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Thursday, June 30, 2011

Abortion and Family Planning-Related Provisions in U.S. Foreign Assistance Legislation and Policy


Luisa Blanchfield
Specialist in International Relations

This report details legislation and policies that restrict or place requirements on U.S. funding of abortion or family planning activities abroad. The level and extent of federal funding for these activities is an ongoing and controversial issue in U.S. foreign assistance and will likely continue to be a point of contention during the 112th Congress.

These issues have been debated for over three decades in the context of a broader domestic abortion controversy that began with the Supreme Court’s 1973 ruling in Roe v. Wade, which holds that the Constitution protects a woman’s decision to terminate her pregnancy. Since Roe, Congress has enacted foreign assistance legislation placing restrictions or requirements on the federal funding of abortions and on family planning activities abroad. Many of these provisions, often referred to by the name of the lawmakers that introduced them, have been included in foreign aid authorizations, appropriations, or both, and affect different types of foreign assistance. Examples include: 

  • the “Helms amendment,” which prohibits the use of U.S. funds to perform abortions or to coerce individuals to practice abortions; 
  • the “Biden amendment,” which states that U.S. funds may not be used for biomedical research related to abortion or involuntary sterilization; 
  • the “Siljander amendment,” which prohibits U.S. funds from being used to lobby for or against abortion; 
  • the “Kemp-Kasten amendment,” which prohibits funding for any organization or program that, as determined by the President, supports or participates in the management of a program of coercive abortion or involuntary sterilization; and 
  • the “Tiahrt amendment,” which places requirements on voluntary family planning projects receiving assistance from USAID. 
The executive branch has also engaged in the debate over international abortion and family planning. In 1984, President Ronald Reagan issued what has become known as the “Mexico City policy,” which required foreign non-governmental organizations receiving USAID family planning assistance to certify that they would not perform or actively promote abortion as a method of family planning, even if such activities were conducted with non-U.S. funds. The policy was rescinded by President Bill Clinton and reinstituted by President George W. Bush. It was rescinded by President Barack Obama in January 2009 and remains a controversial issue in U.S. foreign assistance.

This report focuses primarily on legislative restrictions and executive branch policies related to international abortion and family planning. For information on domestic abortion laws and international population assistance, including funding levels and U.S. programs, see 

  • CRS Report RL33467, Abortion: Judicial History and Legislative Response, by Jon O. Shimabukuro, and 
  • CRS Report RL33250, International Family Planning Programs: Issues for Congress, by Luisa Blanchfield.


Date of Report: June 22, 2011
Number of Pages: 16
Order Number: R41360
Price: $29.95

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Wednesday, June 29, 2011

The Genetic Information Nondiscrimination Act of 2008 (GINA)


Amanda K. Sarata
Analyst in Health Policy and Genetics

Nancy Lee Jones
Legislative Attorney


On May 21, 2008, the Genetic Information Nondiscrimination Act of 2008 (GINA), referred to by its sponsors as the first civil rights act of the 21st century, was enacted. GINA, P.L. 110-233, prohibits discrimination based on genetic information by health insurers and employers. The sequencing of the human genome and subsequent advances raise hope for genetic therapies to cure disease, but this scientific accomplishment is not without potential problems. An employer or health insurer could decide to take adverse action based on a genetic predisposition to disease, and situations have arisen where discriminatory action based on genetic information did occur. In addition, there is evidence that the fear of genetic discrimination has an adverse effect on those seeking genetic testing, as well as on participation in genetic research. GINA was enacted to remedy this situation.

GINA is divided into two main parts: Title I, which prohibits discrimination based on genetic information by health insurers; and Title II, which prohibits discrimination in employment based on genetic information. Title I of GINA amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act (PHSA), and the Internal Revenue Code (IRC), through the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as well as the Social Security Act, to prohibit health insurers from engaging in genetic discrimination. Title II of GINA prohibits discrimination in employment because of genetic information and, with certain exceptions, prohibits an employer from requesting, requiring, or purchasing genetic information. The law prohibits the use of genetic information in employment decisions—including hiring, firing, job assignments, and promotions—by employers, unions, employment agencies, and labormanagement training programs.

