Abortion Services and Military Medical Facilities

David F. Burrelli
Specialist in Military Manpower Policy

In 1993, President Clinton modified the military policy on providing abortions at military medical facilities. Under the change directed by the President, military medical facilities were allowed to perform abortions if paid for entirely with non-Department of Defense (DOD) funds (i.e., privately funded). Although arguably consistent with statutory language barring the use of Defense Department funds, the President’s policy overturned a former interpretation of existing law barring the availability of these services. On December 1, 1995, H.R. 2126, the FY1996 DOD appropriations act, became law (P.L. 104-61). Included in this law was language barring the use of funds to administer any policy that permits the performance of abortions at any DOD facility except where the life of the mother would be endangered if the fetus were carried to term or where the pregnancy resulted from an act of rape or incest. Language was also included in the FY1996 DOD Authorization Act (P.L. 104-106, February 10, 1996) prohibiting the use of DOD facilities in the performance of abortions. These served to reverse the President’s 1993 policy change. Recent attempts to change or modify these laws have failed.

Over the last three decades, the availability of abortion services at military medical facilities has been subjected to numerous changes and interpretations. Within the last 15 years, Congress has considered numerous amendments to effectuate such changes. Although Congress, in 1992, passed one such amendment to make abortions available at overseas installation, it was vetoed.

The changes ordered by the President did not necessarily have the effect of greatly increasing access to abortion services. Abortions are generally not performed at military medical facilities in the continental United States. In addition, few have been performed at these facilities abroad for a number of reasons. First, the U.S. military follows the prevailing laws and rules of foreign countries regarding abortion. Second, the military has had a difficult time finding health care professionals in uniform willing to perform the procedure.

With the enactment of P.L. 104-61 and P.L. 104-106, these questions became moot, because now, neither DOD funds nor facilities may be used to administer any policy that provides for abortions at any DOD facility, except where the life of the mother may be endangered if the fetus were carried to term. Privately funded abortions at military facilities are permitted when the pregnancy was the result of an act of rape or incest.

In 2010, language was added to the Senate version of the FY2011 National Defense Authorization Act that would allow any DOD facilities to perform privately funded abortions. As noted, the military follows local laws and practices to the greatest extent possible. This potential change would not likely have much of an effect outside of the U.S. since nations that host large numbers of U.S. military personnel maintain legal restrictions on abortions. On September 21, 2010, and December 15, 2010, attempts were made to move this legislation to the Senate floor for a vote. However, due to disagreements over procedures, cloture votes were taken and failed. The Housepassed version of this legislation does not contain language pertaining to abortion.


Date of Report: December 16, 2010
Number of Pages: 23-
Order Number: 95-387
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The Individuals with Disabilities Education Act (IDEA): Statutory Provisions and Recent Legal Issues

Nancy Lee Jones
Legislative Attorney

The Individuals with Disabilities Education Act (IDEA) is the major federal statute for the education of children with disabilities. IDEA both authorizes federal funding for special education and related services and, for states that accept these funds, sets out principles under which special education and related services are to be provided. The requirements are detailed, especially when the regulatory interpretations are considered, and have been the subject of numerous judicial decisions. The key concept in IDEA is the requirement for the provision of a free appropriate public education (FAPE) for children with disabilities. In order to implement FAPE, IDEA requires that each child with a disability have an individualized education program. Children with disabilities may also receive related services and must receive their education in the least restrictive environment.

IDEA was originally enacted to respond to situations where children with disabilities were being excluded from school without any statutory recourse. Section 615 of IDEA provides detailed procedural safeguards for children with disabilities and their parents. Procedural safeguards are provisions protecting the rights of parents and children with disabilities regarding a free appropriate public education (FAPE) and include notice of rights, mediation, resolution sessions, and due process procedures. Section 615 has been a continual source of controversy, especially the provisions relating to the discipline of children with disabilities. IDEA also provides for attorneys’ fees in some situations, but the Supreme Court has found that parents are not entitled to expert witness fees.


