Election-year session has Congress in spotlight
By Lisa Kaeser, JD
The Alan Guttmacher Institute
Washington, DC
Congress returned at the end of January to face an election-year session. While most issues relating to family planning and reproductive health were resolved temporarily at the end of 1997, the most contentious of them are likely to be revisited this year.
There have been so many controversies surrounding the Title X family planning program in recent years that many people who do not follow the legislative scene on a daily basis find it hard to keep track of them. After their attempt to defund the program outright three years ago in the U.S. House of Representatives, opponents of family planning services over the last two years have focused their efforts on restricting services to adolescents. Those efforts also have been defeated, but by narrower margins.
Congressmen pledge to attack Title X
This year, Reps. Ernest Istook (R-OK) and Don Manzullo (R-IL) have pledged to renew their attacks on Title X, probably in the guise of amendments that require parents to be informed about, or give prior consent to, their daughters’ or sons’ receipt of family planning services. Among other points, they maintain that family planning providers do not adequately comply with state laws regarding statutory rape and other reporting requirements. If successful, such an amendment would fly in the face of accepted medical practice and the policies of all major medical and health organizations as a violation of every patient’s including teens’ right to receive confidential services.
On the fiscal year 1998 appropriations legislation last year, the House accepted, in place of the Istook/Manzullo amendment, language stating that family planning programs funded by Title X had to certify to the secretary of the Department of Health and Human Services that they encouraged parental involvement and that adolescents receiving services receive information about how to avoid coercive sexual activity.
If a similar amendment or some variation arises again this year, family planning advocates will be hard pressed to find new language that will address concerns about adolescents without compromising the integrity of confidential family planning services.
Although funding for international family planning programs survived by a hair last year, the political fallout is likely to be considerable. Funding for fiscal year 1998 is set at a decreased level of $385 million, to be meted out on a monthly basis a procedure that causes real hardship to program operations. On the other hand, the so-called "Mexico City" policy was not imposed; in countries where it is legal, family planning programs will be able to continue providing information about abortion to clients who request it.
A high-stakes game
To achieve this victory, however, the Clinton administration paid a heavy price on other international policy matters: Congress chose not to fund back payments to the United Nations (just as delicate negotiations with Iraq were taking place), nor the International Monetary Fund bailout. This high-stakes game, which is likely to be repeated in some form early this year, shows the depth of the determination of anti-family planning members of Congress. The fact that the Republican leadership remains willing to stand behind their demands is highly disturbing.
In 1996, the key issue on passage of the Ryan White AIDS reauthorization legislation concerned mandatory testing for HIV. This year, as Congress considers reauthorization of the Atlanta-based Centers for Disease Control and Prevention (CDC), a central debate will occur on whether there should be mandatory reporting of HIV cases, and if so, what information should be included (such as names or other identifiers).
While conservatives have been arguing for years that all people with HIV should be reported to state officials, similar to procedures long in place for other sexually transmitted diseases, many health care professionals have regarded HIV/AIDS differently. These professionals say people with HIV would be discrim-inated against and argue that there are other, non-identifying ways to collect the same information.
Recently, the CDC has been recommending cautiously that states require people with HIV be reported to state health departments. The debate over this complex sensitive issue is likely to be heated. At this time, it is unclear whether issues relating to other sexually transmitted diseases also will be raised.
Access to coverage information
In November, President Clinton’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry issued a draft version of a Consumer Bill of Rights and Responsibilities, the product of input from consumers, providers, and employers. The draft bill makes clear that patients should have complete information about their plan’s coverage and how to access it.
Plans also should offer sufficient numbers of providers available to make that coverage meaningful. The draft also specifically states that women should have direct access to obstetrician/gynecologists for routine preventive care.
None of the major reforms proposed last year passed, so in all likelihood, they will reappear this year. Sen. Jim Jeffords (R-VT), who is chairman of the Senate Labor and Human Resources Committee, probably will introduce a bill based on the advisory panel’s recommendations.
In addition, look for the revival of legislation calling for all health care plans that cover prescription drugs and devices to include contraceptive methods. This measure received a large number of cosponsors last year and likely will be a major agenda item for family planning supporters in 1998.
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