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Sec. 1003 PUBLIC HEALTH SERVICE ACT 478 FORMULA GRANTS TO STATES FOR FAMILY PLANNING SERVICES SEC. 1002. [300a] (a) The Secretary is authorized to make grants, from allotments made under subsection (b), to State health authorities to assist in planning, establishing, maintaining, coordi- nating, and evaluating family planning services. No grant may be made to a State health authority under this section unless such au- TITLE X-POPULATION RESEARCH AND VOLUNTARY thority has submitted, and had approved by the Secretary, a State FAMILY PLANNING PROGRAMS plan for a coordinated and comprehensive program of family plan- ning services. PROJECT GRANTS AND CONTRACTS FOR FAMILY PLANNING SERVICES (b) The sums appropriated to carry out the provisions of this sec- SEC. 1001. [300] (a) The Secretary is authorized to make grants tion shall be allotted to the States by the Secretary on the basis of to and enter into contracts with public or nonprofit private entities the population and the financial need of the respective States. (c) For the purposes of this section, the term "State" includes the to assist in the establishment and operation of voluntary family Commonwealth of Puerto Rico, the Northern Mariana Islands, planning projects which shall offer a broad range of acceptable and Guam, American Samoa, the Virgin Islands, the District of Colum- effective family planning methods and services (including natural bia, and the Trust Territory of the Pacific Islands. family planning methods. infertility services. and services for ado- (d) For the purpose of making grants under this section, there lescents). To the extent practicable, entities which receive grants or are authorized to be appropriated $10,000,000 for the fiscal year contracts under this subsection shall encourage family participa- ending June 30, 1971; $15,000,000 for the fiscal year ending June tion in projects assisted under this subsection. 30, 1972; and $20,000,000 for the fiscal year ending June 30, 1973. (b) In making grants and contracts under this section the Secre- tary shall take into account the number of patients to be served, TRAINING GRANTS AND CONTRACTS the extent to which family planning services are needed locally, the relative need of the applicant, and its capacity to make rapid SEC. 1003. [300a-1] (a) The Secretary is authorized to make and effective use of such assistance. Local and regional entities grants to public or nonprofit private entities and to enter into con- shall be assured the right to apply for direct grants and contracts tracts with public or private entities and individuals to provide the under this section, and the Secretary shall by regulation fully pro- training for personnel to carry out family planning service pro- vide for and protect such right. grams described in section 1001 or 1002. (c) The Secretary, at the request of a recipient of a grant under (b) For the purpose of making payments pursuant to grants and subsection (a), may reduce the amount of such grant by the fair contracts under this section, there are authorized to be appropri- market value of any supplies or equipment furnished the grant re- ated $2,000,000 for the fiscal year ending June 30, 1971; $3,000,000 cipient by the Secretary. The amount by which any such grant is for the fiscal year ending June 30, 1972; $4,000,000 for the fiscal so reduced shall be available for payment by the Secretary of the year ending June 30, 1973; and $3,000,000 each for the fiscal years costs incurred in furnishing the supplies or equipment on which ending June 30, 1974, and June 30, 1975; $4,000,000 for fiscal year the reduction of such grant is based. Such amount shall be deemed 1976; $5,000,000 for the fiscal year ending September 30, 1977; as part of the grant and shall be deemed to have been paid to the $3,000,000 for the fiscal year ending September 30, 1978; $3,100,000 grant recipient. for the fiscal year ending September 30, 1979; $3,600,000 for the (d) For the purpose of making grants and contracts under this fiscal year ending September 30, 1980; $4,100,000 for the fiscal year section, there are authorized to be appropriated $30,000,000 for the ending September 30, 1981; $2,920,000 for the fiscal year ending fiscal year ending June 30, 1971; $60,000,000 for the fiscal year September 30, 1982; $3,200,000 for the fiscal year ending September ending June 30, 1972; $111,500,000 for the fiscal year ending June 30, 1983; $3,500,000 for the fiscal year ending September 30, 1984; 30, 1973; $111,500,000 each for the fiscal years ending June 30, and $3,500,000 for the fiscal year ending September 30, 1985. 1974, and June 30, 1975; $115,000,000 for fiscal year 1976; RESEARCH $115,000,000 for the fiscal year ending September 30, 1977; $186,400,000 for the fiscal year ending September 30, 1978; SEC. 1004. [300a-2] The Secretary may- $200,000,000 for the fiscal year ending September 30, 1979; (1) conduct, and $230,000,000 for the fiscal year ending September 30, 1980; (2) make grants to public or nonprofit private entities and $264,500,000 for the fiscal year ending September 30, 1981; enter into contracts with public or private entities and individ- $126,510,000 for the fiscal year ending September 30, 1982; uals for projects for, $189,200,000 for the fiscal year ending September 30, 1983; research in the biomedical, contraceptive development, behavioral. $150,030,000 for the fiscal ending tember 30, 1984; and and program implementation fields related to family planning and $158,400,000 for the fiscal ending September 30, 1985. population. 