Access to Contraception for Servicemembers and Dependents Act of 2019

II 116TH CONGRESS 1ST SESSION S. 1049 To amend title 10, United States Code, to ensure that members of the Armed Forces and their families have access to the contraception they need in order to promote the health and readiness of all members of the Armed Forces, and for other purposes. IN THE SENATE OF THE UNITED STATES APRIL 4, 2019 Mrs. SHAHEEN (for herself, Ms. BALDWIN, Mr. BENNET, Mr. BLUMENTHAL, Mr. BOOKER, Mr. BROWN, Mr. COONS, Ms. CORTEZ MASTO, Ms. DUCKWORTH, Mrs. GILLIBRAND, Ms. HIRONO, Ms. KLOBUCHAR, Mr. LEAHY, Mr. MARKEY, Mr. MENENDEZ, Mr. REED, Mr. SANDERS, Ms. STABENOW, Mr. VAN HOLLEN, Mr. WHITEHOUSE, Mr. WYDEN, Mr. KAINE, Mrs. FEINSTEIN, Mr. CARDIN, Mr. DURBIN, Ms. HARRIS, Mr. MERKLEY, Mr. MURPHY, Mrs. MURRAY, Mr. PETERS, Ms. ROSEN, Mr. TESTER, and Ms. WARREN) introduced the following bill; which was read twice and referred to the Committee on Armed Services A BILL To amend title 10, United States Code, to ensure that mem- bers of the Armed Forces and their families have access to the contraception they need in order to promote the health and readiness of all members of the Armed Forces, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 00:02 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1049.IS S1049 pamtmann on DSKBFK8HB2PROD with BILLS 2 •S 1049 IS SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Access to Contracep- 2 tion for Servicemembers and Dependents Act of 2019’’. 3 SEC. 2. FINDINGS. 4 Congress finds the following: 5 (1) Women are serving in the Armed Forces at 6 increasing rates, playing a critical role in the na- 7 tional security of the United States. Women com- 8 prise more than 17 percent of members of the 9 Armed Forces and as of 2018, nearly 350,000 10 women serve on active duty in the Armed Forces or 11 in the Selected Reserve of the Ready Reserve of the 12 reserve components of the Armed Forces. 13 (2) Ninety-five percent of women serving in the 14 Armed Forces are of reproductive age and as of 15 2017, more than 700,000 female spouses and de- 16 pendents of members of the Armed Forces on active 17 duty are of reproductive age. 18 (3) The TRICARE program covered 1,563,727 19 women of reproductive age in 2017, including female 20 spouses and dependents of members of the Armed 21 Forces on active duty. 22 (4) The benefits of contraception are widely rec- 23 ognized and include improved health and well-being, 24 reduced global maternal mortality, health benefits of 25 pregnancy spacing for maternal and child health, 26 VerDate Sep 11 2014 00:02 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1049.IS S1049 pamtmann on DSKBFK8HB2PROD with BILLS 3 •S 1049 IS and greater educational and professional opportuni- 1 ties and increased lifetime earnings for women. 2 (5) Studies have shown that when cost barriers 3 to the full range of methods of contraception are 4 eliminated, and women receive comprehensive coun- 5 seling on the various methods of contraception (in- 6 cluding highly effective and more expensive long-act- 7 ing reversible contraceptives), rates of unintended 8 pregnancy decline. 9 (6) Research has also shown that investments 10 in effective contraception save public and private 11 dollars. 12 (7) In order to fill gaps in coverage and access 13 to preventive care critical for women’s health, the 14 Patient Protection and Affordable Care Act (Public 15 Law 111–148) requires all non-grandfathered indi- 16 vidual and group health plans to cover without cost- 17 sharing preventive services, including a set of evi- 18 dence-based preventive services for women supported 19 by the Health Resources and Services Administra- 20 tion of the Department of Health and Human Serv- 21 ices. These women’s preventive services include the 22 full range of female-controlled contraceptive meth- 23 ods, effective family planning practices, and steriliza- 24 tion procedures approved by the Food and Drug Ad- 25 VerDate Sep 11 2014 00:02 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1049.IS S1049 pamtmann on DSKBFK8HB2PROD with BILLS 4 •S 1049 IS ministration. The Health Resources and Services 1 Administration has affirmed that contraceptive care 2 includes contraceptive counseling, initiation of con- 3 traceptive use, and follow-up care (such as manage- 4 ment, evaluation, and changes to and removal or dis- 5 continuation of the contraceptive method). 6 (8) Under the TRICARE program, women 7 members of the Armed Forces on active duty have 8 full coverage of all prescription drugs, including con- 9 traception, without cost-sharing requirements, which 10 is consistent with requirements under the Patient 11 Protection and Affordable Care Act (Public Law 12 111–148), which requires coverage of all contracep- 13 tive methods approved by the Food and Drug Ad- 14 ministration for women and related services and 15 education and counseling. However, women members 16 not on active duty and female dependents of mem- 17 bers do not have similar coverage of all prescription 18 methods of contraception approved by the Food and 19 Drug Administration without cost-sharing when fill- 20 ing a prescription outside of a military medical 21 treatment facility. 