including
intramural and extramural studies;
‘‘(C) maintaining the Commission’s focus
in areas of importance to women;
‘‘(D) supporting the development of meth-
odologies to determine the circumstances in
which obtaining data specific to women (includ-
ing data relating to the age of women and the
membership of women in ethnic or racial
groups) is an appropriate function of clinical
trials of treatments and therapies;
‘‘(E) supporting the development and ex-
pansion of clinical trials of treatments and
therapies for which obtaining such data has
been determined to be an appropriate function;
and
‘‘(F) encouraging the Food and Drug Ad-
ministration Centers to conduct and support
such studies, including such clinical trials.
‘‘(d) REPORTS.—Not later than January 31, 1997,
and January 31 of each second year thereafter, the Direc-
tor shall prepare and submit to the Director of the Public
Health Service Office of Women’s Health, a report de-
scribing the activities carried out under this section during
the preceding 2 fiscal years.’’.
Subtitle 
B—Genetic 
Information
Nondiscrimination in Health In-
surance Act of 1996
SEC. 2151. SHORT TITLE.
This subtitle may be cited as the ‘‘Genetic Informa-
tion Nondiscrimination in Health Insurance Act of 1996’’.
SEC. 2152. PROHIBITION OF HEALTH INSURANCE DISCRIMI-
NATION ON THE BASIS OF GENETIC INFOR-
MATION.
(a) IN GENERAL.—An insurance provider may not
deny or cancel health insurance coverage, or vary the pre-
miums, terms, or conditions for health insurance coverage,
for an individual or a family member of an individual—
(1) on the basis of genetic information; or
(2) on the basis that the individual or family
member of an individual has requested or received
genetic services.
(b) LIMITATION ON COLLECTION AND DISCLOSURE
OF INFORMATION.—
(1) IN GENERAL.—An insurance provider may
not request or require an individual to whom the
provider provides health insurance coverage, or an
individual who desires the provider to provide health
insurance coverage, to disclose to the provider ge-
netic information about the individual or family
member of the individual.
(2) REQUIREMENT
OF
PRIOR
AUTHORIZA-
TION.—An insurance provider may not disclose ge-
netic information about an individual without the
prior written authorization of the individual or legal
representative of the individual. Such authorization
is required for each disclosure and shall include an
identification of the person to whom the disclosure
would be made.
(c) ENFORCEMENT.—
(1) PLANS OTHER THAN EMPLOYEE HEALTH
BENEFIT
PLANS.—The requirements established
under subsections (a) and (b) shall be enforced by
the State insurance commissioner for the State in-
volved or the official or officials designated by the
State, except that in no case shall a State enforce
such requirements as they relate to employee health
benefit plans.
(2) EMPLOYEE
HEALTH
BENEFIT
PLANS.—
With respect to employee health benefit plans, the
Secretary shall enforce the requirements established
under subsections (a) and (b) in the same manner
as provided for under sections 502, 504, 506, and
510 of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1132, 1134, 1136, and
1140).
(3) PRIVATE RIGHT OF ACTION.—A person may
bring a civil action—
(A) to enjoin any act or practice which vio-
lates subsection (a) or (b),
(B) to obtain other appropriate equitable
relief (i) to redress such violations, or (ii) to en-
force any such subsections, or
(C) to obtain other legal relief, including
monetary damages.
(4) JURISDICTION.—State courts of competent
jurisdiction and district courts of the United States
have concurrent jurisdiction of actions under this
subsection. The district courts of the United States
shall have jurisdiction, without respect to the
amount in controversy or the citizenship of the par-
ties, to grant the relief provided for in paragraph (3)
in any action.
(5) VENUE.—For purposes of this subsection
the venue provisions of section 1391 of title 28,
United States Code, shall apply.
(6) REGULATIONS.—The Secretary may pro-
mulgate such regulations as may be necessary or ap-
propriate to carry out this section.
(d) APPLICABILITY.—
(1) PREEMPTION OF STATE LAW.—A State may
establish or enforce requirements for insurance pro-
viders or health insurance coverage with respect to
the subject matter of this section, but only if such
requirements are more restrictive than the require-
ments established under subsections (a) and (b).
(2) RULE OF CONSTRUCTION.—Nothing in this
section shall be construed to affect or modify the
provisions of section 514 of the Employee Retire-
ment Income Security Act of 1974 (29 U.S.C.
1144).
(3) CONTINUATION.—Nothing in this section
shall be construed as requiring a group health plan
or an employee health benefit plan to provide bene-
fits to a particular participant or beneficiary.
(e) DEFINITIONS.—For purposes of this subtitle:
(1) EMPLOYEE HEALTH BENEFIT PLAN.—The
term ‘‘employee health benefit plan’’ means any em-
ployee welfare benefit plan, governmental plan, or
church plan (as defined under paragraphs (1), (32),
and (33) of section 3 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1002)) that
provides or pays for health insurance coverage (such
as provider and hospital benefits) whether—
(A) directly;
(B) through a group health plan; or
(C) otherwise.
(2) FAMILY MEMBER.—The term ‘‘family mem-
ber’’ means, with respect to an individual, another
individual related by blood to that individual.
(3) GENETIC
INFORMATION.—The term ‘‘ge-
netic information’’ means information about genes,
gene products, or inherited characteristics.
(4) GENETIC
SERVICES.—The term ‘‘genetic
services’’ means health services to obtain, assess,
and interpret genetic information for diagnostic and
therapeutic purposes, and for genetic education and
counselling.
(5) GROUP HEALTH PLAN.—The term ‘‘group
health plan’’ has the meaning given such term in
section 607 of the Employee Retirement Income Se-
curity Act of 1974 (29 U.S.C. 1167), and includes
a multiple employer welfare arrangement (as defined
in section 3(40) of such Act) that provides health in-
surance coverage.
(6) HEALTH INSURANCE COVERAGE.—The term
‘‘health insurance coverage’’ means a contractual ar-
rangement for the provision of a payment for health
care, including—
(A) a group health plan; and
(B) any other health insurance arrange-
ment, including any arrangement consisting of
a hospital or medical expense incurred policy or
certificate, hospital or medical service plan con-
tract, or health maintenance organization sub-
scriber contract.
(7) INDIVIDUAL HEALTH PLAN.—The term ‘‘in-
dividual health plan’’ means any health insurance
coverage offered to individuals that is not a group
health plan.
(8) INSURANCE PROVIDER.—The term ‘‘insur-
ance provider’’ means an insurer or other entity pro-
viding health insurance coverage.
(9) PERSON.—The term ‘‘person’’ includes cor-
porations, companies, associations, firms, partner-
ships, societies, and joint stock companies, as well as
individuals.
(10) 
SECRETARY.—The 
term 
‘‘Secretary’’
means the Secretary of Labor.
(11) STATE.—The term ‘‘State’’ means any of
the 50 States, the District of Columbia, Puerto Rico,
the Northern Mariana Islands, the Virgin Islands,
American Samoa, and Guam.
(f) TECHNICAL AMENDMENT.—Section 508 of the
Employee Retirement Income Security Act of 1974 (29
U.S.C. 1138) is amended by inserting ‘‘and under the Ge-
netic Insurance Nondiscrimination in Health Insurance
Act of 1995’’ before the period.
(g) EFFECTIVE DATE.—This section shall apply to
health insurance coverage offered or renewed on or after
the end of the 90-day period beginning on the date of the
enactment of this Act.
Subtitle C—Improved Patient Ac-
cess to Clinical Studies Act of
1996
SEC. 2191. SHORT TITLE.
This subtitle may be cited as the ‘‘Improved Patient
Access to Clinical Studies Act of 1996’’.
SEC. 2192. COVERAGE FOR INDIVIDUALS PARTICIPATING
IN APPROVED CLINICAL STUDIES.
(a) PERMITTING PARTICIPATION IN APPROVED CLIN-
ICAL STUDIES.—A health plan may not deny (or limit or
impose additional conditions on) coverage of items and
services furnished to an enrollee if—
(1) the enrollee is participating in an approved
clinical study,
(2) the items and services are furnished accord-
ing to the design of the study or to treat conditions
resulting from participation in the study, and
(3) the items and services would otherwise be
covered under the plan except for the fact that they
are provided in connection with participation in such
a study.
A health plan may not discriminate against an enrollee
on the basis of the enrollee’s participation in such a study.
(b) CONSTRUCTION.—Nothing in subsection (a) shall
be construed as requiring a health plan to provide for pay-
ment for items and services normally paid for as part of
an approved clinical study.
(c) APPROVED CLINICAL STUDY DEFINED.—In this
section, the term ‘‘approved clinical study’’ means—
(1) a research study approved by the Secretary
of Health and Human Services, the Director of the
National Institutes of Health, the Commissioner of
the Food and Drug Administration, the Secretary of
Veterans Affairs, the Secretary of Defense, or a
qualified nongovernmental research entity (as de-
fined in guidelines of the National Institute of
Health), or
(2) a peer-reviewed and approved research pro-
gram, as defined by the Secretary of Health and
Human Services, conducted for the primary purpose
of determining whether or not a treatment is safe,
efficacious, or having any other characteristic of a
treatment which must be demonstrated in order for
the treatment to be medically necessary or appro-
priate.
Subtitle D—Equitable Health Care
for 
Neurobiological 
Disorders
Act of 1996
SEC. 2201. SHORT TITLE.
This subtitle may be cited as the ‘‘Equitable Health
Care for Neurobiological Disorders Act of 1996’’.
SEC. 2202. FINDINGS.
Congress finds that—
(1) there are sufficient neuroscientific data to
document that many severe ‘‘mental’’ illnesses are
actually physical illnesses known as neurobiological
disorders that are characterized by significant
neuroanatomical and neurochemical abnormalities;
(2) American families should have adequate
health insurance protection for the costs of treating
neurobiological disorders that is commensurate with
the protections provided for other illnesses;
(3) currently, many public and private health
insurance programs discriminate against persons
with neurobiological disorders by providing more re-
strictive coverage for treatments of those illnesses in
comparison to coverage provided for treatments of
other medical problems;
(4) unequal health insurance coverage contrib-
utes to the destructive and unfair stigmatization of
persons with neurobiological disorders that are as
beyond the control of the individuals as are cancer,
diabetes, and other serious physical health problems;
(5) about 95 percent of what is known about
both normal and abnormal structure and function of
the brain has been learned in the last 10 years, but
millions of severely mentally ill people have yet to
benefit from these startling research advances in
clinical and basic neuroscience; and
(6) according to the National Institutes of Men-
tal Health, equitable insurance coverage for severe
mental disorders will yield $2.2 billion annually in
net savings through decreased use of general medical
services and a substantial decrease in social costs.
SEC. 2203. STANDARDS FOR NONDISCRIMINATORY TREAT-
MENT 
OF 
NEUROBIOLOGICAL 
DISORDERS
FOR EMPLOYER HEALTH BENEFIT PLANS.
(a) IN GENERAL.—The standards for the nondiscrim-
inatory and equitable treatment by employer health bene-
fit plans of individuals with neurobiological disorders are
requirements that such plans (and carriers offering such
plans) provide for coverage of services that are essential
to the effective treatment of neurobiological disorders in
a manner that—
(1) is not more restrictive than coverage pro-
vided for other major physical illnesses;
(2) provides adequate financial protection to the
person requiring the medical treatment for a
neurobiological disorder; and
(3) is consistent with effective and common
methods of controlling health care costs for other
major physical illnesses.
(b) PLAN DEEMED TO MEET STANDARDS.—An em-
ployer health benefit plan shall be deemed to meet the
standards described in subsection (a) if the plan provides
for the following:
(1) Stop-loss protection for catastrophic ex-
penses.
(2) Coverage of facility-based care.
(3) Coverage of outpatient medical management
on a par with other medical procedures to encourage
the use of cost-effective ambulatory treatment, in-
cluding treatment in non-traditional settings.
(4) Coverage of visits for psychological support-
ive, therapeutic, and rehabilitative services, with co-
insurance and fees set to ensure effective cost con-
trol of high demand services.