479 PUBLIC HEALTH SERVICE ACT Sec. 1006 1007 P IC HEALTH SERVICE ACT 480 INFORMATIONAL AND EDUCATIONAL MATERIALS party (including a government agency). which is authorized or is under legal obligation to pay such charge. SEC. 1005. [300a-8] (a) The Secretary is authorized to make For purposes of this subsection, the term "low-income family" shall grants to public or nonprofit private entities and to enter into con- be defined by the Secretary in accordance with such criteria as he tracts with public or private entities and individuals to assist in de- may prescribe 80 as to insure that economic status shall not be a veloping and making available family planning and population deterrent to participation in the programs assisted under this title. growth information (including educational materials) to all persons (d)(1) A grant may be made or a contract entered into under desiring such information (or materials). tion 1001 or 1005 only upon assurances satisfactory to the Secre- (b) For the purpose of making payments pursuant to grants and tary that informational or educational materials developed or contracts under this section, there are authorized to be appropri- made available under the grant or contract will be suitable for the ated $750,000 for the fiscal year ending June 30, 1971; $1,000,000 purposes of this title and for the population or community to which for the fiscal year ending June 30, 1972; $1,250,000 for the fiscal they are to be made available, taking into account the educational year ending June 30, 1973; $909,000 each for the fiscal years ending and cultural background of the individuals to whom such materials June 30, 1974, and June 30, 1975; $2,000,000 for fiscal year 1976; are addressed and the standards of such population or community $2,500,000 for the fiscal year ending September 30, 1977; $600,000 with respect to such materials. for the fiscal year ending September 30, 1978; $700,000 for the (2) In the case of any grant or contract under section 1001, such fiscal year ending September 30, 1979; $805,000 for the fiscal year assurances shall provide for the review and approval of the suit- ending September 30, 1980; $926,000 for the fiscal year ending Sep- ability of such materials, prior to their distribution, by an advisory tember 30, 1981; $570,000 for the fiscal year ending September 30, committee established by the grantee or contractor in accordance 1982; $600,000 for the fiscal year ending September 30, 1983; with the Secretary's regulations. Such a committee shall include $670,000 for the fiscal year ending September 30, 1984; and individuals broadly representative of the population or community $700,000 for the fiscal year ending September 30, 1985. to which the materials are to be made available. REGULATIONS AND PAYMENTS VOLUNTARY PARTICIPATION SEC. 1006. [300a-4] (a) Grants and contracts made under this SEC. 1007. [300a-5] The acceptance by any individual of family title shall be made in accordance with such regulations as the Sec- planning services or family planning or population growth informa- retary may promulgate. The amount of any grant under any sec- tion (including educational materials) provided through financial tion of this title shall be determined by the Secretary; except that assistance under this title (whether by grant or contract) shall be no grant under any such section for any program or project for a voluntary and shall not be a prerequisite to eligibility for or receipt fiscal year beginning after June 30, 1975, may be made for less of any other service or assistance from, or to participation in, any than 90 per centum of its costs (as determined under regulations of other program of the entity or individual that provided such serv- the Secretary) unless the grant is to be made for a program or ice or information. project for which a grant was made (under the same section) for the fiscal year ending June 30, 1975, for less than 90 per centum of PROHIBITION OF ABORTION its costs (as so determined), in which case a grant under such sec- tion for that program or project for a fiscal year beginning after SEC. 1008. [300a-6] None of the funds appropriated under this that date may be made for a percentage which shall not be less title shall be used in programs where abortion is a method of than the percentage of its costs for which the fiscal year 1975 grant family planning. was made. PLANS AND REPORTS (b) Grants under this title shall be payable in such installments and subject to such conditions as the Secretary may determine to SEC. 1009. (a) Not later than seven months after the close of h be appropriate to assure that such grants will be effectively utilized fiscal year. the Secretary shall make a report to the Congress for the purposes for which made. ting forth a plan to be carried out over the next five fiscal years (c) A grant may be made or contract entered into under section for- 1001 or 1002 for a family planning service project or program only (1) extension of family planning services to all persons upon assurances satisfactory to the Secretary that- ing such services, (1) priority will be given in such project or program to the (2) family planning and population research programs, furnishing of such services to persons from low-income fami- (3) training of necessary manpower for the programs author- lies; and ized by this title and other Federal laws for which the Secre- (2) no charge will be made in such project or program for tary has responsibility and which pertain to family planning, services provided to any person from a low-income family and except to the ex t that payment will be made by a third 481 PUBLIC HEALTH SERVICE ACT Sec. 1009 (4) carrying out the other purposes set forth in this title and section 1009 repealed the Family Planning Services and Population Research Act of 1970. (b) Such a plan shall, at a minimum, indicate on a phased basis- (1) the number of individuals to be served by family planning by P.L. 105-362, programs under this title and other Federal laws for which the Secretary has responsibility, the types of family planning and population growth information and educational materials to be Federal Reports Elemenation developed under such laws and how they will be made avail- able, the research goals to be reached under such laws, and the manpower to be trained under such laws; Act of 1998 (2) an estimate of the costs and personnel requirements needed to meet the purposes of this