Access to Contraception for Servicemembers and Dependents Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 2091 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 HOUSE OF REPRESENTATIVES APRIL 4, 2019 Ms. SPEIER (for herself, Miss RICE of New York, Ms. MOORE, Mr. FOSTER, Mr. COHEN, Mr. CICILLINE, Ms. SCHAKOWSKY, Ms. DELAURO, Ms. WASSERMAN SCHULTZ, Mr. ESPAILLAT, Ms. JUDY CHU of California, Mr. VEASEY, Ms. JAYAPAL, Ms. NORTON, Mr. RASKIN, Mr. GALLEGO, Ms. DELBENE, Mr. GRIJALVA, Ms. DEGETTE, Ms. MATSUI, Mr. LARSEN of Washington, Mr. POCAN, Mr. BERA, Mr. PASCRELL, Mr. TAKANO, Mr. HIMES, Mr. BLUMENAUER, Mr. PRICE of North Carolina, Mr. NADLER, Ms. BROWNLEY of California, Ms. LEE of California, Mr. SCHIFF, Ms. BONAMICI, Mr. MCGOVERN, Ms. MENG, Mrs. NAPOLITANO, Mr. DEUTCH, Mr. WELCH, Ms. HAALAND, Mr. KILMER, Mr. YARMUTH, Mr. HASTINGS, Mr. DEFAZIO, Mr. SHERMAN, Ms. ROYBAL-ALLARD, Mr. RYAN, Mr. AGUILAR, and Ms. TITUS) introduced the following bill; which was 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 03:17 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2091.IH H2091 kjohnson on DSK79L0C42 with BILLS 2 •HR 2091 IH 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. 12 (2) Ninety-five percent of women serving in the 13 Armed Forces are of reproductive age. And as of 14 2017, more than 700,000 female spouses and de- 15 pendents of active duty members are of reproductive 16 age. 17 (3) The TRICARE program covered 1,563,727 18 women of reproductive age in 2017, including female 19 spouses and dependents of active duty members. 20 (4) The benefits of contraception are widely rec- 21 ognized and include improved health and well-being, 22 reduced global maternal mortality, health benefits of 23 pregnancy spacing for maternal and child health, 24 and women’s greater educational and professional 25 opportunities and increased lifetime earnings. 26 VerDate Sep 11 2014 03:17 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2091.IH H2091 kjohnson on DSK79L0C42 with BILLS 3 •HR 2091 IH (5) Studies have shown that when cost barriers 1 to the full range of methods of contraception are 2 eliminated, and women receive comprehensive coun- 3 seling on the various methods of contraception (in- 4 cluding highly effective and more expensive long-act- 5 ing reversible contraceptives), rates of unintended 6 pregnancy decline. 7 (6) Research has also shown that investments 8 in effective contraception save public and private 9 dollars. 10 (7) In order to fill gaps in coverage and access 11 to preventive care critical for women’s health, the 12 Patient Protection and Affordable Care Act (Public 13 Law 111–148) requires all non-grandfathered indi- 14 vidual and group health plans to cover without cost- 15 sharing preventive services, including a set of evi- 16 dence-based preventive services for women supported 17 by the Health Resources and Services Administra- 18 tion of the Department of Health and Human Serv- 19 ices. These women’s preventive services include the 20 full range of female-controlled contraceptive meth- 21 ods, effective family planning practices, and steriliza- 22 tion procedures, approved by the Food and Drug 23 Administration. The Health Resources and Services 24 Administration has affirmed that contraceptive care 25 VerDate Sep 11 2014 03:17 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2091.IH H2091 kjohnson on DSK79L0C42 with BILLS 4 •HR 2091 IH includes contraceptive counseling, initiation of con- 1 traceptive use, and follow-up care (such as manage- 2 ment, evaluation, and changes to and removal or dis- 3 continuation of the contraceptive method). 4 (8) Under the TRICARE program, women 5 members on active duty have full coverage of all pre- 6 scription drugs, including contraception, without 7 cost-sharing requirements, in line with the Patient 8 Protection and Affordable Care Act (Public Law 9 111–148), which requires coverage of all contracep- 10 tive methods approved by the Food and Drug Ad- 11 ministration for women and related services and 12 education and counseling. However, women members 13 not on active duty and female dependents of mem- 14 bers do not have similar coverage of all prescription 15 methods of contraception approved by the Food and 16 Drug Administration without cost-sharing when they 17 fill their prescriptions outside of a military medical 18 treatment facility. 