Copyright 1999 Federal News Service, Inc.
Federal News Service
FEBRUARY 23, 1999, TUESDAY
SECTION: IN THE NEWS
LENGTH:
3203 words
HEADLINE: PREPARED STATEMENT BY
DR.
CLAUDE EARL FOX
ADMINISTRATOR, HEALTH RESOURCES AND SERVICES ADMINISTRATION
BEFORE THE HOUSE APPROPRIATIONS COMMITTEE
LABOR, HEALTH
AND HUMAN SERVICES AND EDUCATION SUBCOMMITTEE
SUBJECT - FISCAL YEAR 2000
PRESIDENT'S BUDGET REQUEST
FOR THE HEALTH RESOURCES AND SERVICES
ADMINISTRATION
BODY:
Mr. Chairman and Members
of the Committee:
I am pleased to appear before you today to discuss the
Fiscal Year 2000 budget request for the Health Resources and Services
Administration (HRSA). HRSA preserves and protects the health of Americans who
are too poor, too sick or too isolated to access the essential health care
services most of us take for granted.
HRSA opens doors to health care for
poor people, unemployed people, and for hardworking American individuals and
families who earn too much to be eligible for Medicaid, but not enough to afford
private health insurance. We support special programs that serve people with
HIV/AIDS and we work with States to ensure that all pregnant women and children
have access to health care. HRSA puts primary health care services in places
where they are sorely lacking rural communities, public housing complexes, and
urban areas where private health care systems are scarce or non-existent. We
also help to train physicians, nurses and other health care providers in these
communities where their services are so desperately needed.
HRSA helps to
assure that babies are born healthy, children are immunized, and adults receive
the kind of ongoing, preventive care that keeps them productive at work when
they are well--and out of expensive emergency rooms when they are sick.
We
are honored to be entrusted with such an important mission and justifiably proud
of what we have achieved.
But we are also concerned that the need is growing
for the kinds of programs and services HRSA supports. In 1997, more than 43
million Americans had no health insurance, according to the U.S. Census Bureau.
That number is expected to grow.
Already, we're seeing the costs of both
health care and health insurance rise sharply, rebounding from several years of
slowed growth.
Furthermore, we know that cost is not the only barrier to
health care that millions of low income Americans face. For the 62 million
people who live in rural areas, the obstacles are geographic. Their communities
lack the critical mass needed in today's health care marketplace. For the 78
million Americans who are racial and ethnic minorities, the hindrances may also
be cultural and linguistic -- they may be unable to find any health care
providers who literally or figuratively speak their language. Their plight is
further complicated by the documented disparities in health that make minorities
more vulnerable to certain diseases and less likely to receive services to
prevent or treat them.
Serious imbalance within the health care workforce,
in which African Americans, Hispanics, Asian and Pacific Islanders, American
Indians and Alaska Natives remain under-represented, further limits access to
care.
For all Americans who, for whatever reason, are medically underserved,
HRSA programs are the ultimate safety net. While this Congress and your
colleagues in State legislatures work to extend health insurance coverage to
more Americans, HRSA assures that high quality primary health care services are
in place to care for the newly insured and continues to serve the uninsured and
underserved.
Right now we are urgently working with the Health Care
Financing Administration and the States to implement the ambitious State
Children's Health Insurance Program that was established under the Balanced
Budget Act in August 1997. We anticipate that this landmark program will enroll
more than 2 million low income children by the end of 2000 - reducing by 20
percent the number of American children with no health insurance.
In FY
2000, HRSA intends to weave together an ever tighter health care safety net,
with more and better preventive and primary care services to reduce
hospitalization and prevent chronic disease and disability.
HRSA programs:
- expand access to care by eliminating economic, geographic and cultural
barriers;
- assist States and communities in meeting unmet health care
service needs and workforce gaps;
- develop partnerships with States,
communities and the private sector to promote effective, integrated systems of
care for underserved people; and
- recruit, train, and retain in service to
underserved communities a culturally and linguistically competent, racially and
ethically diverse health care workforce.