(5) Coverage of prescription drugs essential to
the cost effective treatment of neurobiological dis-
orders.
(6) Coverage of medically necessary services for
comorbidity of other disorders.
SEC. 2204. ENFORCEMENT THROUGH EXCISE TAX.
(a) IN GENERAL.—Chapter 43 of the Internal Reve-
nue Code of 1986 (relating to qualified pension, etc.,
plans) is amended by adding at the end thereof the follow-
ing new section:
‘‘SEC. 
4980C. 
FAILURE 
TO 
COMPLY 
WITH 
EMPLOYER
HEALTH BENEFIT PLAN STANDARDS FOR
NONDISCRIMINATORY 
TREATMENT 
FOR
NEUROBIOLOGICAL DISORDERS.
‘‘(a) IMPOSITION OF TAX.—There is hereby imposed
a tax on the failure of a carrier or an employer health
benefit plan to comply with the standards relating to the
nondiscriminatory treatment of neurobiological disorders
under section 3 of the Equitable Health Care for
Neurobiological Disorders Act of 1996.
‘‘(b) AMOUNT OF TAX.—
‘‘(1) IN GENERAL.—Subject to paragraph (2),
the tax imposed by subsection (a) shall be an
amount not to exceed 25 percent of the amounts re-
ceived by the carrier or under the plan for coverage
during the period such failure persists.
‘‘(2) LIMITATION IN CASE OF INDIVIDUAL FAIL-
URES.—In the case of a failure that only relates to
specified individuals or employers (and not to the
plan generally), the amount of the tax imposed by
subsection (a) shall not exceed the aggregate of
$100 for each day during which such failure persists
for each individual to which such failure relates. A
rule similar to the rule of section 4980B(b)(3) shall
apply for purposes of this section.
‘‘(c) LIABILITY FOR TAX.—The tax imposed by this
section shall be paid by the carrier.
‘‘(d) EXCEPTIONS.—
‘‘(1) CORRECTIONS WITHIN 30 DAYS.—No tax
shall be imposed by subsection (a) by reason of any
failure if—
‘‘(A) such failure was due to reasonable
cause and not to willful neglect, and
‘‘(B) such failure is corrected within the
30-day period beginning on earliest date the
carrier knew, or exercising reasonable diligence
would have known, that such failure existed.
‘‘(2) WAIVER BY SECRETARY.—In the case of a
failure which is due to reasonable cause and not to
willful neglect, the Secretary may waive part or all
of the tax imposed by subsection (a) to the extent
that payment of such tax would be excessive relative
to the failure involved.
‘‘(e) DEFINITIONS.—For purposes of this section, the
terms ‘carrier’ and ‘employer health benefit plan’ have the
respective meanings given such terms in section 5 of the
Equitable Health Care for Neurobiological Disorders Act
of 1996.’’
(b) CLERICAL AMENDMENT.—The table of sections
for chapter 43 of such Code is amended by adding at the
end thereof the following new item:
‘‘Sec. 4980C. Failure to comply with employer health benefit plan
standards for nondiscriminatory treatment for
neurobiological disorders.’’.
(c) EFFECTIVE DATE.—The amendments made by
this subsection shall apply to plan years beginning after
December 31, 1996.
SEC. 2205. DEFINITIONS.
In this subtitle, the following definitions shall apply:
(1) CARRIER.—The term ‘‘carrier’’ means any
entity which provides health insurance or health ben-
efits in a State, and includes a licensed insurance
company, a prepaid hospital or medical service plan,
a health maintenance organization, the plan sponsor
of a multiple employer welfare arrangement or an
employee benefit plan (as defined under the Em-
ployee Retirement Income Security Act of 1974), or
any other entity providing a plan of health insurance
subject to State insurance regulation.
(2) EMPLOYER HEALTH BENEFIT PLAN.—The
term ‘‘employer health benefit plan’’ means a health
benefit plan (including an employee welfare benefit
plan, as defined in section 3(1) of the Employee Re-
tirement Income Security Act of 1974) which is of-
fered to employees through an employer and for
which the employer provides for any contribution to
such plan or any premium for such plan are de-
ducted by the employer from compensation to the
employee.
(3) 
HEALTH
BENEFIT
PLAN.—The 
term
‘‘health benefit plan’’ means any hospital or medical
expense incurred policy or certificate, hospital or
medical service plan contract, or health maintenance
subscriber contract, or a multiple employer welfare
arrangement or employee benefit plan (as defined
under the Employee Retirement Income Security Act
of 1974) which provides benefits with respect to
health care services, but does not include—
(A) coverage only for accident, dental, vi-
sion, disability income, or long-term care insur-
ance, or any combination thereof,
(B) medicare supplemental health insur-
ance,
(C) coverage issued as a supplement to li-
ability insurance,
(D) worker’s compensation or similar in-
surance, or
(E) automobile medical-payment insurance,
or any combination thereof.
(4) NEUROBIOLOGICAL DISORDER.—
(A) IN GENERAL.—An individual with a
‘‘neurobiological disorder’’ is an individual diag-
nosed with one or more of the following condi-
tions:
(i) Affective disorders, including bipo-
lar disorder and major depressive disorder.
(ii) Anxiety disorders, including obses-
sive-compulsive disorder and panic dis-
order.
(iii) Attention deficit disorders.
(iv) Autism and other pervasive devel-
opmental disorders.
(v) 
Psychotic 
disorders, 
including
schizophrenia spectrum disorders.
(vi) Tourette’s disorder.
(B) PERIODIC REVIEW OF DEFINITION.—
(i) IN GENERAL.—Not later than 6
months after the date of the enactment of
this subtitle, the Secretary of Health and
Human Services shall promulgate regula-
tions directing the National Institute of
Mental Health to conduct a biannual re-
view of the definition of neurobiological
disorders under subparagraph (A). In con-
ducting such review, the National Institute
of Mental Health shall consult with extra-
mural researchers to review such definition
and make recommendations for necessary
revisions.
(ii) REVIEW
BY
ADVISORY
COUNCIL
REQUIRED.—The Secretary may not pro-
mulgate any regulation modifying the defi-
nition of neurobiological disorders under
subsection (a) until the recommendations
of the National Institute of Mental Health
under clause (i) have been reviewed by the
National Advisory Mental Health Council.
Subtitle E—Victims of Abuse
Insurance Protection Act
SEC. 2251. SHORT TITLE.
This subtitle may be cited as the ‘‘Victims of Abuse
Insurance Protection Act’’.
SEC. 2252. DEFINITIONS.
As used in this subtitle:
(1) The term ‘‘abuse’’ means the occurrence of
one or more of the following acts between household
or family (including in-laws or extended family)
members, spouses or former spouses, or individuals
engaged in or formerly engaged in a sexually inti-
mate relationship:
(A) Attempting to cause or intentionally,
knowingly, or recklessly causing another person
bodily injury, physical harm, substantial emo-
tional distress, psychological trauma, rape, sex-
ual assault, or involuntary sexual intercourse.
(B) Engaging in a course of conduct or re-
peatedly committing acts toward another per-
son, including following the person without
proper authority and under circumstances that
place the person in reasonable fear of bodily in-
jury or physical harm.
(C) Subjecting another person to false im-
prisonment or kidnapping.
(D) Attempting to cause or intentionally,
knowingly, or recklessly causing damage to
property so as to intimidate or attempt to con-
trol the behavior of another person.
(2) The term ‘‘abuse-related medical condition’’
means a medical condition which arises in whole or
in part out of an action or pattern of abuse.
(3) The term ‘‘abuse status’’ means the fact or
perception that a person is, has been, or may be a
subject of abuse, irrespective of whether the person
has sustained abuse-related medical conditions or
has incurred abuse-related claims.
(4) The term ‘‘health benefit plan’’ means any
public or private entity or program that provides for
payments for health care, including—
(A) a group health plan (as defined in sec-
tion 607 of the Employee Retirement Income
Security Act of 1974) or a multiple employer
welfare arrangement (as defined in section
3(40) of such Act) that provides health bene-
fits;
(B) any other health insurance arrange-
ment, including any arrangement consisting of
a hospital or medical expense incurred policy or
certificate, hospital or medical service plan con-
tract, or health maintenance organization sub-
scriber contract;
(C) workers’ compensation or similar in-
surance to the extent that it relates to workers’
compensation medical benefits (as defined by
the Federal Trade Commission); and
(D) automobile medical insurance to the
extent that it relates to medical benefits (as de-
fined by the Federal Trade Commission).
(5) The term ‘‘health carrier’’ means a person
that contracts or offers to contract on a risk-assum-
ing basis to provide, deliver, arrange for, pay for or
reimburse any of the cost of health care services un-
less the person assuming the risk is accepting the
risk from a duly licensed health carrier.
(6) The term ‘‘insured’’ means a party named
on a policy, certificate, or health benefit plan as the
person with legal rights to the benefits provided by
the policy, certificate, or health benefit plan. For
group insurance, such term includes a person who is
a beneficiary covered by a group policy, certificate,
or health benefit plan.
(7) The term ‘‘insurer’’ means any person, re-
ciprocal exchange, interinsurer, Lloyds insurer, fra-
ternal benefit society, or other legal entity engaged
in the business of insurance, including agents, bro-
kers, adjusters, and third party administrators. The
term also includes health carriers, health benefit
plans, and life, disability, and property and casualty
insurers.
(8) The term ‘‘policy’’ means a contract of in-
surance, certificate, indemnity, suretyship, or annu-
ity issued, proposed for issuance or intended for is-
suance by an insurer, including endorsements or rid-
ers to an insurance policy or contract.
(9) The term ‘‘subject of abuse’’ means a per-
son to whom an act of abuse is directed, a person
who has had prior or current injuries, illnesses, or
disorders that resulted from abuse, or a person who
seeks, may have sought, or should have sought medi-
cal or psychological treatment for abuse, protection,
court-ordered protection, or shelter from abuse.
SEC. 2253. DISCRIMINATORY ACTS PROHIBITED.
(a) IN GENERAL.—No insurer or health carrier may,
directly or indirectly, engage in any of the following acts
or practices on the basis that the applicant or insured,
or any person employed by the applicant or insured or
with whom the applicant or insured is known to have a
relationship or association, is, has been, or may be the
subject of abuse:
(1) Denying, refusing to issue, renew or reissue,
or canceling or otherwise terminating an insurance
policy or health benefit plan.
(2) Restricting, excluding, or limiting insurance
or health benefit plan coverage for losses as a result
of abuse or denying a claim incurred by an insured
as a result of abuse, except as otherwise permitted
or required by State laws relating to life insurance
beneficiaries.
(3) Adding a premium differential to any insur-
ance policy or health benefit plan.
(4) Terminating health coverage for a subject
of abuse because coverage was originally issued in
the name of the abuser and the abuser has divorced,
separated from, or lost custody of the subject of
abuse or the abuser’s coverage has terminated volun-
tarily or involuntarily and the subject of abuse does
not qualify for extension of coverage under part 6 of
subtitle B of title I or the Employee Retirement In-
come Security Act of 1974 (29 U.S.C. 1161 et seq.)
or 4980B of the Internal Revenue Code of 1986.
Nothing in this paragraph prohibits the insurer from
requiring the subject of abuse to pay the full pre-
mium for the subject’s coverage under the health
plan. The insurer may terminate group coverage
after the continuation coverage required by this
paragraph has been in force for 18 months if it of-
fers conversion to an equivalent individual plan. The
continuation of health coverage required by this
paragraph shall be satisfied by any extension of cov-
erage under part 6 of subtitle B of title I or the Em-
ployee Retirement Income Security Act of 1974 (29
U.S.C. 1161 et seq.) or 4980B of the Internal Reve-
nue Code of 1986 provided to a subject of abuse and
is not intended to be in addition to any extension of
coverage provided under part 6 of subtitle B of title
I or the Employee Retirement Income Security Act
of 1974 (29 U.S.C. 1161 et seq.) or 4980B of the
Internal Revenue Code of 1986.