This report provides background on genetic information, legal implications regarding the use of this information, and relevant laws. It also discusses the statutory provisions of GINA and the regulations regarding both health insurance and employment.



Date of Report: June 13, 2011
Number of Pages: 25
Order Number: RL34548
Price: $29.95

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Sunday, June 26, 2011

Patent Reform in the 112th Congress: Innovation Issues


Wendy H. Schacht
Specialist in Science and Technology Policy

John R. Thomas
Visiting Scholar


Congressional interest in patent reform has increased as the patent system becomes more significant to U.S. industry. Patent ownership is perceived as an incentive to the technological advancement that leads to economic growth. Yet, this augmented attention to patents has been accompanied by persistent concerns about the fairness and effectiveness of the current system. Several studies, including those by the National Academy of Sciences and the Federal Trade Commission, recommended reform of the patent system to address perceived deficiencies in the operation of the patent regime. Other experts maintain that major alterations in existing law are unnecessary and that the patent process can adapt, and is adapting, to technological progress.

Two omnibus patent reform bills introduced in the 112
th Congress, each titled the America Invents Act, would make significant changes to the patent system. Both S. 23 and H.R. 1249 would adopt a first-inventor-to-file priority system, allow assignee filing, establish USPTO feesetting authority, provide for post-issuance review proceedings at the USPTO, and introduce other reforms. Several of these proposals have been the subject of discussion within the patent community for many years, but others present more novel propositions.

Although S. 23 and H.R. 1249 have many similarities, the two bills differ in some respects. For example, S. 23 would address the residency requirement of judges serving on the U.S. Court of Appeals for the Federal Circuit, while H.R. 1249 would not. Unlike S. 23, H.R. 1249 would significantly broaden patent law’s first inventor defense. Other distinctions with respect to USPTO post-issuance review proceedings and other topics exist as well.

While the provisions of the proposed legislation would arguably institute the most sweeping reforms to the U.S. patent system since the nineteenth century, many of these proposals, such as pre-issuance publication and prior user rights, have already been implemented in U.S. law to a more limited extent. These and other reforms, such as the first-inventor-to-file priority system and post-grant review proceedings, also reflect the decades-old patent practices of Europe, Japan, and our other leading trading partners.

Some observers are nonetheless concerned that certain of these provisions would weaken patent rights, thereby diminishing incentives for innovation. Other experts believe that changes of this magnitude, occurring at the same time, do not present the most prudent course for the patent system. Patent reform therefore confronts Congress with difficult legal, practical, and policy issues, but also with apparent possibilities for altering and possibly improving the legal regime that has long been recognized as an engine of innovation within the U.S. economy.



Date of Report: June 13, 2011
Number of Pages: 38
Order Number: R41638
Price: $29.95

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Waiving the Restriction of Annual Limits in Private Health Insurance

Mark Newsom
Specialist in Health Care Financing

Considerable congressional attention has been placed on the dollar value of health insurance coverage in terms of out-of-pocket (OOP) costs placed on policyholders. One method that lowers the dollar value of coverage is the use of annual limits on the dollar amount of coverage. Private health insurers use annual limits to require the consumer to assume 100% of the cost of coverage after a certain amount of spending for the year has been reached. While annual limits may be a benefit design feature in any type of health insurance, they are used as the primary method of cost control for limited benefit plans, which provide low premium coverage typically to low-income part-time or seasonal workers. Limited benefit plans generally have annual limits on both the total dollar coverage and on specific coverage categories (e.g., hospitalizations and outpatient surgeries). Without the limited benefit plan option, many of these low-income workers would likely be uninsured. On the other hand, these plans have been criticized as providing little value and giving a false sense of security to policyholders.

The Patient Protection and Affordable Care Act (P.L. 111-148, PPACA) prohibits the use of annual limits effective 2014 and places certain restrictions on their use effective for plan years starting on or after September 23, 2010. These restrictions would effectively eliminate limited benefit plans. Accordingly, the Secretary of Health and Human Services has implemented a waiver process for limited benefit plans under the authority provided by §1001 of PPACA to define restricted annual limits in such a way as to “ensure that access to needed services is made available with a minimal impact on premiums.”