To accomplish this important work,
HRSA requests a total of $4.2 billion.
HEALTH CENTERS
Health Centers
comprise HRSA's Community Health Centers, Migrant Health Comers, Health Care for
Residents of Public Housing, and Health Care for the Homeless programs.
Collectively, these programs provide case-managed, family-oriented preventive
and primary health care services to nearly 9 million people, including 3.5
million children, who live in medically underserved rural and urban communities.
The request for health centers is $945 million, an increase of $20 million
over the FY 1999 appropriation. This includes $70 million for the President's
Initiative to Eliminate Racial Disparities in Health.
More than half-- 65
percent -- of health center patients are racial and ethnic minorities. By
tailoring services to the most pressing health problems in their own
communities, coordinating the services they provide, and making certain they are
accessible to all in need, health centers have achieved lower hospital admission
rates, shorter hospital stays, lower total annual Medicaid costs, and lower
infant mortality rates than the norm for similar patients who do not use health
centers.
In addition, health centers have proven to be a catalyst for
economic development. Health centers create jobs, attract health professionals
and facilities, and utilize local suppliers.
In FY 1998, HRSA grants to
health centers totaled $825 million - less than one-third of the total $3
billion health center budget when building in Medicaid and other health
insurance reimbursement, State, and local funding are included.
HRSA's
National Health Service Corps scholarship and loan repayment program for health
professionals is integral to the success of these vital health centers. In FY
1998, 40 percent of the Corps' 2,439 health care providers cared for patients in
health centers. The remaining 60 percent provided essential primary care in
like-minded free-standing, community-based sites.
Working in
partnership with State and community organizations, HRSA's health center and
National Health Service Corps programs provide high quality primary care and
also improve the social and economic environment in 3,000 communities
nationwide.
HIV/AIDS
U.S. AIDS-related mortality has decreased
dramatically in recent years due, in large part, to the care and treatment
services supported by Ryan White Comprehensive AIDS Related Emergency (CARE) Act
programs. The FY 2000 budget builds on this impressive record, continues the
President's Investment Initiative for Ryan White, and requests over $99 million
above the FY 1999 appropriation.
The budget continues to focus efforts on
bringing people with HIV/AIDS into care; prolonging their lives and
productivity; reducing their use of expensive emergency room and inpatient care;
expanding systems of care; and extending new, more effective drug therapies to
greater number of infected individuals. It also continues Departmental
initiatives to overcome the burden of HIV/AIDS in racial and ethnic minority
communities.
- for HIV Emergency Relief Grants to 51 eligible metropolitan
areas to increase their capacity to serve persons with low income, uninsured or
underinsured, a $16 million increase is requested, for a total of $521 million.
Eligible metropolitan areas use the funds for a wide range of community based
services such as outpatient health and social support services;
- for HIV
CARE Grants to States a $45 million increase, including $35 million for AIDS
Drug Assistance Programs, is requested. The total request is $783 million.
States rely on these funds to operate HIV service delivery consortia, to provide
home and community-based care, to continue insurance coverage, and to supply
pharmaceuticals that prolong health and slow physical deterioration. The $496
million earmarked for AIDS Drug Assistance Programs helps States to make
available to uninsured and underinsured people living with HIV/AIDS lifesaving
drug therapies;
- for Early Intervention Services an increase of $36 million
is requested, for a total of $130 million. With this increase we can fund early
intervention services program targeted at minorities in the 60 communities
provided with planning grant support in FY 1999; and
- for Pediatric/HIV
services an increase of $2 million, for a total of $48 million, is requested.
These grants create and support community- based care networks that serve
pregnant women, children, youth, and families; and provide educational materials
to women, children, youth, and families with HIV/AIDS and clinical guidelines to
the professionals who care for them.
The FY 2000 request also continues, at
nearly the FY 1999 level, the AIDS Education and Training Center program at $20
million and the AIDS Dental Reimbursement program at $8 million.
