Teenage Pregnancy Prevention: Statistics and Programs

Carmen Solomon-Fears
Specialist in Social Policy

In 2011, U.S. teen births accounted for 8.4% of all births and 18.4% 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, 2009, 2010, and 2011 the teen birth rate dropped below the 2006 teen birth rate, reversing the two-year upward trend. Although the birth rate for U.S. teens has dropped in 18 of the past 20 years, it remains higher than the teen 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 Service 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 $12.4 million for FY2011. The AFL program did not receive any funding for FY2012.

P.L. 111-117 (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 (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 program; $4.4 million for evaluation). P.L. 112- 74 (Consolidated Appropriations Act, 2012) included level funding of $104.790 million for the TPP program for FY2012 and increased funding for program evaluation to $8.5 million. P.L. 113- 6 (Consolidated and Further Continuing Appropriations Act, 2013) included funding of $105.2 million for the TPP program for FY2013 and provided funding of $8.5 million for program evaluation.

P.L. 111-148 (the Patient Protection and Affordable Care Act-ACA) 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. P.L. 112-74 included an additional $5 million for competitive grants for abstinence-only education.


Date of Report: April 15, 2013
Number of Pages: 23
Order Number: RS20301
Price: $29.95

To Order:

e-mail congress@pennyhill.com

Phone 301-253-0881

For email and phone orders, provide a Visa, MasterCard, American Express, or Discover card number, expiration date, and name on the card. Indicate whether you want e-mail or postal delivery. Phone orders are preferred and receive priority processing.

The Independent Payment Advisory Board

Jim Hahn
Specialist in Health Care Financing


Christopher M. Davis
Analyst on Congress and the Legislative Process

In response, in part, to overall growth in Medicare program expenditures and growth in expenditures per Medicare beneficiary, the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148, as amended) created the Independent Payment Advisory Board (IPAB, or the Board) and charged the Board with developing proposals to “reduce the per capita rate of growth in Medicare spending.” The Secretary of Health and Human Services (the Secretary) is directed to implement the Board’s proposals automatically unless Congress affirmatively acts to alter the Board’s proposals or to discontinue the automatic implementation of such proposals.

The annual IPAB sequence of events begins each year, starting April 30, 2013, with the Chief Actuary of the Centers for Medicare & Medicaid Services calculating a Medicare per capita growth rate and a Medicare per capita target growth rate. If the Chief Actuary determines that the Medicare per capita growth rate exceeds the Medicare per capita target growth rate, the Chief Actuary would establish an applicable savings target—the amount by which the Board must reduce future spending. This determination by the Chief Actuary also triggers a requirement that the Board prepare a proposal to reduce the growth in the Medicare per capita growth rate by the applicable savings target. The Board cannot ration care, raise premiums, increase cost sharing, or otherwise restrict benefits or modify eligibility. In generating its proposals, the Board is directed to consider, among other things, Medicare solvency, quality and access to care, the effects of changes in payments to providers, and those dually eligible for Medicare and Medicaid. If the Board fails to act, the Secretary is directed to prepare a proposal.

Board proposals must be submitted to the Secretary by September 1 of each year and to the President and Congress by January 15 of the following year. Board proposals are “fast-tracked” in Congress, and IPAB proposals go into force automatically unless Congress affirmatively acts to amend or block them within a stated period of time and under circumstances specified in the act. Section 3403(d) of the act establishes special “fast track” parliamentary procedures governing House and Senate committee consideration, and Senate floor consideration, of legislation implementing the Board or Secretary’s proposal. These procedures differ from the parliamentary mechanisms the chambers usually use to consider most legislation and are designed to ensure that Congress can act promptly on the implementing legislation should it choose to do so. PPACA also established a second “fast track” parliamentary mechanism for consideration of legislation discontinuing the automatic implementation process for the recommendations of the Board.