(b) USE OF INFORMATION.—
(1) IN
GENERAL.—No insurer may use, dis-
close, or transfer information relating to an appli-
cant’s or insured’s abuse status or abuse-related
medical condition or the applicant’s or insured’s sta-
tus as a family member, employer or associate, per-
son in a relationship with a subject of abuse for any
purpose unrelated to the direct provision of health
care services unless such use, disclosure, or transfer
is required by an order of an entity with authority
to regulate insurance or an order of a court of com-
petent jurisdiction or by abuse reporting laws. Noth-
ing in this paragraph shall be construed as limiting
or precluding a subject of abuse from obtaining the
subject’s own medical records from an insurer.
(2) AUTHORITY
OF
SUBJECT
OF
ABUSE.—A
subject of abuse, at the absolute discretion of the
subject of abuse, may provide evidence of abuse to
an insurer for the limited purpose of facilitating
treatment of an abuse-related condition or dem-
onstrating that a condition is abuse-related. Nothing
in this paragraph shall be construed as authorizing
an insurer or health carrier to disregard such pro-
vided evidence.
SEC. 2254. REASONS FOR ADVERSE ACTIONS.
An insurer that takes any adverse action relating to
any plan or policy of a subject of abuse, shall advise the
subject of abuse applicant or insured of the specific rea-
sons for the action in writing. Reference to general under-
writing practices or guidelines does not constitute a spe-
cific reason.
SEC. 2255. LIFE INSURANCE.
Nothing in this subtitle shall be construed to prohibit
a life insurer from declining to issue a life insurance policy
if the applicant or prospective owner of the policy is or
would be designated as a beneficiary of the policy, and
if—
(1) the applicant or prospective owner of the
policy lacks an insurable interest in the insured; or
(2) the applicant or prospective owner of the
policy is known, on the basis of police or court
records, to have committed an act of abuse.
SEC. 2256. SUBROGATION WITHOUT CONSENT PROHIBITED.
Except where the subject of abuse has already recov-
ered damages, subrogation of claims resulting from abuse
is prohibited with the informed consent of the subject of
abuse.
SEC. 2257. ENFORCEMENT.
(a) FEDERAL TRADE COMMISSION.—The Federal
Trade Commission shall have the power to examine and
investigate any insurer to determine whether such insurer
has been or is engaged in any act or practice prohibited
by this subtitle. If the Federal Trade Commission deter-
mines an insurer has been or is engaged in any act or
practice prohibited by this subtitle, the Commission may
take action against such insurer by the issuance of a cease
and desist order as if the insurer was in violation of sec-
tion 5 of the Federal Trade Commission Act. Such cease
and desist order may include any individual relief war-
ranted under the circumstances, including temporary, pre-
liminary, and permanent injunctive and compensatory re-
lief.
(b) PRIVATE CAUSE OF ACTION.—An applicant or in-
sured claiming to be adversely affected by an act or prac-
tice of an insurer in violation of this subtitle may maintain
an action against the insurer in a Federal or State court
of original jurisdiction. Upon proof of such conduct by a
preponderance of the evidence, the court may award ap-
propriate relief, including temporary, preliminary, and
permanent injunctive relief and compensatory and puni-
tive damages, as well as the costs of suit and reasonable
fees for the aggrieved individual’s attorneys and expert
witnesses. With respect to compensatory damages, the ag-
grieved individual may elect, at any time prior to the ren-
dering of final judgment, to recover in lieu of actual dam-
ages, an award of statutory damages in the amount of
$5,000 for each violation.
Subtitle F—Insurance Protection
for Victims of Domestic Violence
Act
SEC. 2291. SHORT TITLE.
This subtitle may be cited as the ‘‘Insurance Protec-
tion for Victims of Domestic Violence Act’’.
SEC. 2292. PROHIBITION OF HEALTH INSURANCE DISCRIMI-
NATION WITH RESPECT TO VICTIMS OF DO-
MESTIC VIOLENCE.
The Public Health Service Act (42 U.S.C. 201 et
seq.) is amended by adding at the end the following new
title:
‘‘TITLE XXVII—PROHIBITION OF
HEALTH 
INSURANCE 
DIS-
CRIMINATION WITH RESPECT
TO VICTIMS OF DOMESTIC VI-
OLENCE
‘‘SEC. 2701. LIMITATIONS ON UNDERWRITING.
‘‘No insurer may engage in a practice that has the
effect of denying, canceling, or not renewing health insur-
ance coverage or health benefits, or establishing, increas-
ing, or varying the premium charged for the coverage or
benefits or excluding health coverage with respect to
health care items or services related to treatment of a con-
dition—
‘‘(1) to an individual on the basis that the indi-
vidual or family member is, has been, or may be the
subject of abuse, has had prior injuries that resulted
from abuse, or seeks, has sought, or should have
sought medical or psychological treatment for pro-
tection against abuse, or shelter from abuse; or
‘‘(2) to or for a group or employer on the basis
that the group includes or the employer employs, or
provides or subsidizes insurance for, an individual
described in paragraph (1).
‘‘SEC. 2702. ESTABLISHMENT OF STANDARDS.
‘‘(a) ROLE OF NATIONAL ASSOCIATION OF INSUR-
ANCE COMMISSIONERS.—
‘‘(1) IN GENERAL.—The Secretary shall request
the National Association of Insurance Commis-
sioners to develop, in consultation with nonprofit do-
mestic violence victim advocacy organizations, within
9 months after the date of the enactment of this
title, model standards that incorporate the limita-
tions on underwriting set forth in section 2701, and
provide procedures for enforcement for such provi-
sions, including a private right of action.
‘‘(2) REVIEW OF STANDARDS.—If the Associa-
tion develops recommended regulations specifying
the standards within the period, the Secretary shall
review the standards. The review shall be completed
within 90 days after the date the regulations are de-
veloped. Unless the Secretary determines within the
period that such standards do not meet the require-
ments, such standards shall serve as the standards
under this title, with such amendments as the Sec-
retary determines to be necessary.
‘‘(b) CONTINGENCY.—If the Association does not de-
velop the model regulations within the 9 month period be-
ginning on the date of the enactment of this title, or the
Secretary determines that the regulations do not specify
standards that meet the requirements described in sub-
section (a), the Secretary shall specify, within 15 months
after the date of the enactment of this title, standards to
carry out the requirements.
‘‘(c) APPLICATION OF STANDARDS.—
‘‘(1) IN GENERAL.—Each State shall submit to
the Secretary, by the deadline specified in paragraph
(2), a report on actions the State is taking to imple-
ment and enforce the standards established under
this section with respect to insurers and health in-
surance coverage offered or renewed not later than
such deadline.
‘‘(2) DEADLINE
FOR
REPORT.—Each State
shall file the report described in paragraph (1) not
later than 1 year after the date that standards are
established under subsection (a) or, in the event of
the failure of the Association to develop timely model
regulations, under subsection (b).
‘‘(d) FEDERAL ROLE.—
‘‘(1) NOTICE OF DEFICIENCY.—If the Secretary
determines that a State has failed to submit a report
by the deadline specified by subsection (c), or finds
that the State has not implemented and provided
adequate enforcement of the standards established
under subsection (a) or (b), the Secretary shall no-
tify the State and provide the State a period of 60
days in which to submit the report.
‘‘(2) IMPLEMENTATION OF ALTERNATIVE EN-
FORCEMENT MECHANISM.—
‘‘(A) IN GENERAL.—If, after the 60-day
period, the Secretary finds that such a failure
has not been corrected, the Secretary shall
within 30 days provide for a mechanism for the
implementation and enforcement of such stand-
ards in the State as the Secretary determines to
be appropriate.
‘‘(B) CIVIL PENALTY.—Under any imple-
mentation and enforcement mechanism estab-
lished by the Secretary pursuant to this para-
graph, the Secretary shall have the authority to
impose on an insurer a civil monetary penalty
in the amount of $10,000 for each day during
which such insurer violates the requirements
described in section 2701, or the standards de-
veloped under this section. Liability for such
penalty shall begin to accrue on the 30th day
after the Secretary has provided such insurer
with notice of its noncompliance, if the insurer
has failed to correct the deficiency by such date.
‘‘(C) EFFECTIVE PERIOD.—Any such im-
plementation and enforcement mechanism es-
tablished by the Secretary shall take effect with
respect to insurers, and health insurance cov-
erage offered or renewed, on or after 3 months
after the date of the Secretary’s finding under
paragraph (1), and until the date the Secretary
finds that such a failure has been corrected.
‘‘(3) FEDERAL CIVIL RIGHT OF ACTION.—
‘‘(A) IN
GENERAL.—Any individual
aggrieved as a result of conduct prohibited
by section 2701 may bring a civil action in
the appropriate United States district
court against the insurer.
‘‘(B) RELIEF.—Upon proof of such
conduct by a preponderance of the evi-
dence, the insurer shall be subject to a civil
penalty that may include temporary, pre-
liminary, or permanent injunctive relief
and compensatory and punitive damages,
as well as the costs of suit and reasonable
fees for the aggrieved individual’s attor-
neys. With respect to compensatory dam-
ages, the aggrieved individual may elect, at
any time prior to the rendering of final
judgment, to recover in lieu of actual dam-
ages, an award of statutory damages in the
amount of $5,000 for each violation.
‘‘SEC. 2703. APPLICATION TO GROUP HEALTH PLANS AND
ENFORCEMENT.
‘‘(a) APPLICATION.—Subject to subsection (b), the
prohibitions in section 2701 and the standards developed
under section 2702 shall apply to group health plans pro-
viding health coverage in the same manner as they apply
to insurers providing health insurance coverage. The pen-
alty described in section 2702(d)(2)(B) may be imposed
by the Secretary of Labor on group health plans that are
not in compliance with the requirements of sections 2701
and 2702.
‘‘(b) SUBSTITUTION OF FEDERAL OFFICIALS.—For
purposes of subsection (a), any reference in section 2702
to—
‘‘(1) a State or the Secretary of Health and
Human Services is deemed to be a reference to the
Secretary of Labor; and
‘‘(2) an insurer or health insurance coverage is
deemed to be a reference to a group health plan and
health coverage, respectively.
‘‘(c) ENFORCEMENT.—For purposes of part 5 of sub-
title B of title I of the Employee Retirement Income Secu-
rity Act of 1974 (29 U.S.C 1131 et seq.) the provisions
of this title insofar as they relate to group health plans
shall be deemed to be provisions of title I of such Act irre-
spective of exclusions under section 4(b) of such Act.
‘‘(d) REGULATORY AUTHORITY.—With respect to the
regulatory authority of the Secretary of Labor under this
title pursuant to subsection (c), section 505 of the Em-
ployee Retirement Income Security Act of 1974 (29
U.S.C. 1135) shall apply.
100
‘‘SEC. 2704. DEFINITIONS.
‘‘For purposes of this title:
‘‘(1) ASSOCIATION.—The term ‘Association’
means the National Association of Insurance Com-
missioners.
‘‘(2) INSURER.—
‘‘(A) IN
GENERAL.—The term ‘insurer’
means a health benefit plan or a health care
provider that conducts activities related to the
protection of public health.
‘‘(B) HEALTH BENEFIT PLAN.—The term
‘health benefit plan’ means any public or pri-
vate entity or program that provides for pay-
ments for health care, including—
‘‘(i) a group health plan (as defined in
section 607 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C.
1167)) or a multiple employer welfare ar-
rangement (as defined in section 3(40) of
such Act) that provides health benefits;
and
‘‘(ii) any other health insurance ar-
rangement, including any arrangement
consisting of a hospital or medical expense
incurred policy or certificate, hospital or
medical service plan contract, or health
101
maintenance organization subscriber con-
tract.
‘‘(C) HEALTH CARE PROVIDER.—The term
‘health care provider’ means a provider of serv-
ices (as defined in section 1861(u) of the Social
Security Act (42 U.S.C. 1395u)), a physician,
a supplier, or any other person furnishing
health care, including a Federal or State pro-
gram that provides directly for the provision of
health care to beneficiaries.