HEALTH
PROFESSIONS TRAINING
The President's budget for HRSA's health professions
training programs addresses two critical workforce issues that are both
essential to access to health care for underserved people and unlikely to be
resolved without HRSA's intervention: diversity and distribution.
HRSA's
efforts have demonstrated that health care providers who are themselves racial
and ethnic minorities are more likely to work in underserved communities. Yet
minorities continue to be severely under- represented within the health
professions.
Additionally, HRSA programs have documented that providing
health professions training in community-based settings and ensuring that health
professions have early and ongoing exposure to health care in underserved
communities increases the likelihood that graduates will choose careers in
communities with health professions shortages.
Consequently, HRSA health
professions training programs focus on alleviating the geographic
maldistribution of health providers and increasing the number of health
professionals who are racial and ethnic minorities. Diversity is a critical
element in funding and HRSA emphasizes support for Historically Black Colleges
and University, Hispanic Serving Institutions, and other institutions that train
substantial numbers of minority students.
Although less than 1 percent of
the overall Federal investment is in health professions training, HRSA programs
yield considerable return. While increasing the diversity and improving the
distribution of the health professions workforce, these programs simultaneously
provide cost-saving primary care to vulnerable people in public and private
health care facilities across the Nation.
HRSA has initiated a new,
comprehensive performance system that will enable us to quantify this yield far
into the future.Our FY 2000 request for these targeted health professions
programs is $212 million. Our aim is to build a more diverse health professions
workforce that is both prepared and motivated to serve the medically underserved
people in our Nation. The request also includes an additional $40 million for
the Children's Hospitals Graduate Medical Education Program, which will provide
a more adequate level of support for health professions training in U.S.
children's teaching hospitals.
MATERNAL AND CHILD HEALTH
In our Nation,
where 47 percent of the population is age 19 or younger or is a woman in the
childbearing years, from age 20 to 44, maternal and child health must be a
priority. HRSA improves the health of U.S. mothers and children through the
Maternal and Child Health Block Grant to States and related programs. The FY
2000 budget request for the block grant is $695 million, the same as the
comparable amount provided in FY 1999.
HRSA focuses on improving access to
health care for underserved Americans and our maternal and child health programs
are no exception. The Maternal and Child Health Services Block Grant supports a
partnership with States that serves all mothers and children by developing and
maintaining systems of care that adapt quickly to new developments in health
care, from the introduction of new vaccines, technologies, and treatments to the
emergence of new diseases and the evolution of the health care financing and
delivery systems.
The FY 2000 request includes:
- $581 million for block
grant awards to 50 States and U.S. territories, where the funds are used to
build infrastructure, provide population-based prevention services, and to
provide enabling services and direct care for women and children, including
children with special health care needs, who otherwise have inadequate access to
necessary health services;
- $102 million for Special Projects of Regional
and National Significance, which conduct services research and training, provide
genetic services, support hemophilia diagnostic and treatment centers, and
explore innovations in health care for mothers and children; and
- $12
million for Community-Integrated Service Systems, a set-aside that develops and
expands successful models of service delivery.
The FY 2000 request includes
$105 million, the same as the FY 1999 appropriation, to continue the Healthy
Start Initiative that supports underserved communities in meeting the medical,
behavioral and psychosocial needs of women and infants through community-based
systems of care.
CRITICAL CARE PROGRAMS
HRSA's FY 2000 budget combines
into a single administrative entity four programs: Emergency Medical Services
for Children, Traumatic Brain Injury, Trauma Care Emergency Medical Services,
and Poison Control Centers. The request includes a $2.5 million increase that
will provide $1 million to Trauma Care Emergency Medical Services, a joint
effort of HRSA and the National Highway Traffic Safety Administration (NHTSA) to
use recommendations developed in association with State EMS Directors and
emergency physicians to enhance awareness of relevant EMS issues such as
bioterrorism. The recommendations were developed from NHTSA's EMS Agenda for the
Future Initiative. The remaining $1.5 million will support the development and
assessment of uniform patient management guidelines for poison control centers.