19 (9) Studies indicate that women members need 20 comprehensive counseling for pregnancy prevention 21 and the lack thereof is contributing to unintended 22 pregnancies among women members. Additionally, 23 they need counseling on and availability of contra- 24 ception for non-contraceptive benefits (for example, 25 VerDate Sep 11 2014 03:17 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2091.IH H2091 kjohnson on DSK79L0C42 with BILLS 5 •HR 2091 IH menstrual suppression and predictable menstrual 1 patterns) which is important in ensuring readiness 2 for deployment to remote or operational theaters. 3 (10) Research studies based on the Department 4 of Defense Survey of Health Related Behaviors 5 Among Active Duty Military Personnel found a high 6 rate of unintended pregnancy among women mem- 7 bers. Adjusting for the difference between age dis- 8 tributions in the Armed Forces and the general pop- 9 ulation, the rate of unintended pregnancy among 10 women members is higher than among the general 11 population. 12 (11) The Defense Advisory Committee on 13 Women in the Services has recommended that all 14 the Armed Forces, to the extent that they have not 15 already, implement initiatives that inform members 16 of the importance of family planning, educate them 17 on methods of contraception, and make various 18 methods of contraception available, based on the 19 finding that family planning can increase the overall 20 readiness and quality of life of all members of the 21 military. 22 (12) The military departments received more 23 than 6,700 reports of sexual assaults involving mem- 24 bers as victims or subjects during fiscal year 2017. 25 VerDate Sep 11 2014 03:17 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2091.IH H2091 kjohnson on DSK79L0C42 with BILLS 6 •HR 2091 IH Through regulations, the Department of Defense al- 1 ready supports a policy of ensuring that women 2 members who are sexually assaulted have access to 3 emergency contraception, and the initiation of con- 4 traception if desired and medically appropriate. 5 SEC. 3. CONTRACEPTION COVERAGE PARITY UNDER THE 6 TRICARE PROGRAM. 7 (a) IN GENERAL.—Section 1074d of title 10, United 8 States Code, is amended— 9 (1) in subsection (a), by inserting ‘‘FOR MEM- 10 BERS AND FORMER MEMBERS’’ after ‘‘SERVICES 11 AVAILABLE’’; 12 (2) by redesignating subsection (b) as sub- 13 section (d); and 14 (3) by inserting after subsection (a) the fol- 15 lowing new subsections: 16 ‘‘(b) CARE RELATED TO PREVENTION OF PREG- 17 NANCY.—Female covered beneficiaries shall be entitled to 18 care related to the prevention of pregnancy described by 19 subsection (d)(3). 20 ‘‘(c) PROHIBITION ON COST-SHARING FOR CERTAIN 21 SERVICES.—Notwithstanding section 1074g(a)(6), section 22 1075, or section 1075a of this title or any other provision 23 of law, cost-sharing may not be imposed or collected for 24 care related to the prevention of pregnancy provided pur- 25 VerDate Sep 11 2014 03:17 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2091.IH H2091 kjohnson on DSK79L0C42 with BILLS 7 •HR 2091 IH suant to subsection (a) or (b), including for any method 1 of contraception provided, whether provided through a fa- 2 cility of the uniformed services, the TRICARE retail phar- 3 macy program, or the national mail-order pharmacy pro- 4 gram.’’. 5 (b) CARE RELATED TO PREVENTION OF PREG- 6 NANCY.—Subsection (d)(3) of such section, as redesig- 7 nated by subsection (a)(2) of this section, is further 8 amended by inserting before the period at the end the fol- 9 lowing: ‘‘(including all methods of contraception approved 10 by the Food and Drug Administration, contraceptive care 11 (including with respect to insertion, removal, and follow 12 up), sterilization procedures, and patient education and 13 counseling in connection therewith)’’. 14 (c) CONFORMING AMENDMENT.—Section 15 1077(a)(13) of such title is amended by striking ‘‘section 16 1074d(b)’’ and inserting ‘‘section 1074d(d)’’. 17 SEC. 4. PREGNANCY PREVENTION ASSISTANCE AT MILI- 18 TARY MEDICAL TREATMENT FACILITIES FOR 19 SEXUAL ASSAULT SURVIVORS. 20 (a) IN GENERAL.—Chapter 55 of title 10, United 21 States Code, is amended by inserting after section 1074o 22 the following new section: 23 VerDate Sep 11 2014 03:17 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2091.IH H2091 kjohnson on DSK79L0C42 with BILLS 8 •HR 2091 IH ‘‘§ 1074p. Provision of pregnancy prevention assist- 1 ance at military medical treatment facili- 2 ties 3 ‘‘(a) INFORMATION AND ASSISTANCE.—The Sec- 4 retary of Defense shall promptly furnish to sexual assault 5 survivors at each military medical treatment facility the 6 following: 7 ‘‘(1) Comprehensive, medically and factually ac- 8 curate, and unbiased written and oral information 9 about all methods of emergency contraception ap- 10 proved by the Food and Drug Administration. 