title and other Federal laws for which the Secretary has responsibility and which per- tain to family planning programs; and (3) the steps to be taken to maintain a systematic reporting system capable to yielding comprehensive data on which serv- ice figures and program evaluations for the Department of Health, Education, and Welfare shall be based. (c) Each report submitted under subsection (a) shall- (1) compare results achieved during the preceding fiscal year with the objectives established for such year under the plan contained in the previous such report; (2) indicate steps being taken to achieve the objectives during the fiscal years covered by the plan contained in such report and any revisions to plans in previous reports necessary to meet these objectives; and (3) make recommendations with respect to any additional legislative or administrative action necessary or desirable in carrying out the plan contained in such report. Jennifer M. Forshey 11/06/98 09:03:50 AM Record Type: Record To: Jennifer L. Klein/OPD/EOP, Daniel N. Mendelson/OMB/EOP, Richard J. Turman/OMB/EOP CC: Barbara A. Menard/OMB/EOP Subject: Family planning Per your request, the following table illustrates the Title X Family Planning increases since 1993. Since 1993, Title X funding has increased by 24%. Please let me know if you have any further questions. Family Planning Funding 1993-2000 (in millions) Year Enacted 1992 149 1993 173 1994 181 1995 193 1996 193 1997 198 1998 203 1999 215 2000 under discussion 1 Jennifer L. Klein 11/05/98 01:13:25 PM Record Type: Record To: Daniel N. Mendelson/OMB/EOP@EOP, Richard J. Turman/OMB/EOP@EOP CC: Subject: Family planning Can one of you tell me how much of an increase in Title X family planning funds we have received: (1) since 1993; and (2) this year? I am working on a document for the First Lady updating her on progress in various areas, and she has asked for this. Thanks. Public Law 91-572 91st Congress, S. 2108 December 24, 1970 An Act 84 STAT, 1504 To promote public health and welfare by expanding, improving, and better coordi- nating the family planning services and population research activities of the Federal Government, and for other purposes. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, Fami ly Planni Servi and SHORT TITLE Population Research Act SECTION 1. This Act may be cited as the "Family Planning Services of 1970. and Population Research Act of 1970". DECLARATION OF PURPOSE SEC. 2. It is the purpose of this Act- (1) to assist in making comprehensive voluntary family plan- ning services readily available to all persons desiring such services; (2) to coordinate domestic population and family planning research with the present and future needs of family planning programs; (8) to improve administrative and operational supervision of domestic family planning services and of population research programs related to such services; (4) to enable public and nonprofit private entities to plan and develop comprehensive programs of family planning services; (5) to develop and make readily available information (includ- ing educational materials) on family planning and population growth to all persons desiring such information; (6) to evaluate and improve the effectiveness of family plan- ning service programs and of population research; (7) to assist in providing trained manpower needed to effectively carry out programs of population research and family planning services; and -(8) to establish an Office of Population Affairs in the Depart- ment of Health, Education, and Welfare as a primary focus within the Federal Government on matters pertaining to popula- tion research and family planning, through which the Secretary of Health, Education, and Welfare (hereafter in this Act referred to as the "Secretary") shall carry out the purposes of this Act. OFFICE OF POPULATION AFFAIRS Establishment. Deputy Assist- SEC. 8. (a) There is established within the Department of Health, ant Secretary Education, and Welfare an Office of Population A ffairs to be directed for Population by a Deputy Assistant Secretary for Population Affairs under the Affairs, ap- direct supervision of the Assistant Secretary for Health and Scientific pointment. Affairs. The Deputy Assistant Secretary for Population Affairs shall be appointed by the Secretary. (b) The Secretary is authorized to provide the Office of Population Staff and Affairs with such full-time professional and clerical staff and with the consultants services of such consultants as may be necessary for it to carry out its duties and functions. Pub. Law 91-572 - 2 - December 24, 1970 84 STAT, 1505 FUNCTIONS OF THE DEPUTY ASSISTANT SECRETARY FOR POPULATION AFFAIRS SEC. 4. The Secretary shall utilize the Deputy Assistant Secretary for Population Affairs- (1) to administer all Federal laws for which the Secretary has administrative responsibility and which provide for or authorize the making of grants or contracts related to population research and family planning programs; (2) to administer and be responsible for all population and family planning research carried on directly by the Department of Health, Education, and Welfare or supported by the Depart- ment through grants to, or contracts with, entities and individuals; (8) to act as a clearinghouse for information pertaining to domestic and international population research and family plan- ning programs for use by all interested persons and public and private entities; (4) to provide a liaison with the activities carried on by other agencies and strumentalities of the Federal Government relating to population research and family planning; (5) to provide or support training for necessary manpower for domestic programs of population research and family planning programs of service and research; and (6) to coordinate and be responsible for the evaluation of the other Department of Health, Education, and Welfare programs related to population research and family planning and to make periodic recommendations to the Secretary. PLANS AND