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Congressional Testimony
February 08, 2000
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 16107 words
HEADLINE:
TESTIMONY February 08, 2000 DONNA E. SHALALA SECRETARY OF HEALTH AND HUMAN
SERVICES HOUSE APPROPRIATIONS LABOR, HEALTH AND HUMAN SERVICES,
AND EDUCATION LABOR HHS APPROPRIATIONS
BODY:
Testimony of The Honorable Donna Shalala U.S. Secretary of Health and Human
Services before the Subcommittee on Labor, Health and Human Services, Education
and Related Agencies Committee on Appropriations United States House of
Representatives February 8, 2000 Good morning, Chairman Porter, Congressmen
Obey, and members of the Subcommittee. I am pleased to appear before you today
to discuss the President's FY 2001 budget for the Department of Health and Human
Services. A PROUD HISTORY Before I discuss our plans for confronting the
challenges that lie ahead, I think it is important first to take a look back at
where we have been. Over the past seven years, we have worked together to
develop innovative solutions, that have improved the health and well being of
all Americans. Let me note just a few of these accomplishments: Working
together, we have expanded enrollment in Head Start from approximately 714,000
children in 1993 to an estimated 950,000 in this budget, while at the same time
improving the quality of the program, thereby providing a strong foundation for
success for hundreds of thousands of low-income children. Two years ago, the
President called for an increase of almost 50 percent over five years in the NIH
budget as part of his Research for America Fund. Since that time the NIH budget
has increased by over $4.2 billion and with the funding proposed by the
President this year, we will be ahead of schedule in reaching our goal. In
addition, we have increased the number of Research Project Grants funded by the
National Institutes of Health by over 30 percent, from 23,952 in FY 1993 to
31,524 in this budget. This represents a dramatic expansion of our scientific
knowledge base that will pave the way for biomedical advances in the years
ahead. We have nearly tripled the number of people receiving access to
combination drug therapy under the Ryan White Care Act AIDS
Drug Assistance Program (ADAP), from almost 49,000 in 1994 to approximately 14
1,000 with this budget. We have improved the health of our seniors by increasing
the number of healthy meals served to older Americans under the Administration
on Aging's Nutrition programs from 240 million in FY 1994 to 279 million in this
budget year. With the enactment of the Health Insurance Portability and
Accountability Act of 1996, we have helped individuals keep their insurance when
they change jobs, guaranteed renewability of coverage, and helped ensure access
to health insurance for small business. Together with the states, we have
undertaken the largest health care coverage initiative since Medicare, namely
the State Children's Health Insurance Program. In just the two years since its
enactment, the number of children enrolled in SCHIP -- now almost 2 million --
has doubled. In addition, the number of states covering children up to 200
percent of poverty has increased by more than sevenfold. Last year, the
President signed into law the bipartisan Ticket to Work and Work Incentives
Improvement Act that allows people with disabilities to maintain their Medicare
and Medicaid coverage when they go to work. It also includes a new demonstration
program that allows people with disabilities who are still working and are not
sufficiently disabled to qualify for Medicaid to obtain coverage and reforms the
training system for people with disabilities. We created the Vaccines for
Children Program, to finance immunizations for children without private health
coverage. Childhood immunization coverage rates in 1998 were the highest ever
recorded. Ninety percent of toddlers in 1996, 1997 and 1998 received the most
critical doses of each of the routinely recommended vaccines, surpassing the
President's 1993 goal. We have also undertaken a number of new initiatives to
target emerging threats and address long- standing problems. We have launched
new initiatives to promote research on disease prevention and health care
quality, to improve the quality of nursing home care, to provide support for our
nation's children's hospitals, and to increase the number of children adopted
from our child welfare systems. To educate Medicare beneficiaries about their
health care options, we have implemented the largest peacetime outreach campaign
ever undertaken by the federal government. We have stepped up efforts to
increase the availability of substance abuse treatment, to eliminate racial and
ethnic health disparities, and to address the AIDS crisis in minority
communities. And we have invested significant resources to prepare the nation to
respond to the medical and public health consequences of chemical and
bioterrorist attacks. We have launched new initiatives to protect the rights of
Americans in managed care and protect the privacy of electronic medical records
held by health plans, health care clearinghouses, and health care providers.