‘‘(3) VICTIM OF ABUSE.—The term ‘victim of
abuse’ means the occurrence of one or more of the
following acts between family or household members,
current or former sexual or intimate partners, or
persons sharing biological parenthood—
‘‘(A) attempting to cause or intentionally,
knowingly, or recklessly causing bodily injury,
rape, or sexual abuse as such term is defined in
section 2242 of title 18, United States Code.
‘‘(B) placing, by physical menace, another
individual in reasonable fear of imminent seri-
ous bodily injury;
‘‘(C) infliction of false imprisonment; or
‘‘(D) physically or sexually abusing minor
children.’’.
102
Subtitle G—Domestic Violence Vic-
tims Insurance Protection Act
of 1996
SEC. 2301. SHORT TITLE.
This subtitle may be cited as the ‘‘Domestic Violence
Victims Insurance Protection Act of 1996’’.
SEC. 2302. PROTECTION OF DOMESTIC VIOLENCE VICTIMS
FROM HEALTH INSURANCE DISCRIMINATION.
(a) IN GENERAL.—An insurer may not deny or can-
cel health insurance coverage for an individual solely on
the basis that the individual is or has been the subject
of an act of domestic violence.
(b) INTERPRETATION.— Nothing in this section shall
prevent an insurer from underwriting, issuing, or renewing
health insurance coverage on the basis of the physical or
mental history of an individual so long as the insurer does
not take into consideration whether such individual’s con-
dition was caused by an act of domestic violence.
(c) STANDARDS.—
(1) IN GENERAL.—The Secretary of Health and
Human Services shall request the National Associa-
tion of Insurance Commissioners to develop, within
9 months after the date of the enactment of the Act,
model regulations that specify standards with re-
103
spect to the requirements of this subtitle as applica-
ble to carriers and health insurance coverage.
(2) REVIEW OF STANDARDS.—If the National
Association of Insurance Commissioners develops
recommended regulations specifying such standards
within such period, the Secretary shall review the
standards. Such review shall be completed within 60
days after the date the regulations are developed.
Unless the Secretary determines within such period
that the standards do not meet the requirements,
such standards shall serve as the standards under
this section, with such amendments as the Secretary
deems necessary.
(3) APPLICATION OF STANDARDS.—Each State
shall submit to the Secretary a report on steps the
State is taking to implement and enforce the stand-
ards established under paragraph (1) with respect to
carriers and health insurance coverage offered or re-
newed.
(d) DEFINITIONS.—For purposes of this section:
(1) ACT OF DOMESTIC VIOLENCE.—The term
‘‘act of domestic violence’’ means, with respect to an
individual, the occurrence of one or more acts of
harassment, menacing, reckless endangerment, kid-
napping, assault, attempted assault, or attempted
104
murder, in violation of Federal or State law, between
household or family members (including in-laws or
extended family), spouses or former spouses, or indi-
viduals engaged in or formerly engaged in a sexually
intimate relationship, where such an act has resulted
in actual physical or emotional injury, or has created
a substantial risk of physical or emotional harm to
such individual or such individual’s child.
(2) HEALTH INSURANCE COVERAGE.—
(A) IN GENERAL.—Except as provided in
subparagraph (B), the term ‘‘health insurance
coverage’’ means any hospital or medical service
policy or certificate, hospital or medical service
plan contract, or health maintenance organiza-
tion contract offered by an insurer.
(B) EXCEPTION.—Such term does not in-
clude any of the following:
(i) Coverage for accident only, dental
only, vision only, disability income, or long-
term care insurance.
(ii) Medical supplemental health in-
surance.
(iii) Coverage issued as a supplement
to liability insurance.
105
(iv) Liability insurance, including gen-
eral liability insurance and automobile li-
ability insurance.
(v) Worker’s compensation or similar
insurance.
(vi) Automobile medical-payment in-
surance.
(vii) Coverage for a specified disease
or illness.
(3) INSURER.—The term ‘‘insurer’’ means an
insurance company, insurance service, or insurance
organization licensed to engage in the business of in-
surance in a State, and health maintenance organi-
zation.
(4) STATE.—The term ‘‘State’’ means any
State, the District of Columbia, Puerto Rico, the
Northern Mariana Islands, the Virgin Islands,
American Samoa, and Guam.
Subtitle H—Fairness to Minority
Women Health Act
SEC. 2351. SHORT TITLE.
This subtitle may be cited as the ‘‘Fairness to Minor-
ity Women Health Act’’.
106
SEC. 2352. EXCEPTION TO AFDC INCOME AND RESOURCES
ATTRIBUTION RULE FOR CERTAIN BATTERED
ALIENS.
(a) IN GENERAL.—Section 415(f) of the Social Secu-
rity Act (42 U.S.C. 615(f)) is amended—
(1) in the matter preceding paragraph (1), by
striking ‘‘who is—’’ and inserting ‘‘who—’’;
(2) in each of paragraphs (1) and (2), by in-
serting ‘‘is’’ before ‘‘admitted’’;
(3) in paragraph (3), by inserting ‘‘is’’ before
‘‘paroled’’;
(4) in paragraph (4)—
(A) by inserting ‘‘is’’ before ‘‘granted’’;
and
(B) by striking ‘‘or’’ at the end;
(5) in paragraph (5)—
(A) by inserting ‘‘is’’ before ‘‘a Cuban’’;
and
(B) by striking the period at the end and
inserting a semicolon; and
(6) by adding at the end the following:
‘‘(6) is battered by, or is the subject of extreme
cruelty (including physical acts resulting in physical
injury or a threat of physical injury, sexual abuse,
rape, or mental abuse) perpetrated by, the spouse or
other person who executed the affidavit of support
107
or similar agreement referred to in subsection (a)
with respect to the alien, but only after the first day
on which the battery or cruelty occurs after the alien
enters into the United States; or
‘‘(7) is a dependent child, and a relative with
whom the child is living is battered by, or is the sub-
ject of extreme cruelty (including physical acts re-
sulting in physical injury or a threat of physical in-
jury, sexual abuse, rape, or mental abuse) per-
petrated by, the parent or other person who executed
the affidavit of support or similar agreement re-
ferred to in subsection (a) with respect to the alien,
but only after the first day on which the battery or
cruelty occurs after the alien enters into the United
States.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall take effect 90 days after the date of
the enactment of this Act.
SEC. 2353. AMENDMENT TO THE FOOD STAMP ACT OF 1977.
(a) IN GENERAL.—Section 5(i) of the Food Stamp
Act of 1977 (7 U.S.C. 2014(i)) is amended by adding at
the end the following:
‘‘(F) If an alien is battered by the alien’s sponsor,
or is the subject of extreme cruelty perpetrated by the
sponsor, after such alien enters the United States, then
108
after the date the battery or cruelty occurs, this subsection
(other than subparagraph (E) of paragraph (2)) shall not
apply with respect to such alien and to any child of such
alien less than 18 years of age and residing with such
alien.’’.
(b) The amendment made by subsection (a) shall take
effect 90 days after the date of the enactment of this Act.
SEC. 2354. REQUIRING CERTAIN RECIPIENTS OF FEDERAL
FINANCIAL ASSISTANCE TO HAVE PERSON-
NEL AVAILABLE WHO SPEAK PREDOMINANT
LANGUAGE USED IN AREA.
(a) PROVIDERS
OF OBSTETRICAL
AND GYNECO-
LOGICAL SERVICES.—
(1) MEDICAID.—Section 1903(i) of the Social
Security Act (42 U.S.C. 1396b(i)) is amended—
(A) by striking ‘‘or’’ at the end of para-
graph (14);
(B) by striking the period at the end of
paragraph (15) and inserting ‘‘; or’’; and
(C) by inserting after paragraph (15) the
following new paragraph:
‘‘(16) with respect to any amount expended for
obstetrical or gynecological services furnished by or
through a hospital, clinic, or other institutional pro-
vider, unless the hospital, clinic, or provider has
109
available at least one individual who is able to com-
municate in the predominant language used by resi-
dents of the area in which the hospital, clinic, or
provider is located (as determined by the Secretary
on the basis of information provided by the Sec-
retary of Commerce pursuant to the most recent de-
cennial census).’’.
(2) FAMILY
PLANNING
SERVICES.—Section
1001 of the Public Health Service Act (42 U.S.C.
300) is amended—
(A) by redesignating subsections (c) and
(d) as subsections (d) and (e), respectively; and
(B) by inserting after subsection (b) the
following subsection:
‘‘(c) The Secretary may make a grant under this sec-
tion only if the applicant involved agrees to ensure that,
of the individuals providing services under the grant, at
least one will be an individual who is able to communicate
in the predominant language used by residents of the area
in which the family planning project involved is located
(as determined by the Secretary on the basis of informa-
tion provided by the Secretary of Commerce pursuant to
the most recent decennial census).’’.
110
(3) EFFECTIVE DATE.—The amendments made
by this subsection shall apply to services furnished
on or after October 1, 1996.
(b) DOMESTIC VIOLENCE SHELTERS.—
(1) IN GENERAL.—The Family Violence Pre-
vention and Services Act (42 U.S.C. 10401 et seq.)
is amended by adding at the end the following new
section:
‘‘SEC. 319. AVAILABILITY OF BILINGUAL SERVICES.
‘‘No funds may be made available under this title for
any provider of shelter or related assistance unless the
provider has available at least one individual who is able
to communicate in the predominant language used by resi-
dents of the area in which the provider is located (as deter-
mined by the Secretary on the basis of information pro-
vided by the Secretary of Commerce pursuant to the most
recent decennial census).’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply to funds made available
on or after October 1, 1996.
SEC. 2355. STUDY REGARDING DOMESTIC VIOLENCE AND
LATINA WOMEN.
(a) IN GENERAL.—With respect to cases of domestic
violence in which Latina women are the victims, the Sec-
retary of Health and Human Services, in consultation with
111
the Attorney General of the United States, shall conduct
a study for the following purposes:
(1) To determine the incidence of such cases,
and to provide a comparison of such estimate with
the relevant incidence for other populations of
women (utilizing existing data regarding such other
populations).
(2) To determine whether and to what extent
the causes and effects for such cases are different
than for cases of domestic violence in which other
populations of women are the victims (utilizing exist-
ing data regarding such other populations).
(b) REPORT.—Not later than 3 years after the date
of the enactment of this Act, the Secretary of Health and
Human Services shall submit to the Congress a report de-
scribing the findings made in the study under subsection
(a).
Subtitle I—Adolescent Health
Demonstration Projects Act
SEC. 2391. SHORT TITLE.
This subtitle may be cited as the ‘‘Adolescent Health
Demonstration Projects Act’’.
112
SEC. 2392. ESTABLISHMENT OR SUPPORT OF DEMONSTRA-
TION PROJECTS.
The Secretary of Health and Human Services (here-
inafter in this subtitle referred to as the ‘‘Secretary’’) shall
make grants in fiscal years 1997 through 2001 to public
and nonprofit private entities to establish or support ado-
lescent health demonstration projects in secondary schools
or entities associated with secondary schools for the pur-
pose of demonstrating how such projects may be estab-
lished throughout the United States.
SEC. 2393. PROJECT REQUIREMENTS.
An adolescent health demonstration project estab-
lished or supported under section 2392 shall (1) provide
nutrition and hygiene counseling, health care related to
sports, family planning information and services, prenatal
and postpartum care, family life and parenting counseling,
and alcohol and drug abuse education and treatment, (2)
serve adolescents before their graduation from high school,
(3) encourage family participation, to the extent practical,
(4) obtain the approval of the school board in the locality
to be served by the project before the project is imple-
mented, (5) furnish such reports and data as the Sec-
retary may require, including, at a minimum, the number
and characteristics of individuals served, the services pro-
vided, and the results achieved, and (6) establish a com-
munity advisory committee to oversee the establishment
113
and implementation of such project. Such community ad-
visory committee shall include students, parents, school
personnel, physicians, religious and business leaders, and
other community representatives and shall establish poli-
cies for the project with respect to the services to be pro-
vided under the project, the populations to be served, the
personnel who will provide services, fees to be charged, and
other policy issues.
SEC. 2394. AREAS TO BE SERVED.