REPORTS Report to SEC. 5. (a) Not later than six months after the date of enactment of Congress. this Act the Secretary shall make a report to the Congress setting forth R plan, to be carried out over a period of five years, for extension of family planning services to all persons desiring such services, for family planning and population research programs, for training of necessary manpower for the programs authorized by title X of the Post, P. 1506. Public Health Service Act and other Federal laws for which the Sec- retary has responsibility, and for carrying out the other purposes set forth in this Act and in such title X. (b) Such a plan shall, at a minimum, indicate on a phased basis— (1) the number of individuals to be served by family planning programs under title X of the Public Health Service Act and other Federal laws for which the Secretary has responsibility, the types of family planning and population growth information and educational materials to be developed under such laws and how they will be made available, the research goals to be reached under such laws, and the manpower to be trained under such laws; (2) an estimate of the costs and personnel requirements needed to meet these objectives; and (8) the steps to be taken to establish a systematic reporting sys- tem capable of yielding comprehensive data on which service figures and program evaluations for the Department of Health, Education, and Welfare shall be based. Reports to (c) On or before January 1, 1972, and on or before each January 1 Fongress. thereafter for a period of five years, the Secretary shall submit to the Congress a report which shall- (1) compare results achieved during the preceding fiscal year with the objectives established for such year under the plan; December 24, 1970 - 3 - Pub. Law 91-572 84 STAT, 1506 (2) indicate steps being taken to achieve the objective during the remaining fiscal years of the plan and any revisions necessary to meet these objectives; and (3) make recommendations with respect to any additional legis- lative or administrative action necessary or desirable in carrying out the plan. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT SEC. 6. (a) Section 1 of the Public Health Service Act is amended 79 Stat. 930, by striking out "Titles I to IX" and inserting in lieu thereof "Titles I 42 USC 201 to X". note. (b) The Act of July 1, 1944 (58 Stat. 682), as amended, is further amended by renumbering title X (as in effect prior to the enactment of this Act) as title XI, and by renumbering sections 1001 through 1014 (as in effect prior to the enactment of this Act), and references thereto, as sections 1101 through 1114, respectively. (c) The Public Health Service Act (42 U.S.C., ch. 6A) is further amended by adding after title IX the following new title: "TITLE X-POPULATION RESEARCH AND VOLUNTARY FAMILY PLANNING PROGRAMS "PROJECT GRANTS AND CONTRACTS FOR FAMILY PLANNING SERVICES "SEC. 1001. (a) The Secretary is authorized to maké grants to and enter into contracts with public or nonprofit private entities to assist in the establishment and operation of voluntary family planning projects. "(b) In making grants and contracts under this section the Secretary shall take into account the number of patients to be served, the extent to which family planning services are needed locally, the relative need of the applicant, and its capacity to make rapid and effective use of such assistance. (c) For the purpose of making grants and contracts under this sec- Appropriation. tion, there are authorized to be appropriated $30,000,000 for the fiscal year ending June 30, 1971; $60,000,000 for the fiscal year ending June 30, 1972; and $90,000,000 for the fiscal year ending June 30, 1978. "FORMULA GRANTS TO STATES FOR FAMILY PLANNING SERVICES "SEC. 1002. (a) The Secretary is authorized to make grants, from allotments made under subsection (b), to State health authorities to assist in planning, establishing, maintaining, coordinating, and evalu- ating family planning services. No grant may be made to a State health authority under this section unless such authority has submitted, and had approved by the Secretary, a State plan for a coordinated and comprehensive program of family planning services. "(b) The sums appropriated to carry out the provisions of this section shall be allotted to the States by the Secretary on the basis of the population and the financial need of the respective States. "(c) For the purposes of this section, the term 'State' includes the "State." Commonwealth of Puerto Rico, Guam, American Samoa, the Virgin Islands, the District of Columbia, and the Trust Territory of the Pacific Islands. "(d) For the purpose of making grants under this section, there are Appropriation. authorized to be appropriated $10,000,000 for the fiscal year ending Pub. Law 91-572 - 4 - December 24, 1970 84 STAT. 1507 June 30, 1971; $15,000,000 for the fiscal year ending June 30, 1972; and $20,000,000 for the fiscal year ending June 30, 1973. "TRAINING GRANTS AND CONTRACTS "SEC. 1003. (a) The Secretary is authorized to make grants to public or nonprofit private entities and to enter into contracts with public or private entities and individuals to provide the training for personnel to carry out family planning service programs described in section 1001 or 1002. Appropriation. "(b) For the purpose of making payments pursuant to grants and contracts under this section, there are authorized to be appropriated $2,000,000 for the fiscal year ending June 80, 1971; $3,000,000 for the fiscal year ending June 30, 1972; and $4,000,000 for the fiscal year ending June 30, 1973. "RESEARCH GRANTS AND CONTRACTS "SEC. 1004. (a) In order to promote research in the biomedical, con- traceptive development, behavioral, and program implementation fields related to family planning and population, the Secretary is authorized to make grants to public or nonprofit private entities and to enter into contracts with public or private entities and individuals for projects for research and