22 (9) Studies indicate that women members of 23 the Armed Forces need comprehensive counseling for 24 pregnancy prevention and the lack thereof is contrib- 25 VerDate Sep 11 2014 00:02 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1049.IS S1049 pamtmann on DSKBFK8HB2PROD with BILLS 5 •S 1049 IS uting to unintended pregnancies among such women 1 members. Additionally, they need counseling on and 2 availability of contraception for non-contraceptive 3 benefits (for example, menstrual suppression and 4 predictable menstrual patterns), which is important 5 in ensuring readiness for deployment to remote or 6 operational theaters. 7 (10) Research studies based on the Department 8 of Defense Survey of Health Related Behaviors 9 Among Active Duty Military Personnel found a high 10 rate of unintended pregnancy among women mem- 11 bers of the Armed Forces. Adjusting for the dif- 12 ference between age distributions in the Armed 13 Forces and the general population, the rate of unin- 14 tended pregnancy among women members of the 15 Armed Forces is higher than among the general 16 population. 17 (11) The Defense Advisory Committee on 18 Women in the Services has recommended that all 19 the Armed Forces, to the extent that they have not 20 already, implement initiatives that inform members 21 of the Armed Forces of the importance of family 22 planning, educate them on methods of contraception, 23 and make various methods of contraception avail- 24 able, based on the finding that family planning can 25 VerDate Sep 11 2014 00:02 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1049.IS S1049 pamtmann on DSKBFK8HB2PROD with BILLS 6 •S 1049 IS increase the overall readiness and quality of life of 1 all members of the Armed Forces. 2 (12) The military departments received more 3 than 6,700 reports of sexual assaults involving mem- 4 bers of the Armed Forces as victims or subjects dur- 5 ing fiscal year 2017. Through regulations, the De- 6 partment of Defense already supports a policy of en- 7 suring that women members of the Armed Forces 8 who are sexually assaulted have access to emergency 9 contraception, and the initiation of contraception if 10 desired and medically appropriate. 11 SEC. 3. CONTRACEPTION COVERAGE PARITY UNDER THE 12 TRICARE PROGRAM. 13 (a) IN GENERAL.—Section 1074d of title 10, United 14 States Code, is amended— 15 (1) in the header for subsection (a), by insert- 16 ing ‘‘FOR MEMBERS AND FORMER MEMBERS’’ after 17 ‘‘SERVICES AVAILABLE’’; 18 (2) by redesignating subsection (b) as sub- 19 section (d); and 20 (3) by inserting after subsection (a) the fol- 21 lowing new subsections: 22 ‘‘(b) CARE RELATED TO PREVENTION OF PREG- 23 NANCY.—Female covered beneficiaries shall be entitled to 24 VerDate Sep 11 2014 00:02 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1049.IS S1049 pamtmann on DSKBFK8HB2PROD with BILLS 7 •S 1049 IS care related to the prevention of pregnancy described by 1 subsection (d)(3). 2 ‘‘(c) PROHIBITION ON COST-SHARING FOR CERTAIN 3 SERVICES.—Notwithstanding section 1074g(a)(6), section 4 1075, or section 1075a of this title or any other provision 5 of law, cost-sharing may not be imposed or collected for 6 care related to the prevention of pregnancy provided pur- 7 suant to subsection (a) or (b), including for any method 8 of contraception provided, whether provided through a fa- 9 cility of the uniformed services, the TRICARE retail phar- 10 macy program, or the national mail-order pharmacy pro- 11 gram.’’. 12 (b) CARE RELATED TO PREVENTION OF PREG- 13 NANCY.—Subsection (d)(3) of such section, as redesig- 14 nated by subsection (a)(2) of this section, is further 15 amended by inserting before the period at the end the fol- 16 lowing: ‘‘(including all methods of contraception approved 17 by the Food and Drug Administration, contraceptive care 18 (including with respect to insertion, removal, and follow 19 up), sterilization procedures, and patient education and 20 counseling in connection therewith)’’. 21 (c) CONFORMING AMENDMENT.—Section 22 1077(a)(13) of such title is amended by striking ‘‘section 23 1074d(b)’’ and inserting ‘‘section 1074d(d)’’. 24 VerDate Sep 11 2014 00:02 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1049.IS S1049 pamtmann on DSKBFK8HB2PROD with BILLS 8 •S 1049 IS SEC. 4. PREGNANCY PREVENTION ASSISTANCE AT MILI- 1 TARY MEDICAL TREATMENT FACILITIES FOR 2 SEXUAL ASSAULT SURVIVORS. 3 (a) IN GENERAL.