Older Americans Act: Title III Nutrition Services Program

Kirsten J. Colello
Specialist in Health and Aging Policy

The elderly nutrition services program, authorized under Title III of the Older Americans Act, provides grants to state agencies on aging to support congregate and home-delivered meals for people aged 60 and older. The program is designed to address problems of food insecurity, promote socialization, and promote the health and well-being of older persons through nutrition and nutrition-related services. It is the largest Older Americans Act program, funded at $817.8 million in FY2011, accounting for 42% of the Act’s total funding ($1.932 billion). In FY2009, the most recent year for which data are available, almost 242 million meals were served to just under 2.6 million people; 62% were served to frail older people living at home, and 38% were served in congregate settings. The number of home-delivered meals (commonly referred to as “meals on wheels”) served has outpaced congregate meals, growing by almost 47% from FY1990 to FY2009; the number of congregate meals served declined by 35%. The faster growth in homedelivered meals is partially due to relatively higher growth in federal funding for home-delivered meals over that time period, as well as state decisions to focus funds on frail older people living at home. Congress approved the Older Americans Act Amendments of 2006 (P.L. 109-365) extending the Act’s authorization of appropriations through FY2011.

This report describes the nutrition services program authorized under Title III of the Older Americans Act, including the program’s legislative history, purpose, and FY2011 funding levels. It also provides information on service delivery requirements and program data regarding the number of meals served and program participation. The report briefly discusses former and more recent efforts to evaluate these programs. Finally, the report identifies selected issues for federal policymakers, including measuring unmet need for nutrition services, the effects of the economic downturn, additional funding flexibility, and increased cost-sharing.


Date of Report: June 17, 2011
Number of Pages: 15
Order Number: RS21202
Price: $29.95

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Teenage Pregnancy Prevention: Statistics and Programs

Carmen Solomon-Fears
Specialist in Social Policy

In 2009, U.S. teen births accounted for 10.1% of all births and 21.4% of all nonmarital births. The birth rate for U.S. teenagers (ages 15 through 19) increased in 2006 and 2007 after a steady decline since 1991. However, in 2008 and 2009 the teen birth rate dropped below the 2007 teen birth rate, reversing the two-year upward trend. Although the birth rate for U.S. teens has dropped in 16 of the last 18 years, it remains higher than the teenage birth rate of most industrialized nations. Preventing teen pregnancy is generally considered a priority among policymakers and the public because of its high economic, social, and health costs for teen parents and their families.

The Adolescent Family Life (AFL) program, created in 1981 (Title XX of the Public Health Services Act), was the first federal program to focus on adolescents. It was created to support demonstration projects that provide comprehensive and innovative health, education, and social services to pregnant and parenting adolescents, their infants, male partners, and their families. From 1998 to 2009, federal teen pregnancy prevention efforts in the AFL program and in general relied heavily on using abstinence-only education as their primary tool. The appropriation for the AFL program was $16.7 million in FY2010 and is $12.4 million for FY2011.

It appears that a consensus is now growing around the viewpoint that success in the teen pregnancy prevention arena does not necessarily have to be an “either-or” proposition in which abstinence-only education programs are pitted against comprehensive sex education programs. P.L. 111-117 (the Consolidated Appropriations Act, 2010) included a new discretionary Teen Pregnancy Prevention (TPP) program, funded at $110 million for FY2010, which provides grants and contracts, on a competitive basis, to public and private entities to fund “medically accurate and age appropriate” programs that reduce teen pregnancy. P.L. 112-10 (the Department of Defense and Full-Year Continuing Appropriations Act, 2011) included funding of $109.2 million for the TPP program for FY2011 ($104.8 million for the grant program and $4.4 million for program evaluation).

P.L. 111-148 (the Patient Protection and Affordable Care Act) established a new state formula grant program and appropriated $375 million at $75 million per year for five years (FY2010- FY2014) to enable states to operate a new Personal Responsibility Education Program (PREP), which is a comprehensive approach to teen pregnancy prevention that educates adolescents on both abstinence and contraception to prevent pregnancy and sexually transmitted diseases. PREP also provides youth with information on several adulthood preparation subjects (e.g., healthy relationships, adolescent development, financial literacy, parent-child communication, educational and career success, and healthy life skills).