In making grants under section 2392, the Secretary
shall give priority to applications for projects which will
serve areas with low-income residents or minority popu-
lations.
SEC. 2395. ABORTION RESTRICTION.
None of the funds provided under a grant under sec-
tion 2392 may be used to perform or pay for abortions.
SEC. 2396. REPORT.
The Secretary shall, in each fiscal year, set aside not
more than 5 percent of the amount appropriated for
grants under section 2392 to evaluate the operations of
the projects for which grants were made under such sec-
tion. Not later than December 1, 2002, the Secretary shall
report to the Congress the result of such evaluation to-
gether with such recommendations as the Secretary may
have respecting the extension of the grant authority under
114
section 2392 or the establishment of a continuing service
program.
Subtitle J—Eating Disorders Infor-
mation and Education Act of
1996
SEC. 2401. SHORT TITLE.
This subtitle may be cited as the ‘‘Eating Disorders
Information and Education Act of 1996’’.
SEC. 2402. FINDINGS.
The Congress finds the following:
(1) Eating disorders include anorexia nervosa,
bulimia nervosa, and binge eating disorder, as well
as eating disorders not otherwise defined.
(2) Anorexia nervosa and bulimia each can re-
sult in death, cardiac impairments, depression, sub-
stance abuse, osteoporosis, infertility, amenorrhea,
anemia, and other medical conditions.
(3) Medical authorities are uncertain to what
extent eating disorders are caused by physiological
factors, by psychosocial factors, or by both.
(4) Such disorders primarily affect women. As
many as 7 percent of women may be experiencing
eating disorders, and the rate of new cases is in-
creasing. As many as 80 percent of women may dur-
115
ing their lifetimes display symptoms of eating dis-
orders.
(5) There are effective treatments for some eat-
ing disorders.
SEC. 2403. PUBLIC INFORMATION AND EDUCATION ON EAT-
ING DISORDERS.
Subpart 3 of part B of title V of the Public Health
Service Act (42 U.S.C. 290bb–31 et seq.) is amended by
adding at the end the following section:
‘‘EATING DISORDERS
‘‘SEC. 520C. (a) INFORMATION AND EDUCATION.—
The Secretary, acting through the Director of the Center
for Mental Health Services, shall carry out a program to
provide information and education to the public on the
prevention and treatment of eating disorders.
‘‘(b) TOLL-FREE TELEPHONE COMMUNICATIONS.—
In carrying out subsection (a), the Secretary shall provide
for the operation of toll-free telephone communications to
provide information to the public on eating disorders, in-
cluding referrals for services for the prevention and treat-
ment of such disorders. Such communications shall be
available on a 24-hour, 7-day basis.
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there are authorized
to be appropriated $2,000,000 for fiscal year 1997, and
116
such sums as may be necessary for each of the fiscal years
1998 and 1999.’’.
Subtitle K—Women’s Choice and
Reproductive Health Protection
Act of 1996
SEC. 2451. SHORT TITLE.
This subtitle may be cited as the ‘‘Women’s Choice
and Reproductive Health Protection Act of 1996’’.
SEC. 2452. FINDINGS.
The Congress finds that—
(1) reproductive rights are central to women’s
ability to exercise full enjoyment of rights secured to
them by Federal and State law;
(2) abortion has been a legal and constitu-
tionally protected medical procedure throughout the
United States since 1973 and has become part of
mainstream medical practice as is evidenced by the
positions of medical institutions including the Amer-
ican Medical Association, the American College of
Obstetricians and Gynecologists, and the American
Medical Women’s Association;
(3) the availability of abortion services is dimin-
ishing throughout the United States: 84 percent of
counties have no abortion provider and between
117
1982 and 1992 the number of providers decreased
in 45 States; and
(4) at a minimum, Congress must retain the
following policies, which currently preserve women’s
choice and reproductive health:
(A) Funding for abortion services for vic-
tims of rape and incest.
(B) Protection from clinic violence.
(C) The implementation of breast cancer,
cervical cancer and chlamydia screening pro-
grams in all 50 States.
(D) Full implementation of legislation to
establish contraceptive and infertility research
programs.
(E) Authorization of family planning pro-
grams.
(F) The prohibition of a ‘‘gag’’ rule on in-
formation pertaining to reproductive medical
services.
(G) The evaluation of RU–486.
(H) The fundamental right to choose, as
stated by the Supreme Court in Roe v. Wade.
(I) Fairness in insurance.
118
(J) The ability of military personnel over-
seas to purchase abortion services at military
facilities with private funds.
SEC. 2453. SENSE OF CONGRESS WITH RESPECT TO CER-
TAIN REPRODUCTIVE HEALTH ISSUES.
(a) RAPE AND INCEST VICTIM PROTECTION.—It is
the sense of Congress that the current provisions requiring
funding of abortion services in cases of life endangerment,
rape or incest for women eligible for medical assistance
are essential to their health and well-being and therefore
Federal and State governments must provide funding in
these cases.
(b) CLINIC VIOLENCE.—It is the sense of Congress
that—
(1) Federal resources are necessary to ensure
that women have safe access to reproductive health
facilities and that health professionals can deliver
services in a secure environment free from violence
and threats of force; and
(2) it is necessary and appropriate to use Fed-
eral resources to combat the nationwide campaign of
violence and harassment against reproductive health
centers.
(c) PREVENTIVE HEALTH MEASURES REGARDING
BREAST AND CERVICAL CANCER.—It is the sense of the
119
Congress that the program of grants under title XV of
the Public Health Service Act should receive a level of
funding that is adequate for all States to receive grants
under such title.
(d) PROGRAMS REGARDING CONTRACEPTION
AND
INFERTILITY.—
(1) RESEARCH CENTERS.—It is the sense of the
Congress that the program of research centers under
section 452A of the Public Health Service Act
should receive a level of funding that is adequate for
a reasonable number of research centers to be oper-
ated under the program.
(2) LOAN
REPAYMENT
PROGRAM
REGARDING
CONDUCT
OF
RESEARCH.—It is the sense of the
Congress that the program of loan-repayment con-
tracts under section 487B of the Public Health
Service Act should receive a level of funding that is
adequate for a reasonable number of individuals to
conduct research under the program.
(3) SCREENINGS
FOR
INFERTILITY-RELATED
SEXUALLY TRANSMITTED DISEASES.—It is the sense
of the Congress that the program of grants under
section 318A of the Public Health Service Act
should receive a level of funding that is adequate for
120
screenings under such section to be available in all
States.
SEC. 2454. FAMILY PLANNING AMENDMENTS.
Section 1001(d) of the Public Health Service Act (42
U.S.C. 300(d)) is amended to read as follows:
‘‘(d) For the purpose of grants and contracts under
this section, there are authorized to be appropriated
$220,000,000 for fiscal year 1997, $250,000,000 for fis-
cal year 1998, and such sums as may be necessary for
each of the fiscal years 1999 through 2001.’’.
SEC. 2455. FREEDOM OF FULL DISCLOSURE.
Title XI of the Civil Rights Act of 1964 is amended
by adding at the end the following:
‘‘SEC. 1107. (a) Notwithstanding any other provision
of law, no governmental authority shall, in or through any
program or activity that provides health care services or
information, administered or assisted by such authority,
limit the right of any person to provide, or the right of
any person to receive, nonfraudulent information about
the availability of reproductive health care services, includ-
ing family planning, prenatal care, adoption, and abortion
services.
‘‘(b) As used in this section the term ‘governmental
authority’ means any authority of the United States.’’.
121
SEC. 2456. FAIRNESS IN EVALUATION OF RU–486.
The Secretary of Health and Human Services shall—
(1) assure that the Food and Drug Administra-
tion evaluates the drug called Mifepristone or RU–
486 only on the basis provided by law; and
(2) assess initiatives by which the Department
of Health and Human Services can promote the
testing, licensing, and manufacturing in the United
States of this drug or other antiprogestins.
SEC. 2457. FREEDOM OF CHOICE.
(a) FINDINGS.—Congress finds the following:
(1) The 1973 Supreme Court decision in Roe v.
Wade established constitutionally based limits on the
power of States to restrict the right of a woman to
choose to terminate a pregnancy. Under the strict
scrutiny standard enunciated in Roe v. Wade, States
were required to demonstrate that laws restricting
the right of a woman to choose to terminate a preg-
nancy were the least restrictive means available to
achieve a compelling State interest. Since 1989, the
Supreme Court has no longer applied the strict scru-
tiny standard in reviewing challenges to the constitu-
tionality of State laws restricting such rights.
(2) As a result of the Supreme Court’s recent
modification of the strict scrutiny standard enun-
ciated in Roe v. Wade, certain States have restricted
122
the right of women to choose to terminate a preg-
nancy or to utilize some forms of contraception, and
these restrictions operate cumulatively to—
(A)(i) increase the number of illegal or
medically less safe abortions, often resulting in
physical impairment, loss of reproductive capac-
ity or death to the women involved;
(ii) burden interstate commerce by forcing
women to travel from States in which legal bar-
riers render contraception or abortion unavail-
able or unsafe to other States or foreign na-
tions;
(iii) interfere with freedom of travel be-
tween and among the various States;
(iv) burden the medical and economic re-
sources of States that continue to provide
women with access to safe and legal abortion;
and
(v) interfere with the ability of medical
professionals to provide health services;
(B) obstruct access to and use of contra-
ceptive and other medical techniques that are
part of interstate and international commerce;
(C) discriminate between women who are
able to afford interstate and international travel
123
and women who are not, a disproportionate
number of whom belong to racial or ethnic mi-
norities; and
(D) infringe upon women’s ability to exer-
cise full enjoyment of rights secured to them by
Federal and State law, both statutory and con-
stitutional.
(3) Although Congress may not by legislation
create constitutional rights, it may, where authorized
by its enumerated powers and not prohibited by a
constitutional provision, enact legislation to create
and secure statutory rights in areas of legitimate na-
tional concern.
(4) Congress has the affirmative power both
under section 8 of article I of the Constitution of the
United States and under section 5 of the Fourteenth
Amendment of the Constitution to enact legislation
to prohibit State interference with interstate com-
merce, liberty or equal protection of the laws.
(b) PURPOSE.—It is the purpose of this section to
establish, as a statutory matter, limitations upon the
power of States to restrict the freedom of a woman to ter-
minate a pregnancy in order to achieve the same limita-
tions as provided, as a constitutional matter, under the
124
strict scrutiny standard of review enunciated in Roe v.
Wade and applied in subsequent cases from 1973 to 1988.
(c) IN GENERAL.—A State—
(1) may not restrict the freedom of a woman to
choose whether or not to terminate a pregnancy be-
fore fetal viability;
(2) may restrict the freedom of a woman to
choose whether or not to terminate a pregnancy
after fetal viability unless such a termination is nec-
essary to preserve the life or health of the woman;
and
(3) may impose requirements on the perform-
ance of abortion procedures if such requirements are
medically necessary to protect the health of women
undergoing such procedures.
(d) DEFINITION.—As used in this section, the term
‘‘State’’ includes the District of Columbia, the Common-
wealth of Puerto Rico, and each other territory or posses-
sion of the United States.
SEC. 2458. FAIRNESS IN INSURANCE.
Notwithstanding any other provision of law no Fed-
eral law shall be construed to prohibit a provider of health
insurance from offering coverage for the full range of re-
productive health care, including abortion services.
125
SEC. 2459. ABORTIONS IN FACILITIES OF THE UNIFORMED
SERVICES NOT PROHIBITED IF NOT FEDER-
ALLY FUNDED.
Section 1093 of title 10, United States Code, is
amended—
(1) by inserting ‘‘(a) LIMITATION.—’’ before
‘‘Funds’’; and
(2) by adding at the end the following:
‘‘(b) ABORTIONS IN FACILITIES OVERSEAS.—Sub-
section (a) does not limit the performing of an abortion
in a facility of the uniformed services located outside the
48 contiguous States of the United States if—
‘‘(1) the cost of performing the abortion is fully
paid from a source or sources other than funds
available to the Department of Defense;
‘‘(2) abortions are not prohibited by the laws of
the jurisdiction where the facility is located; and
‘‘(3) the abortion would otherwise be permitted
under the laws applicable to the provision of health
care to members and former members of the uni-
formed services and their dependents in such facil-
ity.’’.