—Chapter 55 of title 10, United 4 States Code, is amended by inserting after section 1074o 5 the following new section: 6 ‘‘§ 1074p. Provision of pregnancy prevention assist- 7 ance at military medical treatment facili- 8 ties 9 ‘‘(a) INFORMATION AND ASSISTANCE.—The Sec- 10 retary of Defense shall promptly furnish to sexual assault 11 survivors at each military medical treatment facility the 12 following: 13 ‘‘(1) Comprehensive, medically and factually ac- 14 curate, and unbiased written and oral information 15 about all methods of emergency contraception ap- 16 proved by the Food and Drug Administration. 17 ‘‘(2) Notification of the right of the sexual as- 18 sault survivor to confidentiality with respect to the 19 information and care and services furnished under 20 this section. 21 ‘‘(3) Upon request by the sexual assault sur- 22 vivor, emergency contraception or, if applicable, a 23 prescription for emergency contraception. 24 VerDate Sep 11 2014 00:02 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1049.IS S1049 pamtmann on DSKBFK8HB2PROD with BILLS 9 •S 1049 IS ‘‘(b) INFORMATION.—The Secretary shall ensure that 1 information provided pursuant to subsection (a) is pro- 2 vided in language that— 3 ‘‘(1) is clear and concise; 4 ‘‘(2) is readily comprehensible; and 5 ‘‘(3) meets such conditions (including condi- 6 tions regarding the provision of information in lan- 7 guages other than English) as the Secretary may 8 prescribe in regulations to carry out this section. 9 ‘‘(c) DEFINITIONS.—In this section: 10 ‘‘(1) The term ‘sexual assault’ means the con- 11 duct described in section 1565b(c)(1) of this title 12 that may result in pregnancy. 13 ‘‘(2) The term ‘sexual assault survivor’ means 14 any individual who presents at a military medical 15 treatment facility and— 16 ‘‘(A) states to personnel of the facility that 17 the individual experienced a sexual assault; 18 ‘‘(B) is accompanied by another person 19 who states that the individual experienced a 20 sexual assault; or 21 ‘‘(C) whom the personnel of the facility 22 reasonably believes to be a survivor of sexual 23 assault.’’. 24 VerDate Sep 11 2014 00:02 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1049.IS S1049 pamtmann on DSKBFK8HB2PROD with BILLS 10 •S 1049 IS (b) CLERICAL AMENDMENT.—The table of sections 1 at the beginning of such chapter is amended by inserting 2 after the item relating to section 1074o the following new 3 item: 4 ‘‘1074p. Provision of pregnancy prevention assistance at military medical treat- ment facilities.’’. SEC. 5. EDUCATION ON FAMILY PLANNING FOR MEMBERS 5 OF THE ARMED FORCES. 6 (a) EDUCATION PROGRAMS.— 7 (1) IN GENERAL.—Not later than one year 8 after the date of the enactment of this Act, the Sec- 9 retary of Defense shall establish a uniform standard 10 curriculum to be used in education programs on 11 family planning for all members of the Armed 12 Forces, including both men and women members, 13 during the following periods: 14 (A) The first year of service. 15 (B) When a member is in training to as- 16 sume command. 17 (C) When an enlisted member becomes a 18 senior enlisted member. 19 (2) SENSE OF CONGRESS.—It is the sense of 20 Congress that the education programs under para- 21 graph (1) should be evidence-informed and use the 22 latest technology available to efficiently and effec- 23 VerDate Sep 11 2014 00:02 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1049.IS S1049 pamtmann on DSKBFK8HB2PROD with BILLS 11 •S 1049 IS tively deliver information to members of the Armed 1 Forces. 2 (b) ELEMENTS.—The uniform standard curriculum 3 under subsection (a) shall include the following: 4 (1) Information for members of the Armed 5 Forces on active duty to make informed decisions re- 6 garding family planning. 7 (2) Information about the prevention of unin- 8 tended pregnancy and sexually transmitted infec- 9 tions, including human immunodeficiency virus 10 (commonly known as ‘‘HIV’’). 11 (3) Information on— 12 (A) the importance of providing com- 13 prehensive family planning for members of the 14 Armed Forces, including commanding officers; 15 and 16 (B) the positive impact family planning 17 can have on the health and readiness of the 18 Armed Forces. 19 (4) Current, medically accurate information. 20 (5) Clear, user-friendly information on— 21 (A) the full range of methods of contracep- 22 tion approved by the Food and Drug Adminis- 23 tration; and 24 VerDate Sep 11 2014 00:02 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1049.IS S1049 pamtmann on DSKBFK8HB2PROD with BILLS 12 •S 1049 IS (B) where members of the Armed Forces 1 can access their chosen method of contracep- 2 tion. 3 (6) Information on all applicable laws and poli- 4 cies so that members of the Armed Forces are in- 5 formed of their rights and obligations. 6 (7) In [Text truncated for display. Full text available on Congress.gov.]