The Title V Abstinence Education Block Grant to states was authorized under P.L. 104-193 (the Personal Responsibility and Work Opportunity Reconciliation Act of 1996). The Title V Abstinence Education program is a formula grant program, specifically for abstinence-only education, funded by mandatory spending. The program’s funding expired on June 30, 2009, but P.L. 111-148 reauthorized the program and restored funding to it at the previous annual level of $50 million for each of FY2010-FY2014.

This report briefly examines some of the data collected by the National Center for Health Statistics on teenage childbearing, offers potential reasons for high teen pregnancy and birth rates, and provides basic information on federal programs whose purpose is primarily to delay sexual activity among teenagers and to reduce teen pregnancy.


Date of Report: June 9, 2011
Number of Pages: 21
Order Number: RS20301
Price: $29.95

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Temporary Federal High Risk Health Insurance Pool Program

Mark Newsom
Specialist in Health Care Financing

This report briefly describes the temporary federal high risk pool (HRP) program, more commonly known as the Pre-Existing Condition Insurance Plan (PCIP) program. The PCIP program was established by the Patient Protection and Affordable Care Act (PPACA, P.L. 111- 148, as amended). Under PPACA, the PCIP program is intended to help individuals with preexisting conditions who have been uninsured for six or more months to obtain health insurance coverage before 2014. In 2014, coverage will be available on a guaranteed issue basis and preexisting condition exclusions will be prohibited.

To be a qualified PCIP, the insurance coverage must have an actuarial value (the average percentage of expenses that the plan covers) at least equal to 65% of total allowed costs, and outof- pocket costs cannot exceed $5,950 for an individual in 2011. The premiums must be established at a standard rate for a standard population, and age rating cannot exceed a factor of 4 to 1. Claims and administrative costs will be subsidized by the federal government.

States can run the program or elect to have the Department of Health and Human Services (HHS) operate the program in their states. Slightly more than half of states (27 states) contracted to operate their own PCIPs. HHS administers the PCIPs in 23 states and the District of Columbia. PPACA appropriates $5 billion of federal funds to support the program, available from July 1, 2010, until the program ends on January 1, 2014. Originally projected to have 200,000 or more enrollees, the PCIPs had 21,454 enrollees as of April 30, 2011. This is a 168.65% increase from the first enrollment statistics released on November 1, 2010.

This report provides an overview of the temporary federal high risk pool program and will be periodically updated to reflect any legislative or regulatory changes.


Date of Report: June 13, 2011
Number of Pages: 18
Order Number: R41235
Price: $29.95

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Federal R&D, Drug Discovery, and Pricing: Insights from the NIH-University-Industry Relationship

Wendy H. Schacht
Specialist in Science and Technology Policy

Public interest in approaches that might provide prescription drugs at lower cost, particularly for the elderly, has rekindled discussion over the role the federal government plays in facilitating the creation of new pharmaceuticals for the marketplace. In the current debate, some argue that the government’s financial, scientific, and/or clinical support of health-related research and development (R&D) entitles the public to commensurate considerations in the prices charged for any resulting drugs. Others view government intervention in price decisions based upon initial federal funding as contrary to a long-term trend of government promotion of innovation, technological advancement, and the commercialization of technology by the business community leading to new products and processes for the marketplace.

The government traditionally funds R&D to meet the mission requirements of the federal departments and agencies. It also supports work in areas where there is an identified need for research, primarily basic research, not being performed in the private sector. Over the past 25 or more years, congressional initiatives have expanded the government’s role to include the promotion of technological innovation to meet other national needs, particularly the economic growth that flows from the use of new and improved goods and services. Various laws facilitate commercialization of federally-funded R&D through technology transfer, cooperative R&D, and intellectual property rights. The legislated incentives are intended to encourage additional private sector investments often necessary to further develop marketable products. The current approach to technology development attempts to balance the public sector’s interest in new and improved technologies with concerns over providing companies valuable benefits without adequate accountability or compensation.