Considerable attention has been paid to the fairness and transparency of the waiver process. For context, it is relevant to note that Congress has not consistently specified the manner in which information concerning health care waivers is to be released to the public. Indeed, the annual limits provision of PPACA does not even have a specific public reporting requirement. As a result of different legal standards, or in some cases the absence of a congressional directive, no standardized practice for releasing information about health care waivers has ever been developed. With respect to the annual limits waivers, no obvious bias could be found in the publicly available application materials. Moreover, the Government Accountability Office found that the waivers were granted when an application projected a significant increase in premiums or significant reduction in access to health care benefits and not based on organizations factors (e.g., being a union).



Date of Report: June 15, 2011
Number of Pages: 13
Order Number: R41627
Price: $29.95

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Discretionary Funding in the Patient Protection and Affordable Care Act (PPACA)

C. Stephen Redhead, Coordinator
Specialist in Health Policy

Kirsten J. Colello
Specialist in Health and Aging Policy

Elayne J. Heisler
Analyst in Health Services

Sarah A. Lister
Specialist in Public Health and Epidemiology

Amanda K. Sarata
Specialist in Health Policy


The Patient Protection and Affordable Care Act (PPACA; P.L. 111-148) authorizes new funding for numerous existing discretionary grant and other programs and activities. PPACA also creates a number of new discretionary grant programs and activities and provides for each an authorization of appropriations. Funding for all of these programs and activities is subject to action by congressional appropriators. This report summarizes all the discretionary spending provisions in PPACA that authorize appropriations for grant programs and other activities. A companion product, CRS Report R41301, Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act (PPACA), summarizes all the mandatory appropriations and Medicare trust fund transfers in the new law.

Among the provisions that are intended to strengthen the nation’s health care safety net and improve access to care, PPACA permanently reauthorizes the federal health centers program and the National Health Service Corps (NHSC). The NHSC provides scholarships and student loan repayments to individuals who agree to a period of service as a primary care provider in a federally designated Health Professional Shortage Area. In addition, the new law seeks to address concerns about the current size, specialty mix, and geographic distribution of the health care workforce. It reauthorizes and expands existing health workforce education and training programs under Titles VII and VIII of the Public Health Service Act (PHSA). Title VII supports the education and training of physicians, dentists, physician assistants, and public health workers through grants, scholarships, and loan repayment. PPACA creates several new programs to increase training experiences in primary care, in rural areas, and in community-based settings, and provides training opportunities to increase the supply of pediatric subspecialists and geriatricians. It also expands the nursing workforce development programs authorized under PHSA Title VIII to bolster undergraduate and graduate nursing education and training.

As part of a comprehensive framework for federal community-based (i.e., public health) prevention activities, including a national strategy and a national education and outreach campaign, PPACA authorizes several new grant programs with a focus on preventable or modifiable risk factors for disease (e.g., sedentary lifestyle, tobacco use). The new law also leverages a number of mechanisms to improve the quality of health care, including new requirements for quality measure development, collection, analysis, and public reporting; programs to develop and disseminate innovative strategies for improving the quality of health care delivery; and support for care coordination programs such as medical homes, patient navigators, and the co-location of primary health care and mental health services.

Additionally, PPACA authorizes funding for programs to prevent elder abuse, neglect, and exploitation; grants to expand trauma care services and improve regional coordination of emergency services; and demonstration projects to implement alternatives to current tort litigation for resolving medical malpractice claims, among other provisions.

The new law also reauthorizes the Indian Health Care Improvement Act (IHCIA), which sets out the national policy for Indian health care and authorizes programs and services provided by the Indian Health Service. For more information on PPACA’ s Indian health provisions, which are not discussed in this report, see CRS Report R41152, Indian Health Care: Impact of the Patient Protection and Affordable Care Act (PPACA).
 


Date of Report: June 15, 2011
Number of Pages: 35
Order Number: R41390
Price: $29.95

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