research training in such fields. Appropriation. "(b) For the purpose of making payments pursuant to grants and contracts under this section, there are authorized to be appropriated $30,000,000 for the fiscal year ending June 30, 1971; $50,000,000 for the fiscal year ending June 30, 1972; and $65,000,000 for the fiscal year ending June 30, 1978. "INFORMATIONAL AND EDUCATIONAL MATERIALS "SEC. 1005. (a) The Secretary is authorized to make grants to public or nonprofit private entities and to enter into contracts with public or private entities and individuals to assist in developing and making available family planning and population growth information (including educational materials) to all persons desiring such infor- mation (or materials). Appropriation. "(b) For the purpose of making payments pursuant to grants and contracts under this section, there are authorized to be appropriated $750,000 for the fiscal year ending June 80, 1971; $1,000,000 for the fiscal year ending June 30, 1972; and $1,250,000 for the fiscal year ending June 30, 1978. "REGULATIONS AND PAYMENTS "SEC. 1006. (a) Grants and contracts made under this title shall be made in accordance with such regulations as the Secretary may promulgate. "(b) Grants under this title shall be payable in such installments and subject to such conditions as the Secretary may determine to be appro- priate to assure that such grants will be effectively utilized for the purposes for which made. '(c) A grant may be made or contract entered into under section 1001 or 1002 for a family planning service project or program only upon assurances satisfactory to the Secretary that- "(1) priority will be given in such project or program to the furnishing of such services to persons from low-income families; and December 24, 1970 - 5 - Pub. Law 91-572 84 STAT, 1508 "(2) no charge will be made in such project or program for services provided to any person from a low-income family except to the extent that payment will be made by a third party (includ- ing a government agency) which is authorized or is under legal obligation to pay such charge. For purposes of this subsection, the term 'low-income family' shall be "Low-income defined by the Secretary in accordance with such criteria as he may family." prescribe. "VOLUNTARY PARTICIPATION "SEO. 1007. The acceptance by any individual of family planning services or family planning or population growth information (in- cluding educational materials) provided through financial assistance under this title (whether by grant or contract) shall be voluntary and shall not be a prerequisite to eligibility for or receipt of any other service or assistance from, or to participation in, any other program of the entity or individual that provided such service or information. "PROHIBITION OF ABORTION "SEC. 1008. None of the funds appropriated under this title shall be used in programs where abortion is a method of family planning." Approved December 24, 1970. LEGISLATIVE HISTORY: HOUSE REPORTS: No. 91-1472 accompanying H.R. 19318 (Comm. on Interstate and Foreign Commerce) and No. 91-1667 (Comm. of Conference). SENATE REPORT No. 91-1004 (Comm. on Labor and Public Welfare). CONGRESSIONAL RECORD, Vol. 116 (1970): July 14, considered and passed Senate. Nov. 16, considered and passed House, amended, in lieu of H.R. 19318. Dec. 8, House agreed to conference report. Dec. 10, Senate agreed to conference report. GPO 48-139 FAMILY PLANNING PROGRAM--Title X HISTORY TABLE Fiscal Year Appropriation 1971 $6,000,000 1972 61,815,000 1973 100,615,000 1974 100,615,000 1975 100,615,000 1976 100,615,000 1977 113,000,000 1978 135,000,000 1979 135,000,000 1980 162,000,000 1981 161,671,000 1982 124,176,000 1983 124,088,000 1984 140,000,000 1985 142,500,000 1986 136,372,000 1987 142,500,000 1988 139,663,000 1989 138,320,000 1990 139,135,000 1991 144,311,000 1992 149,585,000 1993 173,418,000 1994 180,918,000 1995 193,349,000 1996 192,592,000 1997 198,452,000 1998 203,452,000 1999 215,000,000 2000 Estimate 239,952,000 $10 M above passback Family Planning Funding History 250,000,000 200,000,000 Dollars 150,000,000 100,000,000 50,000,000 0 1971 1978 1985 1992 1999 Fiscal Years Title X- Family Planning FY 1995--FY 1998 Funding Distribution Categories 1995 1996 1997 1998 Services 180,156,000 178,272,000 182,264,000 186,348,750 Training 4,920,680 5,752,952 5,666,000 5,164,088 Research 2,788,067 2,684,075 2,670,654 2,677,338 Male Initiative Projects 0 0 1,935,346 2,539,662 Information and Education 357,000 180,000 303,000 289,270 Evaluation and Assessments 903,000 1,560,000 1,408,000 2,172,884 Secretary's Transfer 0 0 0 (526,185) Program Management 4,224,253 4,142,973 4,205,000 4,260,008 Total Title X 193,349,000 192,592,000 198,452,000 202,925,815 Secretary's Transfer Add Back 526,185 Total Title X Appro 193,349,000 192,592,000 198,452,000 203,452,000 Family Planning Funds Distribution FY 1998 Program Mgmt (2.10%) Secretary's Transfer (0.26%) Eval/Assessment (1.00%) Info/Education (0.14%) Male Initiative Projects (1.24%) Research (1.37%) Training (2.53%) Services (91.35%) EXECUTIVE OFFICE OF THE PRESIDENT LRM NO: 2250 OFFICE OF MANAGEMENT AND BUDGET Washington, D.C. 20503-0001 FILE NO: 982 8/7/95 LEGISLATIVE REFERRAL MEMORANDUM Total Page(s): 10 FROM: Janet FORSGREN TO: Legislative Liaison Officer . See Distribution Bellici bolow: (for) Assistant Director for Legislative Reference OMB CONTACT: Robert PELLICCI 395-4871 Legislative Assistant's line (for simple responses): 395-7302 SUBJECT: HHS Proposed Testimony on the title X family planning program URGENT DEADLINE: 10:00 a.m. Wedncsday, August 09,1995 In accordance with OMB Circular A-19, OMB requests the views of your agency on the above subject before advising on its relationship to the program of the President. Please advise us if this item will affect direct spending or receipts for purposes of the "Pay-As-You-Go" provisions of Title XIII of the Omnibus Budget Reconciliation Act of 1990. COMMENTS: I learing is before the Senate Appropriations Subcommittee