UNIVERSAL NEWBORN HEARING SCREENING HRSA's FY 2000 budget
request includes a new proposal of $4 million for the Universal Newborn
Hearing Screening and Early Intervention Program.
This program
will provide grants to States to: (1) develop and expand statewide universal
newborn hearing screening programs; (2) link
screening programs to intervention within the community service
system; (3) monitor the impact of early detection and intervention on child,
family, and systems; and (4) provide technical assistance.
OFFICE OF RURAL
HEALTH POLICY
The Office of Rural Health Policy manages the Rural Hospital
Flexibility Program. The budget includes $25 million for grants to states to
assist them in implementing this program. States are working with small
hospitals which are candidates for conversion to rural Critical Access
Hospitals. This is a strategy for maintaining emergency and limited acute care
inpatient services in rural communities which can no longer sustain full service
hospitals.
OFFICE FOR THE ADVANCEMENT OF TELEHEALTH
HRSA established The
Office for the Advancement of Telehealth last year to promote the effective use
of telehealth technologies to improve access to both rural and urban health
services and health professions education. Modem health care increasingly
involves the effective use of telecommunications and information technology to
bring care to where the people are. The FY 2000 request is $13 million, the same
as the FY 1999 comparable amount.
FAMILY PLANNING
HRSA requests $240
million, a $25 million increase over FY 1999, for Family Planning. The increase
will enable the Title X program to support key Departmental initiatives,
including assuring a healthy start for every child by increasing the proportion
of pregnancies that are intended; promoting personal responsibility for healthy
lifestyles; and eliminating racial and ethnic disparities in health.
PROGRAM
MANAGEMENT
To make these worthy programs work at maximum efficiency, HRSA
has implemented an aggressive and successful effort to reduce operating costs
and increase productivity. Even as significant program appropriations have
increased, new programs have been initiated, and recent legislation has required
expanded performance measurement and reporting, HRSA has eliminated more than
300 program management FTEs since 1993, consistent with the President's goal of
reducing the size of the Federal workforce.
The FY 2000 program management
request is $122 million, an increase of $3 million over the FY 1999
appropriation.
ANNUAL PERFORMANCE PLAN
HRSA has made a strong effort to
build a performance management approach into the way it conducts its business.
The agency has gone through an internal strategic planning process, and has used
a preliminary set of long-term goals to guide the development of its Annual
Performance Plans. This Annual Performance Plan includes both a Revised Final FY
1999 Annual Performance Plan reflecting the FY 1999 appropriation, and the FY
2000 Plan.
HRSA has made a number of improvements in this version of the
Performance Plan. We have:
- improved the linkage to both the Department and
our own internal Strategic Plans;
- strengthened the quality of data sources
and information used to measure performance goals;
- streamlined and
consolidated the number of performance goals. The original FY 1999 Performance
Plan had approximately 150 goals. The revised FY 1999 Plan and the FY 2000 Plan
has some 86 goals. As we develop the FY 2001 budget, we expect further
development of cross- cutting and consolidated measures; and
- added
performance plans for six areas not included in the original FY 1999 Plan,
including: Nursing Loan Repayment, Children's Hospitals Graduate Medical
Education, Rural Hospital Flexibility Grants, Telehealth, Family. Planning, and
Program Management.
CONCLUSION
We in the U.S. enjoy the finest health
care in the world and we can only make it better by improving access to care for
those children, women, and men for whom health care remains outside their reach.
Lacking access to high quality, community-based health care, they get no
preventive care. Untreated, their illnesses become medical emergencies and they
end up requiring much more intensive, much more expensive care.
There are
pockets of need in every State. There are places -- like the 3,000 urban and
rural communities that are designated medically underserved. And there are
people -- like the 352,000 individuals reported to be living with HIV/AIDS, the
4 million babies born each year, and the 40 million people who live in health
professional shortage areas. We can do better by these people and these places,
and through HRSA's programs, we will.
Mr. Chairman and members of the
Committee, I will be pleased to address any questions or comments you may have
on the specifics of this budget request.
END
LOAD-DATE: February 25, 1999
