Following their unsuccessful attempt to repeal the Patient Protection and Affordable Care Act (P.L. 111–148), commonly referred to as health care reform legislation, Republicans in the House of Representatives have set out to dismantle it piece-by-piece. They started by introducing “five pieces of legislation that would repeal mandatory spending created” by health care reform.[1] If enacted, these measures—H.R. 1213–1217, et seq.—would eliminate the Prevention and Public Health Fund and funding to states to enable them to establish the health insurance exchanges that are a key component of health care reform. Additionally, these measures would convert mandatory funding for construction of school-based health centers and establishing “new accredited or expanded primary care residency programs in teaching health centers” into discretionary funding, so the current annual funding amounts mandated by the legislation would be nullified and funding for these programs would instead be set by Congress each year.[2]

 

H.R. 1215, introduced by Congressman Bob Latta (R-OH), similarly would convert to discretionary funding the $75 million allocated annually for the Personal Responsibility Education Program (PREP). PREP is the first-ever federal funding stream dedicated to providing young people with more comprehensive approaches to sex education for the prevention of unintended pregnancy, HIV, and other sexually transmitted diseases (STDs). The program was funded for Fiscal Years 2010–2014. The largest portion of PREP is a $55 million state-grant program that provides grants for medically accurate, evidence-based comprehensive sexuality education that provides information about both abstinence and contraception, with substantial emphasis placed on both.

 

Programs funded by PREP state-grant funds also must address other vital adulthood preparation topics such as healthy relationships, adolescent development, parent-child communication, financial literacy, educational and career success, and healthy life skills “such as goal-setting, decision making, negotiation, communication and interpersonal skills, and stress management.”[3] States have the discretion whether or not to apply for PREP funding and the response from states has been overwhelmingly positive: 43 states, the District of Columbia, the Federated States of Micronesia, and Puerto Rico applied for PREP in its first year and two additional states have already indicated they intend to apply for the program’s second year. For states that do not apply for PREP within its first two years, organizations located in those states will be able to apply for their state’s share of PREP funding for the remaining three years of the program.

 

Each year, PREP also includes $10 million in funding for innovative approaches, $3.5 million for tribes and tribal organizations, and funding for evaluation and technical assistance. H.R. 1215 also would rescind any funds currently allocated that have not yet been distributed. This means that the $6.5 million for tribes and tribal organizations for Fiscal Years 2010 and 2011 that has yet to be awarded would be rescinded. In addition, funds that state organizations could apply for (if their state did not apply for PREP) would no longer exist.

 

If enacted, H.R. 1215 would subject PREP to the politically charged annual appropriations process. Given House Republicans’ rush to slash funding for domestic programs related to sexual and reproductive health (including the Teen Pregnancy Prevention Initiative) that was evident in their draconian budget proposals for Fiscal Years 2011 and 2012, as well as the intent to bring the culture wars back to the halls of Congress that they displayed in their efforts to eliminate funding for the Title X family planning program and Planned Parenthood, it is probable that, given the opportunity, they would eliminate funding for PREP.

 

To justify their proposition to effectively eliminate PREP funding, House Republicans claimed that the program “appears to duplicate existing government programs” totaling nearly $2 billion that are aimed at young people. While the federal government does provide support for the overall well-being of adolescents through a handful of funding streams, PREP is the only state-grant program that provides funding for effective approaches to prevent unintended pregnancy, HIV, and other STDs among young people by providing information about abstinence, contraception, and other adulthood preparation subjects.[4] For example, proponents of H.R. 1215 allege that PREP is duplicative of the Effective Teaching and Learning for a Well-Rounded Education program, a competitive grant program administered by the Department of Education “to develop and expand innovative practices to improve teaching and learning in the arts, foreign languages, civics and government, history, geography, economics and financial literacy.”[5] While the element of financial literacy does indeed overlap, the Effective Teaching and Learning program does not mention any element of comprehensive sexuality education or have that as a goal. Many of the programs that Representative Latta claims are duplicative address clinical and related services (such as the Title X family planning program or the Maternal and Child Health Block Grants) or funds toward capacity building (such as Promise Neighborhoods, Promoting Safe and Stable Families, or the Minority AIDS Initiative) that do not provide sex education at all. What makes PREP distinct from all of these programs is that it aims to target the broader spectrum of adolescents with comprehensive sexuality education.

 

Despite their purported desire to cut unnecessary government spending and their clear intent to attempt to eliminate any program associated with health care reform, House Republicans left intact mandatory funding for the Title V abstinence-only-until-marriage program that Congress had allowed to expire on June 30, 2009, but resurrected in health care reform. The program is funded at $50 million for Fiscal Years 2010–2014. The federal government’s own study showed that the ideologically driven programs “had no beneficial impact on young people’s sexual behavior.”[6] The “misguided, deeply divisive, and unabashedly hypocritical” nature of H.R. 1215 was not lost on Democrats on the House Energy and Commerce Committee, which considered and ultimately approved the bill in hearings at both the subcommittee (15–11) and committee (25–17) levels. In those hearings, as well as the Committee Report accompanying H.R. 1215, Democrats who support PREP rebuked their adversaries who have claimed that “their opposition centers on PREP’s being supported through mandatory spending” yet

 

reject[ed] an amendment offered during the full Committee mark up to terminate mandatory spending for the Title V abstinence-only-until-married program, choosing instead to maintain mandatory spending for a program that has been shown not to work while ending mandatory spending for a program that has proven it clearly does. [Republicans on the Energy and Commerce Committee] also rejected an amendment to treat both programs the same in terms of their funding mechanism. Moreover, Republicans had no answer when asked how they could justify these positions given their staunch objection to mandatory funding as a matter of principal [sic]—opposing mandatory spending not necessarily because of the substance of a program, but because of the stated belief that mandatory spending usurps Congress’s prerogative to fund or not to fund health programs.[7]

           

Finally, Energy and Commerce Committee Democrats concluded that “Republicans cannot have it both ways—they must either vote consistently and every time to end mandatory spending for federal programs or they must acknowledge that in some instances, it is, in fact, appropriate and necessary.”[8]

 

“SIECUS is deeply grateful to the numerous Democrats on the House Energy and Commerce Committee who have expressed strong support for the Personal Responsibility Education Program and called out the Republicans’ hypocrisy in not attacking the ineffective Title V abstinence-only program,” comments Jen Heitel Yakush, director of public policy at the Sexuality Information and Education Council of the United States. “We are disappointed with House Republicans for attacking an evidence-based program that has the overwhelming support of nearly all states across the country, regardless of the political affiliation of their governors and legislatures. We hope that reason and evidence will triumph over ideology, that the Senate will stop this bill in its tracks if it advances out of the House of Representatives, and that President Obama will veto this measure if it ever makes its way to his desk.”

 

H.R. 1215 is expected to come to the House floor for a vote in the coming weeks.

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