126
Subtitle L—Women’s Right To
Know Act of 1996
SEC. 2491. SHORT TITLE.
This subtitle may be cited as the ‘‘Women’s Right
To Know Act of 1996’’.
SEC. 2492. FIRST AMENDMENT RIGHTS.
Title XI of the Civil Rights Act of 1964 is amended
by adding at the end the following:
‘‘SEC. 1107. (a) Notwithstanding any other provision
of law, no governmental authority shall in or through any
program or activity, administered or assisted by such au-
thority, that provides health care services or information,
limit the right of any person to provide, or the right of
any person to receive, nonfraudulent information about
the availability of reproductive health care services, includ-
ing family planning, prenatal care, adoption, and abortion
services.
‘‘(b) As used in this section—
‘‘(1) the term ‘governmental authority’ means
any authority of any State or of the United States;
and
‘‘(2) the term ‘State’ includes the District of
Columbia, Puerto Rico, and any other territory or
possession of the United States.’’.
127
Subtitle 
M—International 
Popu-
lation Stabilization and Repro-
ductive Health Act
SEC. 2501. SHORT TITLE.
This subtitle may be cited as the ‘‘International Pop-
ulation Stabilization and Reproductive Health Act’’.
SEC. 2502. AUTHORITIES RELATING TO UNITED STATES
POPULATION ASSISTANCE.
Part I of the Foreign Assistance Act of 1961 is
amended—
(1) in section 104(b), by striking ‘‘on such
terms and conditions as he may determine’’ and in-
serting ‘‘in accordance with the provisions of chapter
12’’; and
(2) by adding at the end the following new
chapter:
‘‘CHAPTER 12—UNITED STATES
POPULATION ASSISTANCE
‘‘SEC. 499. DEFINITION.—For purposes of this chap-
ter, the term ‘United States population assistance’ means
assistance provided under section 104(b) of this Act.
‘‘SEC. 499A. CONGRESSIONAL FINDINGS.—The Con-
gress makes the following findings:
‘‘(1) Throughout much of the developing world,
the inability of women and couples to exercise choice
128
over childbearing undermines the role of women in
economic development, contributes to death and suf-
fering among women and their children, puts pres-
sure on the environment and the natural resources
on which many poor families depend for their sur-
vival, and in other ways vitiates the efforts of fami-
lies to lift themselves out of the poverty in which
more than one billion of the world’s 5.6 billion peo-
ple live.
‘‘(2) Through 2015, the world’s population will
continue to grow, with annual population increments
predicted to be above 86 million. This will lead to a
tripling of the world’s population before stabilization
can occur.
‘‘(3) As the population within individual coun-
tries grows, cities grow rapidly, movement in and be-
tween countries increases, and regional distributions
of population become unbalanced.
‘‘(4) After more than a quarter century of expe-
rience and research, a global consensus is emerging
on the need for increased international cooperation
in regard to population in the context of sustainable
development.
‘‘(5) To act effectively on this consensus, the
ability to exercise reproductive choice should be ex-
129
panded through broader dissemination of fertility
regulation services that involve women, couples, and
the community and which are competent in meeting
individual, family, and community needs and values.
‘‘(6) Although a number of barriers to family
planning remain, in many countries a large and
growing unmet desire exists for fertility regulation
among women and men who are too poor to pay the
full cost of services or for whom services are other-
wise inaccessible. Worldwide, estimates are that
more than 350 million couples want to space or pre-
vent another pregnancy, but lack access to family
planning methods.
‘‘(7) Millions of women, most of them mothers,
are killed or injured each year as a result of unsafe
abortions. The availability of safe and effective fer-
tility regulation methods and services and increased
access to quality reproductive health care can help
prevent many of these tragedies.
‘‘(8) In addition to the personal toll on families,
the impact of human population growth and wide-
spread poverty is evident in mounting signs of stress
on the world’s environment, particularly in tropical
deforestation, erosion of arable land and watersheds,
extinction of plant and animal species, global climate
130
change, waste management, and air and water pollu-
tion.
‘‘(9) Traditionally, United States population as-
sistance has not focused on achieving specific goals
with respect to international population stabilization
or the expansion of reproductive choice. The absence
of clear goals in those areas has led to a lack of cri-
teria for allocating funds and evaluating program
success.
‘‘DECLARATION OF POLICY
‘‘SEC. 499B. (a) IN GENERAL.—Congress declares
that to reduce population growth and stabilize world popu-
lation at the lowest level feasible and thereby improve the
health and well-being of the world’s families, to ensure the
role of women in the development process, and to protect
the global environment, an important objective of the for-
eign policy of the United States shall be to assist the inter-
national community to achieve universal availability of
quality fertility regulation services through a wide choice
of safe and effective means of family planning, including
programs of public education and other health and devel-
opment efforts in support of smaller families.
‘‘(b) FINANCIAL TARGETS.—The Congress endorses
a target for global expenditures in developing countries of
at least $17,000,000,000 by the year 2000 for population
programs described in section 499C, and establishes a goal
131
for United States population assistance by the year 2000
of $1,850,000,000 in constant 1993 dollars.
‘‘SEC. 499C. AUTHORIZED
ACTIVITIES.—United
States population assistance is authorized to provide—
‘‘(1) support for the expansion of quality, af-
fordable, voluntary family planning services, which
emphasize informed choice among a variety of safe
and effective fertility regulation methods and closely
related reproductive health care services, including
the prevention and control of HIV–AIDS, sexually
transmitted diseases, and reproductive tract infec-
tions;
‘‘(2) support for adequate and regular supplies
of quality contraceptives, quality family planning
counseling, information, education, communication,
and services emphasizing the use of the mass media
to improve public knowledge of fertility regulation
and related disease prevention methods and where
they may be obtained and to promote the benefits of
family planning and reproductive health to individ-
uals, families, and communities;
‘‘(3) support to United States and foreign re-
search institutions and other appropriate entities for
biomedical research to develop and evaluate im-
proved methods of safe fertility regulation and relat-
132
ed disease control, with particular emphasis on
methods which—
‘‘(A) are likely to be safer, easier to use,
easier to make available in developing country
settings, and less expensive than current meth-
ods;
‘‘(B) are controlled by women, including
barrier methods and vaginal microbicides;
‘‘(C) are likely to prevent the spread of
sexually transmitted diseases; and
‘‘(D) encourage and allow men to take
greater responsibility for their own fertility;
‘‘(4) support for field research on the character-
istics of programs most likely to result in sustained
use of effective family planning in meeting each indi-
vidual’s lifetime reproductive goals, with particular
emphasis on the perspectives of family planning
users, including support for relevant social and be-
havioral research focusing on such factors as the
use, nonuse, and unsafe or ineffective use of various
fertility regulation and related-disease control meth-
ods;
‘‘(5) support for the development of new evalua-
tion techniques and performance criteria for family
133
planning programs, emphasizing the family planning
user’s perspective and reproductive goals;
‘‘(6) support for research and research dissemi-
nation related to population policy development, in-
cluding demographic and health surveys to assess
population trends, measure unmet needs, and evalu-
ate program impact, and support for policy-relevant
research on the relationships between population
trends, poverty, and environmental management, in-
cluding implications for sustainable agriculture,
agroforestry, biodiversity, water resources, energy
use, and local and global climate change;
‘‘(7) support for prevention of unsafe abortions
and management of complications of unsafe abor-
tions, including research and public information dis-
semination on the health and welfare consequences;
‘‘(8) support for special programs to reach ado-
lescents and young adults before they begin child-
bearing, including health education programs which
stress responsible parenthood and the health risks of
unprotected sexual intercourse, as well as service
programs designed to meet the information and con-
traception needs of adolescents;
134
‘‘(9) support for a broad array of governmental
and nongovernmental communication strategies de-
signed—
‘‘(A) to create public awareness worldwide;
‘‘(B) to generate a consensus on the need
to address reproductive health issues and the
problems associated with continued world popu-
lation growth;
‘‘(C) to emphasize the need to educate men
as well as women and mobilize their support for
reproductive rights and responsibilities; and
‘‘(D) to remove all major remaining bar-
riers to family planning use, including unneces-
sary legal, medical, clinical, and regulatory bar-
riers to information and methods, and to make
family planning an established community
norm;
‘‘(10) support for programs and strategies that
actively discourage harmful practices such as female
genital mutilation; and
‘‘(11) support for prenatal, safe delivery pro-
grams and postnatal care programs that include
breastfeeding as a child survival strategy and means
for enhancing birth spacing.
135
‘‘SEC. 499D. TERMS
AND CONDITIONS.—United
States population assistance is authorized to be provided
subject to the following conditions:
‘‘(1) Such assistance may only support, directly
or through referral, those activities which provide a
broad range of fertility regulation methods permitted
by individual country policy and a broad choice of
public and private family planning services, includ-
ing networks for community-based and subsidized
commercial distribution of high quality contracep-
tives.
‘‘(2) No program supported by United States
population assistance may deny an individual family
planning services because of such individual’s inabil-
ity to pay all or part of the cost of such services.
‘‘(3) In each recipient country, programs sup-
ported by United States population assistance shall,
to the extent possible, support an integrated ap-
proach, consistent with respect for the rights of
women as decisionmakers in matters of reproduction
and sexuality, for the provision of public and private
reproductive health services.
‘‘(4) Family planning services and related re-
productive health care services supported by United
States population assistance shall ensure—
136
‘‘(A) privacy and confidentiality and main-
tain the highest medical standards possible
under local conditions; and
‘‘(B) regular oversight of the quality of
medical care and other services offered, includ-
ing followup care such as care for the side ef-
fects of contraceptive use.
‘‘(5) United States population assistance pro-
grams shall furnish only those contraceptive drugs
and devices which have received approval for mar-
keting in the United States by the Food and Drug
Administration or which have been tested and deter-
mined to be safe and effective under research proto-
cols comparable to those required by the Food and
Drug Administration or have been determined to be
safe by an appropriate international organization or
the relevant health authority in the country to which
they are provided.
‘‘(6) Family planning services supported by
United States population assistance shall be de-
signed to take into account the needs of the family
planning user, including the constraints on women’s
time, by involving members of the community, in-
cluding both men and women, in the design, man-
agement, and ongoing evaluation of the services
137
through appropriate training and recruitment ef-
forts. The design of services shall stress easy acces-
sibility, by locating services as close as possible to
potential users, by keeping hours of service conven-
ient, and by improving communications between
users and providers through community outreach
and involvement. Related services shall be included,
either on site or through referral.
‘‘(7) United States population assistance to ad-
olescent fertility programs shall be provided in the
context of prevailing norms and customs in the re-
cipient country.
‘‘(8)(A) Programs supported by United States
population assistance shall—
‘‘(i) support the prevention of the spread
of HIV–AIDS infection;
‘‘(ii) raise awareness regarding HIV–AIDS
prevention and consequences; and
‘‘(iii) provide quality counselling, medical
care and support services to HIV–AIDS in-
fected individuals in a manner which respects
individual rights and confidentiality.
‘‘(B) Responsible sexual behavior, including vol-
untary abstinence, for the prevention of HIV infec-
138
tion should be promoted and included in education
and information programs.
‘‘(9) None of the funds made available by the
United States Government to foreign governments,
international organizations, or nongovernmental or-
ganizations may be used to coerce any person to un-
dergo contraceptive sterilization or involuntary abor-
tion or to accept any other method of fertility regu-
lation.
‘‘ELIGIBILITY FOR POPULATION ASSISTANCE
‘‘SEC. 499E. (a) ELIGIBLE COUNTRIES.—Notwith-
standing any other provision of law, United States popu-
lation assistance shall be available, directly or through
intermediary organizations, to any country which the
President determines has met one or more of the following
criteria:
‘‘(1) The country accounts for a significant pro-
portion of the world’s annual population increment.
‘‘(2) The country has significant unmet needs
for fertility regulation and requires foreign assist-
ance to implement, expand, or sustain quality family
planning services for all its people.