The Board’s charge is to develop proposals for the Secretary to implement that reduce the per capita growth in Medicare expenditures, not to reduce Medicare expenditures. Therefore, while the CBO projects that the cumulative impact of the Board’s recommendations from 2015 through 2019 will reduce total spending by $15.5 billion, during the same period, Medicare expenditures will total $3.9 trillion with average spending per beneficiary forecast to increase from $13,374 to $15,749. While the Board’s potential impact on total expenditures is likely to be relatively small compared to overall Medicare expenditures, its impact on particular Medicare providers or suppliers may be significant, particularly if the Board alters payment mechanisms.

The President’s FY2013 budget, as submitted to Congress on February 13, 2012, includes a proposal to strengthen the IPAB. On March 22, 2012, the House passed a combined version of the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 (H.R. 5) that contained provisions from H.R. 452, the Medicare Decisions Accountability Act of 2011, which would repeal the IPAB.


Date of Report: April 17, 2013
Number of Pages: 41
Order Number: R41511
Price: $29.95

To Order:

R41511.pdf  to use the SECURE SHOPPING CART

e-mail congress@pennyhill.com

Phone 301-253-0881

For email and phone orders, provide a Visa, MasterCard, American Express, or Discover card number, expiration date, and name on the card. Indicate whether you want e-mail or postal delivery. Phone orders are preferred and receive priority processing.

Submission of Mental Health Records to NICS and the HIPAA Privacy Rule

Edward C. Liu, Coordinator
Legislative Attorney

Erin Bagalman
Analyst in Health Policy

Vivian S. Chu
Legislative Attorney

C. Stephen Redhead
Specialist in Health Policy

Questions about the scope and efficacy of the background checks required during certain firearm purchases have gained prominence following recent mass shootings. These background checks are intended to identify whether potential purchasers are prohibited from purchasing or possessing firearms due to one or more “prohibiting factors,” such as a prior felony conviction or a prior involuntary commitment for mental health reasons. Operationally, such background checks primarily use information contained within the National Instant Criminal Background Check System (NICS) and a particular focus of the debate in Congress has been whether federal privacy standards promulgated under the Health Insurance Portability and Accountability Act (i.e., the HIPAA privacy rule) or state privacy laws are an obstacle to the submission of mental health records to NICS.

Under the Gun Control Act of 1968 (GCA), as amended, persons adjudicated to be mentally defective or who have been committed to a mental institution are prohibited from possessing, shipping, transporting, and receiving firearms and ammunition. Neither a diagnosis of a mental illness nor treatment for a mental illness is sufficient to qualify a person as “adjudicated as a mental defective.” Rather, an individual’s “adjudication as a mental defective” relies upon a determination or decision by a court, board, commission, or other lawful authority. The definition of “committed to a mental institution” may apply only to inpatient settings. At least one federal court has held that the Supreme Court’s recent recognition of an individual right to possess a firearm suggests that some emergency hospitalization or commitment procedures, that may not have as many procedural safeguards as formal commitment, should not be included within the meaning of “involuntary commitment” for purposes of the GCA. In 2007, Congress passed the NICS Improvement Amendments Act (NIAA), which authorizes the Attorney General to make additional grants to states to improve electronic access to records as well as to incentivize states to turn over records of persons who would be prohibited from possessing or receiving firearms.

In 2012, the Government Accountability Office (GAO) reported that a variety of technological, coordination, and legal (i.e., privacy) challenges limit the states’ ability to report mental health records to NICS. The HIPAA privacy rule, which applies to most health care providers, regulates the use or disclosure of protected health information. On February 14, 2013, HHS announced that it will seek to amend the HIPAA privacy rule to remove any potential impediments to state reporting of mental health records to NICS. The privacy rule is most relevant as a potential obstacle where information used to generate mental health records on individuals prohibited from gun possession under the GCA is held by health care providers in states that do not expressly require disclosure of such records to NICS. Courts and health care providers that generate such prohibiting mental health records may also be subject to state health privacy laws that may be more restrictive than the HIPAA privacy rule.