on Labor, Health and Human Services. and Education on Thursday, August 10th. HHS Secretary Shalala is 1110 witness. URGENT AGENCIES: EOP: 217-JUSTICE - Andrew Fois . (202) 514-2141 Nancy-Ann Min 429-National Economic Council . Sonyis Matthews - (202) 456-2174 Martha Foley 257-Officc of National Drug Control Policy . John Carnevale - (202) 395-0736 Melanne Verveer Palsy Fleming James Castello Jennifer Klein Janet Murgula Diana Fortuna Barbara Chow Barry Ciendenin Richard Turman Bob Damus Nani Coloretti Beth Rossman Martha Cagne Allison Eydt Mark Miller Lydia Muniz Jim Murr Janet Forsgren AUG 07'95 20:52 No 007 P.01 RESPONSE TO LRM NO: 2250 LEGISLATIVE REFERRAL MEMORANDUM FILE NO: 982 If your response to this request for views is simple (e.g., concur/no comment), we prefer that you respond by e-mail or by faxing us this response shoot. If the response is simple and you prefer to call, please call the branch-wide line shown below (NOT the analyst's line) to leave a message with a legislative assistant. You may also respond by: (1) calling the analyst/attorney's direct line (you will be connected to voice mail if the analyst does not answer); or (2) sending us a memo or letter. Please include the LRM number shown above, and the subject shown below. TO: Robert PELLICCI 395-4871 Office of Management and Budget Fax Number: 395-6148 Branch-Wide Line (to reach legislative assistant): 395-7362 FROM: (Dato) (Name) (Agency) (Telephone) SUBJECT: HHS Proposed Testimony on the title X family planning program The following is the response of our agency to your request for views on the above-captioned subject: Concur No Objection No Comment See proposed edits on pages Other: FAX RETURN of pages, attached to this response sheet 20:52 No.007 P.02 $6.20 DUG 8719-S6-:I SENI 7021 1 0- 1-30 I 4.50PM 4 1 Testimony Donna B. shalala Secretary of Health and Human Services at Title X Hearing August 10, 1995 Good morning, Mr. Chairman and members of the Subcommittee. Twenty-five years ago, when the Title X Family Planning Program was created with strong bipartisan support, Senator said, "....." That's more important than ever today. When we talk about the federal government's only program dedicated to family planning, we need to separate fiction from fact. There are some who want Americans to believe that Title X family planning dollars go to abortion services. Nothing could be further from the truth. Since the program was enacted in 1970, no Title X money has ever been used to pay for abortions. Not one cent. 7 AUG 07'95 20:53 No .007 P.03 819-6-0:0I The $193 million that we are spending on Title X in 1995 will provide a range of family planning and preventive health services to over 4 million women and men in more than 4,000 clinics in every Congressional district. It provides educational materials to hundreds of community groups and religious organizations across the country to help young people say "no" to sex. And, it helps train 250 Certified Family Planning Nurse Practitioners each year. When we talk about Title X, we must look at the human faces -- the 4 million faces -- behind the issue. These woman are our mothers and daughters, our neighbors and our friends. They are: A recent high school graduate in Philadelphia -- who needs a job and independence, not a child and dependence. A 30 year-old store clerk in Des Moines -- who doesn't have health insurance and can't qualify for Medicaid. 2 - 20:53 No.007 P.04 $6.20 AUG SENT By:xerox lelecopier 7021 ; 8- 7-85 ; 4:40PM : 833301401# 00000 4 A 40 year-old mother of two in Greenville -- who depends upon a Title X clinic for her annual gynecologic check-ups. These women all have something in common: They may be just one unintended pregnancy away from poverty, unemployment, and welfare. Some people say that we can't afford to spend our resources on family planning. I say we can't afford not to. For every dollar we spend on family planning we save more than $4 in medical care, welfare benefits, and other social services. That's what I call a good investment. Unfortunately, the House Appropriations Committee disagreed. They voted to abolich this program and fold it into the Maternal and Child Health (MCII) block grant and the community and migrant health centers program. I was pleased that the majority of the House recognized that plan for what it was: a big mistake. 3 20:54 No.007 P.05 $6.20 SENT relecopier 1021 I o- 7-95 1 4.40PM It's a big mistake to force Title X clinics -- sometimes the only provider in a community -- to shut their doors and turn off their lights. It's a big mistake to dismantle our family planning eystem and send the message that we don't care about clinics that provide low-income women with preventative health care. And, it's a mistake to take us down a dangerous road leading to: More abortions. More women and children living in poverty and on welfare; More unintended pregnancies. Migher rates of infant mortality; And, more women living without the security of critical preventive care, like pap smears, mammograms, and screening for STDs. We don't need to turn back the clocks on women's health. 4 20:54 No.007 P.06 $6.20 GUG 8719-S6-0:0I SENT BY:Xerox lelecopier 7021 5- 7-95 4.41PM We need a much different approach. Together, we must maintain our bipartisan commitment to the women of America, while still giving states the flexibility they need to prioritize their resources and provide services at the local level. And, that's just what we're accomplishing with this family planning program. We're operating in the pro-family tradition by working to ensure that every pregnancy and every child is wanted. In the days ahead, all us will need to keep reiterating what Title X is -- and what it is not. It is not -- nor has it ever been -- about funding abortions. It is not about increasing teen pregnancy or encouraging teen sexual activity. Family planning is about preventing unintended pregnancies, decreasing abortions, lowering infant mortality rates, and improving the health of women and their children. 