‘‘(3) The country demonstrates a strong policy
commitment to population stabilization through the
expansion of reproductive choice.
139
‘‘(b) ELIGIBILITY OF NONGOVERNMENTAL AND MUL-
TILATERAL ORGANIZATIONS.—In determining eligibility
for United States population assistance, the President
shall not subject nongovernmental and multilateral organi-
zations to requirements which are more restrictive than
requirements applicable to foreign governments for such
assistance.
‘‘PARTICIPATION IN MULTILATERAL ORGANIZATIONS
‘‘SEC. 499F. (a) FINDING.—The Congress recognizes
that the recent attention, in government policies toward
population stabilization owes much to the efforts of the
United Nations and its specialized agencies and organiza-
tions, particularly the United Nations Population Fund.
‘‘(b) AVAILABILITY OF FUNDS.—United States popu-
lation assistance shall be available for contributions to the
United Nations Population Fund in such amounts as the
President determines would be commensurate with United
States contributions to other multilateral organizations
and with the contributions of other donor countries.
‘‘(c) PROHIBITIONS.—(1) The prohibitions contained
in section 104(f) of this Act shall apply to the funds made
available for the United Nations Population Fund.
‘‘(2) No United States population assistance may be
available to the United Nations Population Fund unless
such assistance is held in a separate account and not com-
mingled with any other funds.
140
‘‘(3) No funds may be available for the United Na-
tions Population Fund unless the Fund agrees to prohibit
the use of those funds to carry out any program, project,
or activity that involves the use of coerced abortion or in-
voluntary sterilization.
‘‘(d) ALLOCATION OF FUNDS.—Of the funds made
available for United States population assistance, the
President shall make available for the Special Programme
of Research, Development and Research Training in
Human Reproduction for each of the fiscal years 1996 and
1997 an amount commensurate with the contributions of
the other donor countries for the purpose of furthering
international cooperation in the development and evalua-
tion of fertility regulation technology.
‘‘SUPPORT FOR NONGOVERNMENTAL ORGANIZATIONS
‘‘SEC. 499G. (a) FINDING.—Congress finds that in
many developing countries, nongovernmental entities, in-
cluding private and voluntary organizations and private
sector entities, such as the International Planned Parent-
hood Federation and the Planned Parenthood Federation
of America, are the most appropriate and effective provid-
ers of United States assistance to population and family
planning activities.
‘‘(b) PROCEDURES.—The President shall establish
simplified procedures for the development and approval of
141
programs to be carried out by nongovernmental organiza-
tions that have demonstrated—
‘‘(1) a capacity to undertake effective popu-
lation and family planning activities which encourage
significant involvement by private health practition-
ers, employer-based health services, unions, and co-
operative health organizations; and
‘‘(2) a commitment to quality reproductive
health care for women.
‘‘(c) PRIORITY FOR NONGOVERNMENTAL ORGANIZA-
TIONS.—The largest share of United States population as-
sistance made available for any fiscal year shall be made
available through United States and foreign nongovern-
mental organizations.
‘‘SEC. 499H. REPORTS TO CONGRESS.—The Presi-
dent shall prepare and submit to the Congress, as part
of the annual presentation materials on foreign assistance,
a report on world progress toward population stabilization
and universal reproductive choice. The report shall in-
clude—
‘‘(1) estimates of expenditures on the popu-
lation activities described in section 499C by na-
tional governments, donor agencies, and private sec-
tor entities;
142
‘‘(2) an assessment by country, of the availabil-
ity and use of all methods of fertility regulation and
abortion, whether lawful or unlawful in that country;
‘‘(3) an analysis by country and region of the
impact of population trends on a set of key social,
economic, political, and environment indicators,
which shall be identified by the President in the first
report submitted pursuant to this section and ana-
lyzed in that report and each subsequent report; and
‘‘(4) a detailed statement of prior year and pro-
posed direct and indirect allocations of population
assistance, by country, which describes how each
country allocation meets the criteria set forth in this
section.’’.
SEC. 2503. AUTHORIZATIONS OF APPROPRIATIONS.
Section 104(g)(1) of the Foreign Assistance Act of
1961 (22 U.S.C. 2151b(g)(1) is amended by amending
subparagraph (A) to read as follows:
‘‘(A) $635,000,000 for fiscal year 1997 and
$695,000,000 for fiscal year 1998 to carry out sub-
section (b) of this section; and’’.
SEC. 2504. OVERSIGHT OF MULTILATERAL DEVELOPMENT
BANKS.
(a) FINDINGS.—The Congress finds that—
143
(1) multilateral development banks have an im-
portant role to play in global population efforts;
(2) although the increased commitment by mul-
tilateral development banks to population-related ac-
tivities is encouraging, together the banks provided
less than $200,000,000 in 1994 in assistance for
core population programs, and their overall lending
for population, health, and nutrition decreased by
more than one-half between 1993 and 1994; and
(3) the banks themselves have recognized a
need to improve oversight of programs, strengthen
the technical skills of their personnel, and improve
their capacity to work with borrowers, other donors,
and nongovernmental organizations in formulating
creative population projects to meet diverse borrower
needs.
(b) SENSE OF CONGRESS.—It is the sense of the
Congress that the multilateral development banks should
increase their annual support for the population activities
described in section 499C of the Foreign Assistance Act
of 1961, as added by this Act, to not less than a total
of $1,000,000,000 by December 31, 2001.
(c) REPORT REQUIRED.—Not later than July 31 of
each year, the Secretary of the Treasury shall prepare and
144
transmit to Congress a report which includes, with respect
to the preceding calendar year—
(1) information on the resources made available
by each multilateral development bank for the popu-
lation activities described in section 499C of the
Foreign Assistance Act of 1961, as added by this
Act;
(2) 
if 
such 
resources 
total 
less 
than
$1,000,000,000, any specific actions taken by the
United States executive directors to the banks to en-
courage increases in such resources and in policy-
level discussions with donor and developing country
governments; and
(3) an analysis of the progress made by the
banks towards—
(A) meeting the objectives of the popu-
lation activities which are supported by the
banks;
(B) increasing their in-country manage-
ment staff;
(C) improving the technical skills of their
personnel; and
(D) assuring their responsiveness to bor-
rower needs.
145
(d) DEFINITION.—As used in this section, the term
‘‘multilateral development banks’’ means the International
Bank for Reconstruction and Development, the Inter-
national Development Association, the African Develop-
ment Bank, the Asian Development Bank, the Inter-
American Development Bank, and the European Bank for
Reconstruction and Development.
SEC. 2505. ECONOMIC AND SOCIAL DEVELOPMENT INITIA-
TIVES TO STABILIZE WORLD POPULATION.
(a) 
CONGRESSIONAL
FINDINGS.—The 
Congress
makes the following findings:
(1) Women represent 50 percent of the world’s
human resource potential. Therefore, improving the
health, social, and economic status of women and in-
creasing their productivity are essential for economic
progress in all countries. Improving the status of
women also enhances their decisionmaking capacity
at all levels in all spheres of life, including in the
area of reproductive health.
(2) Throughout the world, women who partici-
pate in the social, economic, and political affairs of
their communities are more likely to exercise their
choice about childbearing than women who do not
participate in such activities.
146
(3) Effective economic development strategies
address issues such as infant and child survival
rates, educational opportunities for girls and women,
and gender equality in development.
(4) Comprehensive population stabilization ef-
forts which include both family planning services
and economic development activities achieve lower
birth rates and stimulate more development than
those which pursue these objectives independently.
(5) The most powerful, long-term influence on
birthrates is education, especially educational attain-
ment among women. Education is one of the most
important means of empowering women with the
knowledge, skills and self confidence necessary to
participate in their communities.
(6) In most societies, men traditionally have ex-
ercised preponderant power in nearly all spheres of
life. Therefore, improving communication between
men and women on reproductive health issues and
increasing their understanding of joint responsibil-
ities are essential to ensuring that men and women
are equal partners in public and private life.
(7) In addition to enabling women to partici-
pate in the development of their societies, edu-
cational attainment has a strong influence on all
147
other aspects of family welfare, including child sur-
vival. However, of the world’s 130 million children
who are not enrolled in primary school, 70 percent
are girls.
(8) In a number of countries, lower rates of
school enrollment among girls, the practice of pre-
natal sex selection, and higher rates of mortality
among very young girls suggest that ‘‘son pref-
erence’’ is curtailing the access of girl children to
food, health care, and education.
(9) Each year, nearly 15 million children under
the age of 5 die, most from preventable causes.
Wider availability of vaccines, simple treatments for
diarrheal disease and respiratory infections, and im-
proved nutrition could prevent many of these deaths.
(10) Each year, 500,000 or more women world-
wide die from complications related to pregnancy,
childbirth, illegal abortion, or inadequate or inacces-
sible reproductive health care services. Another 10
million women annually suffer long-term illness or
permanent physical impairment from such causes.
(11) Malnutrition and anemia are widespread
among poor women in their childbearing years, yet
the worldwide campaign to encourage breastfeeding
148
has devoted little attention to the nutritional needs
of nursing mothers.
(12) By mid-1993, the cumulative number of
AIDS cases since the pandemic began was estimated
at 2.5 million, and an estimated 14 million people
had been infected with HIV. By year 2000, esti-
mates are that 40 million people will be HIV in-
fected.
(13) As of mid-1993, four-fifths of all persons
ever infected with HIV lived in developing countries.
Women are the fastest growing group of new cases.
(b) DECLARATION OF POLICY.—Congress declares
that, to further the United States foreign policy objective
of assisting the international community in achieving uni-
versal availability of quality fertility regulation services
and stabilizing world population, additional objectives of
the foreign policy of the United States shall be—
(1) to help achieve universal access to basic
education for women and men, with particular prior-
ity being given to primary and technical education
and job training;
(2) to increase understanding of the con-
sequences of population growth through effective
education strategies that begin in primary school
and continue through all levels of formal and
149
nonformal education and which take into account
the rights and responsibilities of parents and the
needs of children and adolescents;
(3) to reduce the gap between male and female
levels of literacy and between male and female levels
of primary and secondary school enrollment;
(4) to help ensure that women worldwide have
the opportunity to become equal partners with men
in the development of their societies;
(5) to help eliminate all forms of discrimination
against girl children and the root causes of son pref-
erence, which result in harmful and unethical prac-
tice such as female infanticide and prenatal sex se-
lection;
(6) to increase public awareness of the value of
girl children through public education that promotes
equal treatment of girls and boys in health, nutri-
tion, education, socioeconomic and political activity,
and equitable inheritance rights;
(7) to promote gender equality in all spheres of
life, including family and community life, and to en-
courage and enable men to take responsibility for
their sexual and reproductive behavior and their so-
cial and family roles;
150
(8) to help ensure that women and men have
the information and means needed to achieve good
reproductive health and to exercise their reproduc-
tive rights through responsible sexual behavior and
equity in gender relations;
(9) to reduce global maternal and infant mor-
tality rates; and
(10) to improve worldwide maternal and child
health status and quality of life.