Date of Report: April 15, 2013
Number of Pages: 17
Order Number: R43040
Price: $29.95

To Order:

R43040.pdf  to use the SECURE SHOPPING CART

e-mail congress@pennyhill.com

Phone 301-253-0881

For email and phone orders, provide a Visa, MasterCard, American Express, or Discover card number, expiration date, and name on the card. Indicate whether you want e-mail or postal delivery. Phone orders are preferred and receive priority processing.

The Emergency Food and Shelter National Board Program and Homeless Assistance

Francis X. McCarthy
Analyst in Emergency Management Policy

The Emergency Food and Shelter National Board (EFS) Program provides supplemental funding to homeless services providers across the nation. EFS was first authorized by P.L. 100-77, the Stewart B. McKinney-Bruce Vento Homeless Assistance Act (Title III, McKinney-Vento Act), which became law in 1987. Eligible services include the provision of overnight shelter and served meals, assistance to food banks and pantries, one month’s rental or mortgage assistance to prevent evictions, and one month’s utility payments to prevent service cut-offs.

Since its inception, the program’s recipient organizations have provided over 2 billion meals, 241 million nights of shelter, 4.3 million rent and mortgage payments, and 5.9 million utility payments. The program is administered by the EFS National Board, which is chaired by the Federal Emergency Management Agency (FEMA) of the Department of Homeland Security (DHS), and is comprised of representatives from the American Red Cross, Catholic Charities USA, the National Council of Churches, the Salvation Army, the Jewish Federations of North America, and United Way Worldwide. Two of the program’s distinguishing features are its focus on local decision-making, and its relatively modest administrative costs.

The program was last authorized in 1994, and has been operating under authority provided by annual appropriations acts. In the past, its funding has generally increased during times of high unemployment and decreased as the unemployment rate declined. For example, in FY2009, the program received an appropriation of $200 million. The American Recovery and Reinvestment Act of 2009 (P.L. 111-5, ARRA) then temporarily increased the EFS program’s funding to $300 million for FY2009. In more recent years, the program’s funding has declined. The program received an appropriation of $200 million for FY2010, $120 million for FY2011, and $120 million for FY2012. Under the full-year Continuing Resolution (CR, P.L. 113-6) for FY2013, the EFS program is scheduled to receive just under $120 million; however, with sequester amounts not yet confirmed the final amount could be less than that.

Although legislation providing EFS an appropriation of $120 million for FY2012 was signed into law on December 23, 2011, the distribution of the program’s funds did not begin until August 15, 2012, the latest award distribution date in the program’s history. FY2011 was also a notable year for the program because the EFS National Board changed its distribution formulas, resulting in some large jurisdictions not receiving direct funding for the first time.

The National Board’s distribution formula uses unemployment and poverty statistics to determine amounts awarded directly to communities across the nation. After notifying jurisdictions of the amount that they will be receiving, EFS Local Boards, comprised of local affiliates of the organizations represented on the National Board, at least one homeless or previously homeless person, and representatives of local government, are convened. Local Boards advertise the availability of funds, accept applications for funding, and determine which local agencies to fund and how the funds are to be used. The National Board also provides funding to State Set-aside Committees (SSA) which provide funding to jurisdictions with significant needs that may not have qualified under the National Board’s formula, or to further supplement funding to jurisdictions that received a direct award. Each state, through direct awards and SSA, receives a minimum of $250,000.


Date of Report: April 10, 2013
Number of Pages: 25
Order Number: R42766
Price: $29.95

To Order:

R42766.pdf  to use the SECURE SHOPPING CART

e-mail congress@pennyhill.com

Phone 301-253-0881

For email and phone orders, provide a Visa, MasterCard, American Express, or Discover card number, expiration date, and name on the card. Indicate whether you want e-mail or postal delivery. Phone orders are preferred and receive priority processing.

