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May 9, 2000

H.R. 4386 - Breast and Cervical Cancer Treatment Act
(Reps. Myrick (R) NC, Danner (D) MO, and Lazio (R) NY)

The Administration strongly supports the provisions of H.R. 4386 that would allow States to provide full Medicaid benefits to uninsured women whose cancers are detected through a certain federally funded screening program. This proposal, which was included in the President's FY 2001 Budget, would help States eliminate the barriers low-income women face to getting treatment for breast or cervical cancer.

The Administration has no objection to House passage of H.R. 4386, but will work with the Senate to address a number of concerns with provisions of the bill relating to condom labeling and human papillomavirus (HPV) screening programs.

Many of the provisions of H.R. 4386 concerning HPV will strengthen public health efforts to prevent HPV infection. Unfortunately, the provisions of the bill requiring labeling of condoms and providing information on condom effectiveness in all informational materials related to condoms or sexually transmitted diseases (STDs) will be problematic and potentially counterproductive to prevention efforts.

The Administration supports the goal of better informing the public about HPV and the fact that the use of condoms may not fully prevent HPV transmission. Public education, however, should be conducted in a manner to increase awareness about the issue while not confusing the public about when condoms are effective. It is well-documented that condoms are an effective method of preventing transmission of HIV and other STDs. In addition, requiring that information on condom effectiveness be provided on all STD informational materials could be confusing and contrary to the intent of the materials (e.g., materials related to "abstinence only" education).

The goal of HPV prevention efforts should be educating Americans about enhancing their ability to protect and preserve their health in a way that does not confuse them about means of protecting themselves from other STDs such as HIV.

Pay-As-You-Go Scoring

H.R. 4386 would increase direct spending; therefore, it is subject to the pay-as-you-go requirement of the Omnibus Budget and Reconciliation Act of 1990. The bill's provisions allowing Medicaid treatment for breast or cervical cancer would increase direct spending by $15 million in FY 2001 and a total of $220 million during FYs 2001-2005. The bill does not contain provisions to offset the increased direct spending. Therefore, if the bill were enacted, its net budget costs could contribute to a sequester of mandatory programs. The Administration supports the Medicaid benefit provisions of the bill and will work with the Congress to avoid a sequester.