5 20'd 200' ON 20:55 $6.20 GUG SENI BT-XOΓOX 1010COD197 7021 0- card 4:4:PM It's about ensuring that every pregnancy is a planned one, and that all children are born into the loving and supportive families they need not just to survive -- but to thrive. That is our collective challenge. Mr. Chairman, this is a great country because it is a good country. We are good to our people -- and we don't play politics with their lives and their futures. Almost 80 years ago, Margaret Sanger opened a birth control clinic in an extremely poor slum in Brooklyn. Women lined up outside the olinic to receive services, and by the end of nine days, they had seen 464 women. Shortly after the clinic opened, Margaret Sanger and her two assistants were arrested -- and all their supplies and files were confiscated. Today, we must ask ourselves whether we want to travel back to those days of darkness. 6 80°d 200' ON 20:55 $6.20 AUG 819-6-: JEIN 1021 0- can 4.42PM 00000140,0 9 Do we want to go back to the days when poor women got back alley abortions because they couldn't afford birth control? Do we want to go back to the days when women were not given the tools they needed to control their lives? Do we want to go back to the days when the health care needs of 52 percent of the population were considered a "controversial issue?" And, do we want to go back to the days when we punished innocent children by making a woman's access to birth control dependent upon the size of her wallet? We cannot -- and we must not. Mr. Chairman, Title X is -- and has always been -- a bipartisan program -- a distinctly American program. It saves precious resources -- and precious lives. It empowers men and women to take personal responsibility for their health and their families. And, it helps us stop the epidemic of unintended pregnancies by preventing them before they happen. 7 20:55 No.007 P.09 $6.20 9NH 819-S6-0:I 1021 1-02 1 4:46PM 00000 g Mr. Chairman, I urge you and members of the Subcommittee to continue support for the Title X family planning program as a strong and separate public health service program. The future of millions of men, women and children hang in the balance. Thank you for giving me this opportunity to testify. I would be happy to answer any questions at this time. 8 1 AUG 07'95 20:56 No.007 P.10 819-S6-:I Clinton Presidential Records Digital Records Marker This is not a presidential record. This is used as an administrative marker by the William J. Clinton Presidential Library Staff. This marker identifies the place of a publication. Publications have not been scanned in their entirety for the purpose of digitization. To see the full publication please search online or visit the Clinton Presidential Library's Research Room. The ISSUES Alan Guttmacher Institute New York and Washington in A Not-for-Profit Corporation for Reproductive Health Research, Policy Analysis and Public Education 120 Wall Street BRIEF New York, NY 10005 Telephone: 212 248-1111 FAX: 212 248-1951 1120 Connecticut Avenue, NW Suite 460 Washington, DC 20036 Telephone: 202 296-4012 FAX: 202 223-5756 U.S. Support for Family Planning The Origins and Principles Overseas: The Program and the Politics Of U.S. Population Policy Governmental emphasis on family plan- As the 21st century approaches, U.S. for- Over the last three decades, a world- ning arose at a time of rising concern eign aid is undergoing radical change. wide consensus has gradually emerged, about the environment, poverty allevia- Its size is being dramatically reduced embraced by poor and wealthy countries tion and the rights of women -- and con- and its purposes sharply narrowed. Al- alike, that population stabilization is current technological advances, most though the large majority of Americans critical to a key set of inter-related goals: notably the advent of the birth control pill supports assistance to developing coun- promoting democracy and enhancing po- and the IUD in the early 1960s. In 1967, tries on humanitarian grounds, the dwin- litical stability; alleviating poverty and as Congress was requiring for the first time dling U.S. budget for development as- facilitating economic growth; and pro- that family planning services be made sistance increasingly will need to be jus- tecting the global environment. Further, available on a voluntary basis to poor tified on strategic grounds or by the eco- progress during this period has indeed women in the United States, it also added nomic benefit that aid returns to the been made in lowering birth rates and im- Section 104 to the Foreign Assistance Act United States. Since international popu- proving women's status -- and these years of 1961 to specify that funds be allocated lation assistance remains a large com- of experience are pointing the way toward to increase "opportunities and motivation ponent of overall development assis- future progress. for family planning and to reduce the rate tance, it too must prove its value, effec- This Issues in Brief outlines the of population growth." tiveness and continued reason for be- international population assistance While demographic concerns were ing. Perhaps more than any other aspect program. It examines the program's a driving force in creating the U.S. popu- of U.S. foreign aid, however, population policy origins and how its structure and lation assistance program, the authoriz- assistance has been subjected to this priorities are evolving in relation to the ing statute also stressed that "good level of scrutiny from its beginnings. consensus of world governments ratified health conditions are a principal element A woman's ability to control her at the 1994 United Nations Interna- in improved quality of life and contribute fertility has implications not only for tional Conference on Population and to the individual's capacity to participate herself and her family but globally as Development and amplified at the 1995 in the development process, while poor well. In recognition of this fact, the U.S. Fourth World Conference on Women. It health