(c) AUTHORIZED ACTIVITIES.—United States devel-
opment assistance shall be available, on a priority basis,
for—
(1) countries which either have adopted and im-
plemented, or have agreed to adopt and implement,
strategies to help ensure—
(A) before 2015, the achievement of the
goal of universal primary education for girls
and boys in all countries and access to second-
ary and higher levels of education, including vo-
cational education and technical training, for
girls and women;
(B) by 2005, the reduction of adult illit-
eracy by at least one-half the country’s 1990
level;
151
(C) by 2005, the elimination of the gap be-
tween male and female levels of literacy and be-
tween male and female levels of primary and
secondary school enrollment; and
(D) the establishment of programs de-
signed to meet adolescent health needs, which
include services and information on responsible
sexual behavior, family planning practice, repro-
ductive health and sexually transmitted dis-
eases, and HIV–AIDS prevention;
(2) governmental and nongovernmental pro-
grams which, with respect to a targeted country, are
intended—
(A) by 2005, to increase life expectancy at
birth to greater than 70 years of age and by
2015, to 75 years of age;
(B) by 2005, to reduce by one-third the
country’s mortality rates for infants and chil-
dren under 5 years of age, or to 50 per 1,000
live births for infants and 70 per 1,000 for chil-
dren under 5 years of age, whichever is less;
and by 2015, to reduce the country’s infant
mortality rate below 35 per 1,000 births and
the under-5 mortality rate below 45 per 1,000;
152
(C) by 2005, to reduce maternal mortality
by one-half of the 1990 level and by a further
one-half by 2015;
(D) by 2005, to reduce significantly mal-
nutrition among the country’s children under 5
years of age;
(E) to maintain immunizations against
childhood diseases for significant segments of
the country’s children; and
(F) to reduce the number of childhood
deaths in the country which result from diar-
rheal disease and acute respiratory infections;
(3) governmental and nongovernmental pro-
grams which are intended to increase women’s pro-
ductivity and ensure equal participation and equi-
table representation at all levels of the political proc-
ess and public life in each community and society
through—
(A) improved access to appropriate labor-
saving technology, vocational training, and ex-
tension services and access to credit and child
care;
(B) equal participation of women and men
in all areas of family and household responsibil-
ities, including family planning, financial sup-
153
port, child rearing, children’s education, and
maternal and child health and nutrition;
(C) fulfillment of the potential of women
through education, skill development and em-
ployment, with the elimination of poverty, illit-
eracy and poor health among women being of
paramount importance; and
(D) recognition and promotion of the equal
value of children of both sexes;
(4) governmental and nongovernmental pro-
grams which are intended to increase the access of
girls and women to comprehensive reproductive
health care services pursuant to subsection (d); and
(5) governmental and nongovernmental pro-
grams which are intended to eliminate all forms of
exploitation, abuse, harassment, and violence against
women, adolescents, and children.
(d) SAFE MOTHERHOOD INITIATIVE.—(1)(A) The
President is authorized to establish a grant program, to
be known as the Safe Motherhood Initiative, to help im-
prove the access of girls and women worldwide to com-
prehensive reproductive health care services.
(B) Such program shall be carried out in accordance
with this section and shall be subject to the same terms,
conditions, prohibitions, and restrictions as are applicable
154
to assistance made available under sections 499D, 499E,
and 499F of the Foreign Assistance Act of 1961, as added
by this Act.
(2) Comprehensive reproductive health care programs
which are eligible for assistance under this section in-
clude—
(A) fertility regulation services;
(B) prenatal care and screening for high risk
pregnancies and improved access to safe delivery
services for women with high risk pregnancies;
(C) supplemental food programs for pregnant
and nursing women;
(D) child survival and other programs that pro-
mote birth spacing through breastfeeding;
(E) expanded and coordinated programs that
support responsible sexual behavior, including vol-
untary abstinence, and which prevent, detect, and
treat sexually transmitted diseases, including HIV–
AIDS, reproductive tract infections, and other
chronic reproductive health problems;
(F) programs intended to eliminate traditional
practices injurious to women’s health, including fe-
male genital mutilation;
155
(G) improvements in the practice of midwifery,
including outreach to traditional birth attendants;
and
(H) expanded and coordinated programs to pre-
vent, detect, and treat cancers of the reproductive
system.
(e) REPORTS TO CONGRESS.—(1) Not later than De-
cember 31, 1996, the President shall prepare and submit
to Congress a report which includes—
(A) estimates of the total financial resources
needed to achieve, by the year 2005, the specific ob-
jectives set forth in subsection (c) with respect to
education, rates of illiteracy, malnutrition, immuni-
zation, maternal and child mortality and morbidity,
and improvements in the economic productivity of
women;
(B) an analysis of such estimates which sepa-
rately lists the total financial resources needed from
the United States, other donor nations, and non-
governmental organizations;
(C) an analysis, by country, which—
(i) identifies the legal, social, economic,
and cultural barriers to women’s self-determina-
tion and to improvements in the economic pro-
156
ductivity of women in traditional and modern
labor sectors; and
(ii) describes initiatives needed to develop
appropriate technologies for use by women,
credit programs for low-income women, ex-
panded child care, vocational training, and ex-
tension services for women; and
(D) a comprehensive description of—
(i) new and expanded initiatives to ensure
safe motherhood worldwide;
(ii) findings on the major causes of mortal-
ity and morbidity among women of childbearing
age in various regions of the world;
(iii) actions needed to reduce, by the year
2005, world maternal mortality by one-half of
the worldwide 1990 level and a further one-half
by 2015; and
(iv) the financial resources needed to meet
this goal from the United States, other donor
nations, and nongovernmental organizations.
(2) In each annual country human rights report, the
Secretary of State shall include—
(A) information on any patterns within the
country of discrimination against women in inherit-
ance laws, property rights, family law, access to
157
credit and technology, hiring practices, formal edu-
cation, and vocational training; and
(B) an assessment which makes reference to all
significant forms of violence against women, includ-
ing rape, domestic violence, and female genital muti-
lation, the extent of involuntary marriage and child-
bearing, and the prevalence of marriage among
women under 18 years of age.
(f) AUTHORIZATION OF APPROPRIATIONS.—(1) Of
the aggregate amounts available for United States devel-
opment and economic assistance programs for education
activities, $165,000,000 for fiscal year 1997 and
$200,000,000 for fiscal year 1998 shall be available only
for programs in support of increasing primary and second-
ary school enrollment and equalizing levels of male and
female enrollment.
(2) There are authorized to be appropriated
$330,000,000 for fiscal year 1997 and $380,000,000 for
fiscal year 1998 to the Child Survival Fund under section
104(c)(2) of the Foreign Assistance Act of 1961, which
amounts shall be available for child survival activities only,
including the Children’s Vaccine Initiative, the worldwide
immunization effort, and oral rehydration programs.
158
(3) There are authorized to be appropriated
$100,000,000 for the Safe Motherhood Initiative for each
of fiscal years 1996 and 1997.
(g) DEFINITIONS.—For purposes of this section—
(1) the term ‘‘annual country human rights re-
port’’ refers to the report required to be submitted
pursuant to section 502B(b) of the Foreign Assist-
ance Act of 1961 (22 U.S.C. 2304(b)); and
(2) the term ‘‘United States development and
economic assistance’’ means assistance made avail-
able under chapter 1 of part I and chapter 4 of part
II of the Foreign Assistance Act of 1961.
SEC. 2506. AIDS PREVENTION AND CONTROL FUND.
(a) IN GENERAL.—Section 104(c) of the Foreign As-
sistance Act of 1961 (22 U.S.C. 2151b(c)) is amended by
adding at the end the following new paragraph:
‘‘(4)(A)(i) The President is authorized to provide as-
sistance, under such terms and conditions as he may de-
termine, with respect to activities relating to research on,
and the treatment and control of, acquired immune defi-
ciency syndrome (AIDS) in developing countries.
‘‘(ii) Assistance provided under clause (i) shall in-
clude—
‘‘(I) funds made available directly to the World
Health Organization for its use in financing the
159
Global Program on AIDS (including activities imple-
mented by the Pan American Health Organization);
and
‘‘(II) funds made available to the United Na-
tions Children’s Fund (UNICEF) for AIDS-related
activities.
‘‘(B) Appropriations pursuant to subparagraph (A)
may be referred to as the ‘AIDS Prevention and Control
Fund’.’’.
(b) AUTHORIZATION OF APPROPRIATIONS.—Section
104(g)(1) of the Foreign Assistance Act of 1961 (22
U.S.C. 2151b(g)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (A);
(2) in subparagraph (B), by striking ‘‘sub-
section (c) of this section.’’ and inserting ‘‘sub-
section (c) of this section (other than paragraph (4)
thereof); and’’; and
(3) by adding at the end thereof the following
new subparagraph:
‘‘(C) $125,000,000 for fiscal year 1997
and $145,000,000 for fiscal year 1998 to carry
out subsection (c)(4) of this section.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall take effect October 1, 1996.
160
SEC. 2507. SUPPORT FOR UNITED NATIONS FORWARD
LOOKING STRATEGIES FOR THE ADVANCE-
MENT OF WOMEN.
(a) IN GENERAL.—The President shall direct the
United States representatives to the United Nations Com-
mission on the Status of Women to take all actions nec-
essary to ensure the rapid implementation of the United
Nations Forward Looking Strategies for the Advancement
of Women, as adopted in 1985 at the United Nations Con-
ference ending the Decade for Women.
(b) REVIEW AND ANNUAL REPORTS.—Not later than
December 31, 1996, the Secretary of State shall submit
the 5-year review of the status of United States women,
as called for at the conference, and shall submit such an-
nual reports as are requested by the United Nations Com-
mission on the Status of Women.
SEC. 2508. SUPPORT FOR THE CONVENTION ON THE ELIMI-
NATION OF ALL FORMS OF DISCRIMINATION
AGAINST WOMEN.
The President shall promptly complete the review of
the United Nations Convention on the Elimination of All
Forms of Discrimination Against Women, which was
signed by the United States on July 17, 1980, and submit
to the Senate any reservations, understandings, or dec-
larations that the President considers necessary in order
that the Senate may give its advice and consent to ratifica-
161
tion, or report to the Congress why he is unable or unwill-
ing to do so.
Subtitle N—Federal Prohibition of
Female Genital Mutilation Act
of 1996
SEC. 2551. SHORT TITLE.
This subtitle may be cited as the ‘‘Federal Prohibi-
tion of Female Genital Mutilation Act of 1996’’.
SEC. 2552. TITLE 18 AMENDMENT.
(a) IN GENERAL.—Chapter 7 of title 18, United
States Code, is amended by adding at the end the follow-
ing new section:
‘‘§ 116. Female genital mutilation
‘‘(a) Except as provided in subsection (b), whoever
knowingly circumcises, excises, or infibulates the whole or
any part of the labia majora or labia minora or clitoris
of another person who has not attained the age of 18 years
shall be fined under this title or imprisoned not more than
5 years, or both.
‘‘(b) A surgical operation is not a violation of this
section if the operation is—
‘‘(1) necessary to the health of the person on
whom it is performed, and is performed by a person
licensed in the place of its performance as a medical
practitioner; or
162
‘‘(2) performed on a person in labor or who has
just given birth and is performed for medical pur-
poses connected with that labor or birth by a person
licensed in the place it is performed as a medical
practitioner, midwife, or person in training to be-
come such a practitioner or midwife.
‘‘(c) In applying subsection (b)(1), no account shall
be taken of the effect on the person on whom the operation
is to be performed of any belief on the part of that or
any other person that the operation is required as a mat-
ter of custom or ritual.
‘‘(d) Whoever knowingly denies to any person medical
care or services or otherwise discriminates against any
person in the provision of medical care or services, be-
cause—
‘‘(1) that person has undergone female cir-
cumcision, excision, or infibulation; or
‘‘(2) that person has requested that female cir-
cumcision, excision, or infibulation be performed on
any person;
shall be fined under this title or imprisoned not more than
one year, or both.’’.
(b) CLERICAL AMENDMENT.—The table of sections
at the beginning of chapter 7 of title 18, United States
163
Code, is amended by adding at the end the following new
item:
‘‘116. Female genital mutilation.’’.
SEC. 2553. INFORMATION AND EDUCATION REGARDING FE-
MALE GENITAL MUTILATION.
(a) IN GENERAL.—The Secretary of Health and
Human Services shall do the following:
(1) Compile data on the number of females liv-
ing in the United States who have been subjected to
female genital mutilation (whether in the United
States or in their countries of origin), including a
specification of the number of girls under the age of
18 who have been subjected to such mutilation.
(2) Identify communities in the United States
that practice female genital mutilation, and design
and carry out outreach activities to educate individ-
uals in the communities on the physical and psycho-
logical health effects of such practice. Such outreach
activities shall be designed and implemented in col-
laboration with representatives of the ethnic groups
practicing such mutilation and with representatives
of organizations with expertise in preventing such
practice.
(3) Develop recommendations for the education
of students of schools of medicine and osteopathic
medicine regarding female genital mutilation and