THE FINAL COUNTDOWN THE LAST YEAR OF THE BUSH ADMINISTRATION Federal Legislative and Regulatory Action on Reproductive Health in 2008 The Final Countdown: The last year of the Bush Administration Federal Legislative and Regulatory Action on Reproductive Health in 2008 This publication is made possible with the generous support of the Robert Sterling Clark Foundation. Table of Contents I. Executive Summary ............................................................ 5 II. Issue Summaries ................................................................. 6 a. Title X Family Planning ................................................................... 6 i. Fiscal Year 2009 Appropriations ........................................... 6 ii. New Research on the Impact of Family Planning ...................... 7 iii. DASPA Resignation ............................................................. 9 b. Preventing Unintended Pregnancy ................................................. 10 i. The Prevention First Act ...................................................... 10 ii. Other Federal Legislation ................................................... 10 c. The War on Contraception ........................................................... 11 i. HHS Provider Refusal Regulations ........................................ 11 ii. Pharmacy Refusals ............................................................ 13 d. Contraceptive Use and Access ...................................................... 14 i. States Take Action on Contraceptive Access .......................... 14 ii. New Research on Contraceptive Use and Access .................. 14 e. Medicaid-Funded Family Planning Services ................................... 17 i. Expanding Eligibility for Family Planning Services Under Medicaid ...................................... 17 ii. Bush Administration Issues Harmful Medicaid Rules ................. 17 iii. State Action on Medicaid-Funded Family Planning Services ...... 17 f. Abstinence-Only Programs ........................................................... 19 i. Historic Hearing on Abstinence Programs.............................. 19 ii. State Refusal of Federal Funds ............................................. 19 iii. Studies on Abstinence-Only Programs and Teen Sexuality ......... 19 Table of Contents g. Access to Abortion Care .............................................................. 21 i. Federal Action ................................................................. 21 ii. State Legislation and Ballot Initiatives .................................... 22 iii. Product Safety ................................................................. 22 iv. “Abortion” Barred in Public Health Database ......................... 22 v. Reproductive Health: Breast and Cervical Cancer .................. 23 vi. State Action .................................................................... 23 vii. New Studies on Breast and Cervical Cancer ......................... 23 h. Food & Drug Administration (FDA) Actions ................................... 24 i. HPV Vaccines .................................................................. 24 ii. Continued Controversy on Safety of the Contraceptive Patch ................................................. 25 iii. Rule on Condom Labeling in Line with Scientific Evidence on STIs ........................................... 25 iv. Marketing Issues .............................................................. 25 i. Centers for Disease Control and Prevention (CDC) ......................... 27 i. CDC Data Highlights Changes in STIs, HIV, and Teen Pregnancy ................................................... 27 j. International Family Planning ....................................................... 28 i. PEPFAR Reauthorization ..................................................... 28 ii. USAID Bars a Family Planning Organization from Getting Contraceptives ............................................... 28 iii. New Research in HIV/AIDS ............................................... 28 III. Legislative Outlook for 2009 and Beyond ......................... 29 About NFPRHA ........................................................................................ 31 Executive Summary Making policy in an election year is never easy, and this year The election of Senator Barack Obama as the 44th President of was no exception. With all eyes focused on the race for the the United States, however, offers reproductive rights advocates White House, congressional action on major issues, including hope that the new year will bring family planning and repro- appropriations, largely ground to a halt. The pending end of ductive health to the forefront of federal policy and the nation’s the Bush Administration, however, did not mean an end to consciousness. During the campaign, President-elect Obama Executive Branch attacks on family planning – before year’s end put the issue of unintended pregnancy center-stage, signaling the outgoing Administration launched one final salvo in its War an important shift in the debate over reproductive health, away on Contraception with the issuance of new regulations designed from the rhetoric of abortion and toward the common-ground, to undermine access to contraception. common-sense solution that family planning represents. Obama said: As anticipated, the appropriations process ended in a continuing resolution which funds the vast majority of non-security-related “Surely there is some common ground when both those government programs at their Fiscal Year 2008 levels until March who believe in choice and those who are opposed to 6, 2009. Under the stopgap spending package, which passed in abortion can come together and say, we should try to late Sep tember, Title X was flat-funded at $300 mil lion, while prevent unintended pregnancies. .” the ineffective and dangerous Community-Based Abstinence Education (CBAE) program continues to receive critical tax As we continue to work along with our national partners in the dollars totaling $113 million. reproductive health community and a broad-based coalition of groups to undo the damage done by the Bush Administration, The Bush Administration spent much of the year approving we also look forward to moving forward a proactive family plan- new rules from nearly twenty agencies on a range of topics ning agenda with the help of the new Obama Administration largely favoring business and embodying conservative ideology. and one of the largest pro-family planning congressional majori- NFPRHA and our allies spent months fighting a dangerous rule ties in history. We are hopeful that the coming years will bring allowing providers to refuse to provide basic health care services great gains in reproductive health, and that the goal of ensuring to patients at federally funded health care entities, which could access to quality, comprehensive family planning services for all jeopardize access to contraceptives for millions of men and those who need them is not far from becoming a reality. women. When the Department of Health and Human Services announced the proposed provider refusal regulations in August, NFPRHA immediately moved to stop this assault on family planning. Despite intense opposition from states, organizations, individuals, and even the Equal Employment Opportunity Commission (EEOC), the Bush Administration published the final version of the HHS regulation in December. National Family Planning THE FINAL COUNTDOWN: THE LAST YEAR OF THE BUSH Administration & Reproductive Health Association Federal Legislative and Regulatory Action on Reproductive Health in 2008 5 Title X Family Planning Fiscal Year 2009 Appropriations Congressional Budget On March 5, congressional leaders unveiled their own budget The President’s Budget plans. The FY 2009 House budget resolution called for $57.559 billion for health-related discretionary spending, an increase of President Bush set the tone for the budget battle by vowing to $4.438 billion (8.4 percent) over FY 2008. The Senate budget veto all appropriations bills not containing spending cuts. In his resolution called for an even larger increase - $58.908 billion for State of the Union address in January 2008 the President pledged health spending, which is $5.27 billion (9.8 percent) over FY “to veto any appropriations bill Congress sends him that does not 2008. Any increase for health-related spending under the budget cut the number and cost of earmarks in half.” resolution translates to a higher allocation for the Labor, Health and Human Services and Education (Labor-HHS) appropria- President Bush then released his Fiscal Year 2009 budget tions subcommittee, a necessary ingredient for any increased which funded Title X at the FY 2008 level of $300 million. appropriation for Title X. As predicted, the President’s budget did not include increased funding for Title X, continuing to ignore the needs of millions Work on the twelve annual appropriations bills, including of women and men without access to comprehensive family Labor-HHS, was delayed in light of controversy surrounding a planning services. supple mental spending package to fund military action in Iraq and Afghanistan. In June, the House and Senate Appropria tions Mary Jane Gallagher, President and CEO of NFPRHA, Committees finally approved what are known as the “302(b) reminded budget negotiators about the dire need for additional allocations,” which set the total amount of money that each Title X funding after decades of stagnant appropriations. subcommittee