and debilitating disease can limit government initiated its population assis- discusses the impact the program has productivity." Further, the statute called tance program almost 30 years ago. At had over the years relative to critical for coordination of population planning the time, the United States was one of only U.S. economic and foreign policy goals. efforts with other programs aimed at "re- a handful of nations in the world to assert Finally, it describes the unique and un- ducing the infant mortality rate, provid- leadership in this area. Even in those precedented public policy challenges ing better nutrition for pregnant women quarters where the problems associated the program is confronting as the scope and infants, and raising the standard of with rapid population growth and un- and fundamental tenets of U.S. foreign living for the poor." wanted childbearing were acknowledged, assistance are being called into ques- The formal launching of the pro- most were skeptical that anything could tion, and as a target of the antiabortion gram was quickly followed by its real be done to ameliorate the situation. movement and Christian right. political send-off when President Nixon, Issues in Brief September 1995 The Alan Guttmacher Institute Clinton Presidential Records Digital Records Marker This is not a presidential record. This is used as an administrative marker by the William J. Clinton Presidential Library Staff. This marker identifies the place of a publication. Publications have not been scanned in their entirety for the purpose of digitization. To see the full publication please search online or visit the Clinton Presidential Library's Research Room. The ISSUES Alan Guttmacher Institute New York and Washington in A Not-for-Profit Corporation for Reproductive Health Research, Policy Analysis and Public Education 120 Wall Street BRIEF New York, NY 10005 Telephone: 212 248-1111 FAX: 212 248-1951 1120 Connecticut Avenue, NW Suite 460 Washington, DC 20036 Telephone: 202 296-4012 FAX: 202 223-5756 The U.S. Family Planning Program amended a number of federal laws to al- Faces Challenges and Change low family planning services to be pro- vided under certain existing programs. Although a woman's reproductive years This Issues in Brief describes the In 1965, as part of the so-called War on span half of her lifetime, the typical current structure and funding of the na- Poverty, federal funds were made avail- American woman today wants only two tional family planning program, and the able for family planning through the children -- a goal that is unrealistic with- reproductive health and other preventive Office of Economic Opportunity. In out the use of contraception. In 1990, services it provides. It examines the im- 1967, Title IV-A of the Social Security approximately 30.5 million women were pact of the program on the prevention Act was amended to require state wel- considered to be at risk of unintended of unintended pregnancies, births and fare agencies to offer and provide fam- pregnancy (that is, they were sexually abortions as well as on the reduction of ily planning services to women receiv- active and fertile, but were neither preg- low birth weight and infant mortality. It ing public assistance. nant nor desiring pregnancy); over 15 also discusses the central role that Title Then, in 1970, with broad biparti- million were low-income women and X of the Public Health Service Act, the san support, legislation establishing Title teenagers in need of subsidized contra- historic core of the federal effort, plays X of the Public Health Service Act was ceptive services. The nation's organized in determining the shape and substance enacted and signed into law by President family planning program was estab- of the national family planning service Richard Nixon, creating for the first time lished to address their needs. delivery system. a comprehensive federal program de- One in three women who made a voted entirely to the provision of family family planning visit in 1988 -- the last planning services on a national basis. In year for which comprehensive data are Overview his Message on Population Growth and available reported going to a publicly History. Studies conducted during the the American Future, delivered the pre- funded family planning clinic. These 1960s showed that rates of unwanted ceding year, President Nixon declared clinics complement the private health childbearing among low-income women that "no American woman should be de- care system in several ways: They serve were at least twice as high as those nied access to family planning assistance Medicaid-eligible women when other among the more affluent -- a phenom- because of her economic condition. I providers refuse to accept them; provide enon that could be traced in large part to believe, therefore, that we should estab- subsidized services to low-income inequalities in access to family planning lish as a national goal the provision of women who are not eligible for Medi- services. By the end of the decade, a family planning services to all who caid; offer more extensive counseling on sizeable, bipartisan consensus had want but cannot afford them." contraceptive methods; provide confi- emerged favoring government support of Following the enactment of Title dential services for teenagers and other voluntary family planning programs as X, public expenditures for family plan- women who may not be able to discuss a means of expanding economic devel- ning grew rapidly in the early 1970s, as reproductive health issues with their opment, alleviating poverty, avoiding the clinics Title X helped to create be- regular physicians; and offer contracep- welfare dependency and improving the came established across the country. By tive supplies at a lower cost than is health of women and their families. fiscal year 1983, $340 million in public usually available elsewhere. In the meantime, Congress had federal and state -- funds were being Issues in Brief -- June 1995 The Alan Guttmacher Institute