Potential Employer Penalties Under the Patient Protection and Affordable Care Act (ACA)

Janemarie Mulvey
Specialist in Health Care Financing

The Patient Protection and Affordable Care Act (ACA, P.L. 111-148), as amended, increases access to health insurance coverage, expands federal private health insurance market requirements, and requires the creation of health insurance exchanges to provide individuals and small employers with access to insurance. To ensure that employers continue to provide some degree of coverage, ACA includes a “shared responsibility” provision. This provision does not explicitly mandate that an employer offer employees health insurance; however, ACA imposes penalties on “large” employers if at least one of their full-time employees obtains a premium credit through the newly established exchange. Employers are not subject to a penalty if their fulltime workers are eligible for Medicaid or CHIP. According to the Congressional Budget Office (CBO), employers are projected to pay $130 billion in penalty payments over a 10-year period.

ACA sets out a two-part calculation for determining, first, which firms are subject to the penalty (e.g., definition of large), and, second, to which workers within a firm the penalty is applied. Because the treatment of part-time and seasonal workers differs across these two parts of the calculation, this has led to some confusion among policymakers and employers. For example, part-time employees are included in what is termed a full-time equivalent calculation to determine if an employer has at least 50 full-time equivalent employees (FTEs) and is thus considered large for purposes of applying the penalty. However, the actual penalty, if applicable, is levied only on full-time workers (those working at least 30 hours a week on average). This report discusses these definitions and the application to the employer penalty in greater detail.

The potential employer penalty applies to all common law employers, including an employer that is a government entity (such as federal, state, local, or Indian Tribal government entities) and an employer that is a nonprofit organization that is exempt from federal income taxes. If a franchise is owned by one individual or entity, employees in each of the franchises must be aggregated to determine the number of both full-time equivalent and full-time employees.

The actual amount of the penalty varies depending on whether an employer currently offers insurance coverage or not. In order for employers who do provide health insurance coverage to avoid paying a penalty, health insurance coverage that is both affordable and adequate must be offered to the employee and his/her dependents. Dependent is defined as a child of an employee who has not attained age 26. Dependent does not include a spouse. Coverage is considered affordable if the employee’s required contribution to the plan does not exceed 9.5% of the employee’s household income for the taxable year. However, IRS has provided a safe harbor for employers to use the employee’s W-2 income for this calculation (since most employers do not readily have information on an employee’s household income). A health plan is considered to provide adequate coverage if the plan’s actuarial value (i.e., the share of the total allowed costs that the plan is expected to cover) is at least 60%. This report provides greater detail on these requirements.

The total penalty for any applicable large employer is based on its number of full-time employees. ACA specified that working 30 hours or more a week is considered full-time. However, the statute did not specify what time period (i.e., monthly or annually) employers would use to determine if a worker is full-time. To address this issue, the Secretary of Health and Human Services (HHS) and the Secretary of Labor have published proposed regulations to provide guidance for employers to use to determine which employees are considered full-time employees for purposes of administering the ACA employer penalty provision. The proposed regulations provide employers some flexibility to designate certain measurement or look-back periods (up to 12 months) during which they will calculate whether a worker is full-time or not. Once an employee is determined to be full-time, there will then be an administrative period to enroll employees in a health plan, if necessary. If an employer penalty is levied under the ACA requirements, it applies only for the time period following the administrative period, which is called the stability period. Employers are not penalized if an employee enters the exchange and receives a premium credit during the measurement period. In addition, because of this latest guidance, it is unlikely that employers will pay a penalty for seasonal workers who do not work at least 30 hours, on average over a pre-specified time period (up to 12-months). This report describes these proposed regulations in greater detail and provides examples of potential dates when employers will need to begin measuring full-time status for their on-going employees.

Date of Report: April 8, 2013
Number of Pages: 18
Order Number: R41159
Price: $29.95

To Order:

R41159.pdf  to use the SECURE SHOPPING CART

e-mail congress@pennyhill.com

Phone 301-253-0881

For email and phone orders, provide a Visa, MasterCard, American Express, or Discover card number, expiration date, and name on the card. Indicate whether you want e-mail or postal delivery. Phone orders are preferred and receive priority processing.