Some question whether or not the current balance is appropriate, particularly with respect to drug discovery. The particular nature and expense of health-related R&D have focused attention on the manner in which the National Institutes of Health (NIH) undertakes research activities. Critics maintain that any need for technology development incentives in the pharmaceutical and/or biotechnology sectors is mitigated by industry access to government-supported work at no cost, monopoly power through patent protection, and additional regulatory and tax advantages such as those conveyed through the Hatch-Waxman Act, the Biologics Price Competition and Innovation Act, and the Orphan Drug Act. Supporters of the existing approach argue that these incentives are precisely what are required and have given rise to robust pharmaceutical and biotechnology industries. It remains to be seen whether or not decisions related to federal involvement in issues related to pharmaceutical R&D will change the nature of the current approach to government-industry- university cooperation.


Date of Report: June 10, 2011
Number of Pages: 32
Order Number: RL32324
Price: $29.95

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Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act (PPACA)

C. Stephen Redhead
Specialist in Health Policy

Among its many provisions, the Patient Protection and Affordable Care Act (PPACA, as amended) restructures the private health insurance market, sets minimum standards for health coverage, creates a mandate for most U.S. residents to obtain health insurance, and provides for the establishment by 2014 of insurance exchanges through which certain individuals and families will be able to receive federal subsidies to reduce the cost of purchasing that coverage. PPACA also expands eligibility for Medicaid; amends the Medicare program in ways that are intended to reduce the growth in Medicare spending that had been projected under preexisting law; imposes an excise tax on insurance plans found to have high premiums; and makes other changes to the tax code, Medicare, Medicaid, and many other federal programs.

PPACA includes numerous appropriations that provide billions of dollars to support new or existing grant programs and other activities. Several other provisions require the Secretary of Health and Human Services (HHS) to transfer amounts from the Medicare Part A and Part B trust funds for specified purposes. This report summarizes all these mandatory spending provisions. They include funding for a temporary insurance program for individuals who have been uninsured for several months and have a preexisting condition, as well as funding for states to plan and establish exchanges. PPACA also provides funding for various Medicare and Medicaid demonstration programs, for the creation of a Center for Medicare and Medicaid Innovation to test and implement innovative payment and service delivery models, and for an independent board to provide Congress with proposals for reducing Medicare cost growth and improving quality of care for Medicare beneficiaries.

In addition, PPACA appropriates funding for health workforce and maternal and child health programs, and establishes three multi-billion dollar funds. The first fund will provide a total of $11 billion over five years in supplementary funding for community health centers and the National Health Service Corps. (A separate appropriation provides $1.5 billion for health center construction and renovation.) The second fund will support comparative effectiveness research through FY2019 with a mixture of appropriations and fund transfers. The third fund, which is funded in perpetuity, is to support prevention, wellness, and other public health-related programs and activities authorized under the Public Health Service Act (PHSA).

Lawmakers opposed to PPACA have introduced numerous bills in the 112th Congress, several of which have seen legislative action. They includes measures to (1) repeal PPACA and replace it with new law; (2) repeal or amend specific PPACA provisions; (3) eliminate certain mandatory appropriations and rescind all unobligated funds; and (4) block or otherwise delay PPACA implementation.

This report will be updated regularly to reflect recent PPACA funding announcements and legislative activity. In addition to the mandatory appropriations discussed herein, PPACA authorizes new funding for numerous existing discretionary grant and other programs and activities, primarily ones authorized under the PHSA. The law also creates a number of new discretionary grant programs and activities and provides for each an authorization of appropriations. Funding for these discretionary programs and activities is subject to action by congressional appropriators. A companion product, CRS Report R41390, Discretionary Funding in the Patient Protection and Affordable Care Act (PPACA), coordinated by C. Stephen Redhead, summarizes all the provisions in PPACA for which appropriations are authorized.


Date of Report: June 9, 2011
Number of Pages: 27
Order Number: R41301
Price: $29.95

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