Date of Report: December 3, 2010
Number of Pages: 19
Order Number: R40690
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Extensively Drug-Resistant Tuberculosis (XDR-TB): Emerging Public Health Threats and Quarantine and Isolation

Kathleen S. Swendiman
Legislative Attorney

Nancy Lee Jones
Legislative Attorney

The international saga of Andrew Speaker, a traveler thought to have XDR-TB, a drug-resistant form of tuberculosis, placed a spotlight on existing mechanisms to contain contagious disease threats and raised numerous legal and public health issues. This report presents the factual situation presented by Andrew Speaker. It also discusses the application of various public health measures available to contain an emerging public health threat posed by an individual who ignores medical advice and attempts to board an airplane or take other forms of public transportation. These measures include quarantine and isolation authorities, the “Do Not Board” List, and application of certain provisions of the International Health Regulations. This report also examines constitutional issues relating to due process and equal protection. Legal issues which may be raised by application of federal nondiscrimination laws when emergency public health measures are used to contain emerging public health threats are also discussed.


Date of Report: November 26, 2010
Number of Pages: 18
Order Number: RL34144
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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 Population Assistance and Family Planning Programs: Issues for Congress, by Luisa Blanchfield.

Date of Report: December 1, 2010
Number of Pages: 16
Order Number: R41360
Price: $29.95

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Medicare Physician Payment Updates and the Sustainable Growth Rate (SGR) System

Jim Hahn
Analyst in Health Care Financing

Each year since 2002, the statutory method for determining the annual updates to the Medicare physician fee schedule, known as the sustainable growth rate (SGR) system, has resulted in a reduction in the reimbursement rates (or a “negative update”). With the exception of 2002, when a 4.8% decrease was applied, Congress has passed a series of bills to override the reductions. The SGR system was established because of the concern that the Medicare fee schedule itself would not adequately constrain overall increases in spending for physicians’ services. While the fee schedule limits the amount that Medicare will pay for each service, there are no limits on the volume or mix of services. The SGR system was intended to serve as a restraint on aggregate spending. If expenditures over a period are less than the cumulative spending target for the period, the update is increased. However, if spending exceeds the cumulative spending target over a certain period, future updates are reduced to bring spending back in line with the target. 

In the first few years of the SGR system, the actual expenditures did not exceed the targets and the updates to the physician fee schedule were close to the Medicare economic index (MEI, a price index of inputs required to produce physician services) in the first two years (2.3% in 1998 and 1999, compared with a MEI of 2.2% in 1998 and 2.3% in 1999). For the next two years, in 2000 and 2001, the actual physician fee schedule update was more than twice the MEI for those years (5.5% update vs. MEI of 2.4% in 2000, 5.0% update vs. MEI of 2.1% in 2001). However, beginning in 2002, the actual expenditure exceeded allowed targets and the discrepancy has grown with each year, resulting in a series of ever-larger cuts under the formula.

Some criticisms of the SGR system point to purported flaws in the technical details behind the formula, while others have just expressed displeasure with the resultant outcome. Although modifications have been proposed to replace the SGR system, no proposal has garnered sufficient support and almost all proposals would be expensive to implement compared against the current baseline, which necessarily assumes that significant cuts to the fee schedule will occur.

Legislative activity in the current session of Congress includes several bills. The FY2010 Defense Appropriations Act delayed the implementation of the reductions for two months, through February 28, 2010. The Statutory Pay-As-You-Go Act of 2010 (P.L. 111-139) exempts the amount it would cost to freeze payments for five years from PAYGO rules. H.R. 4691, which became law on March 2, 2010, delayed the payment cuts through March 31, 2010. On April 15, the Senate passed an amended version of H.R. 4851 that extended the payment cut delay through May 31, 2010. The House passed the amended bill, and the President signed P.L. 111-157 into law that day. On June 25, 2010, several weeks after the expiration of the extension created by the Continuing Extension Act, an amended version of H.R. 3962 was signed into law that increases fee schedule payments 2.2% retroactive to June 1 and continuing through November 30, 2010. On November 30, 2010, the President signed the Physician Payment and Therapy Relief Act of 2010 into law (P.L. 111-286), which extends the 2.2% increase for an additional month through December 31, 2010.


Date of Report: December 3, 2010
Number of Pages: 23
Order Number: R40907
Price: $29.95

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