11 ‘‘(2) Notification of the right of the sexual as- 12 sault survivor to confidentiality with respect to the 13 information and care and services furnished under 14 this section. 15 ‘‘(3) Upon request by the sexual assault sur- 16 vivor, emergency contraception or, if applicable, a 17 prescription for emergency contraception. 18 ‘‘(b) INFORMATION.—The Secretary shall ensure that 19 information provided pursuant to subsection (a) is pro- 20 vided in language that— 21 ‘‘(1) is clear and concise; 22 ‘‘(2) is readily comprehensible; and 23 ‘‘(3) meets such conditions (including condi- 24 tions regarding the provision of information in lan- 25 VerDate Sep 11 2014 03:17 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2091.IH H2091 kjohnson on DSK79L0C42 with BILLS 9 •HR 2091 IH guages other than English) as the Secretary may 1 prescribe in regulations to carry out this section. 2 ‘‘(c) DEFINITIONS.—In this section: 3 ‘‘(1) The term ‘sexual assault survivor’ means 4 any individual who presents at a military medical 5 treatment facility and— 6 ‘‘(A) states to personnel of the facility that 7 the individual experienced a sexual assault; 8 ‘‘(B) is accompanied by another person 9 who states that the individual experienced a 10 sexual assault; or 11 ‘‘(C) whom the personnel of the facility 12 reasonably believes to be a survivor of sexual 13 assault. 14 ‘‘(2) The term ‘sexual assault’ means the con- 15 duct described in section 1565b(c) of this title that 16 may result in pregnancy.’’. 17 (b) CLERICAL AMENDMENT.—The table of sections 18 at the beginning of such chapter is amended by inserting 19 after the item relating to section 1074o the following new 20 item: 21 ‘‘1074p. Provision of pregnancy prevention assistance at military medical treat- ment facilities.’’. SEC. 5. EDUCATION ON FAMILY PLANNING FOR MEMBERS 22 OF THE ARMED FORCES. 23 (a) EDUCATION PROGRAMS.— 24 VerDate Sep 11 2014 03:17 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2091.IH H2091 kjohnson on DSK79L0C42 with BILLS 10 •HR 2091 IH (1) IN GENERAL.—Not later than one year 1 after the date of the enactment of this Act, the Sec- 2 retary of Defense shall establish a uniform standard 3 curriculum to be used in education programs on 4 family planning for all members of the Armed 5 Forces, including both men and women members, 6 during the following periods: 7 (A) The first year of service. 8 (B) When a member is in training to as- 9 sume command. 10 (C) When an enlisted member becomes a 11 senior enlisted member. 12 (2) SENSE OF CONGRESS.—It is the sense of 13 Congress that the education programs under para- 14 graph (1) should be evidence-informed and use the 15 latest technology available to efficiently and effec- 16 tively deliver information to members of the Armed 17 Forces. 18 (b) ELEMENTS.—The uniform standard curriculum 19 under subsection (a) shall include the following: 20 (1) Information for members of the Armed 21 Forces on active duty to make informed decisions re- 22 garding family planning. 23 (2) Information about the prevention of unin- 24 tended pregnancy and sexually transmitted infec- 25 VerDate Sep 11 2014 03:17 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2091.IH H2091 kjohnson on DSK79L0C42 with BILLS 11 •HR 2091 IH tions, including human immunodeficiency virus 1 (commonly known as ‘‘HIV’’). 2 (3) Information on— 3 (A) the importance of providing com- 4 prehensive family planning for members, includ- 5 ing commanding officers; and 6 (B) the positive impact family planning 7 can have on the health and readiness of the 8 Armed Forces. 9 (4) Current, medically accurate information. 10 (5) Clear, user-friendly information on— 11 (A) the full range of methods of contracep- 12 tion approved by the Food and Drug Adminis- 13 tration; and 14 (B) where members can access their cho- 15 sen method of contraception. 16 (6) Information on all applicable laws and poli- 17 cies so that members are informed of their rights 18 and obligations. 19 (7) Information on patients’ rights to confiden- 20 tiality. 21 (8) Information on the unique circumstances 22 encountered by members and the effects of such cir- 23 cumstances on the use of contraception. 24 Æ VerDate Sep 11 2014 03:17 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\H2091.IH H2091 kjohnson [Text truncated for display. 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