While we should be proud of past accomplishments, we must continue to address
ongoing health and human services challenges. These include: expanding access to
quality health care and extending protections to the uninsured and at-risk;
supporting working families and bettering the lives of our nation's children;
encouraging greater scientific advancement; and creating a healthier America.
Thanks to our continuing economic prosperity, we have a great opportunity to
meet these challenges. In the last two years, we have recorded back-to-back
surpluses for the first time since the 1950's. The combination of a strong
economy, fiscal discipline, and unprecedented advances in our scientific
knowledge give us the opportunity to make the investments needed to build on all
of our achievements over the last seven years. Mr. Chairman, the total HHS
budget request for FY 2001 is $421.4 billion (Outlays). The amount before this
subcommittee totals $267 billion (BA), of which $44.8 billion is discretionary.
This discretionary component represents an increase of $4.5 billion over last
year. Let me now highlight the main components of our FY 2001 budget request.
EXPANDED HEALTH CARE COVERAGE We live in an age of remarkable advances in the
biomedical sciences. Yet too many of our citizens are denied the benefits of
these advances because they lack access to quality, affordable health care.
Throughout his Administration, President Clinton has made expanding access to
health care one of his most important goals. Working with the Congress, we have
had some notable successes, including enactment of the State Children's Health
Insurance Program, which today covers nearly 2 million children; the Health
Insurance Portability and Accountability Act, which allows workers to keep
health insurance coverage when they change jobs and limits the ability of
insurers to deny coverage based on pre-existing conditions; and most recently,
the Ticket to Work and Work Incentives Improvement Act, which allows disabled
Americans to return to work without losing their Medicare and Medicaid coverage.
But even with these successes, approximately one-seventh of the population still
lacks health insurance. Our budget seeks to address these problems through a
number of initiatives designed not only to expand access to care but to improve
the quality of health care as well. Expanding Coverage under Medicaid and SCHIP
The State Children's Health Insurance Program (SCHIP), enacted in 1997, now
provides nearly two million low-income, uninsured children with access to health
insurance, preventive medicine, and immunizations. While the success of the
SCHIP program has greatly enhanced the health of these children, many of their
parents remain uninsured. And there still are many children who are eligible for
Medicaid and SCHIP who are not currently enrolled. With the country's resources
growing, the economy booming, and the SCHIP program showing great progress, it
makes sense to take advantage of this opportunity to implement new options for
low- income working families without health insurance. The President's budget
includes proposals to create a new "FamilyCare" program that expands coverage to
the parents of children eligible for Medicaid and SCHIP, increase outreach
efforts, and simplify the enrollment process. Under FamilyCare, parents would be
enrolled in the same programs as their children, and states would receive the
higher SCHIP matching payments for expanding coverage to parents. To ensure that
the original intent of the SCHIP program is met, states would be required to
expand eligibility for children up to 200 percent of poverty before accessing:
funds to cover parents. As is the case with children, priority in enrollment
would be given to lower-income parents before covering higher-income parents.
If, after five years, some states have not expanded coverage of parents to at
least 100 percent of poverty, they would then be required to do so. By 2006, all
poor parents would be eligible for coverage just as their children are today. We
believe that enrolling parents in Medicaid or SCHIP will not only improve their
health, but will also make it easier for entire families to access insurance
through one source, thereby increasing the number of children participating in
the program. This FamilyCare initiative is a practical, targeted approach to
encouraging greater insurance coverage. Over eighty percent of parents of
uninsured children under 200 percent of poverty are themselves uninsured, while
nearly two-thirds of uninsured parents (6.5 million) have children eligible for
Medicaid or SCHIP. The budget proposes to extend and improve the transitional
Medicaid program, which provides important health insurance coverage for
families moving from welfare to work. Our proposals would use existing state
administrative and delivery systems and no new bureaucracies would be needed. In
addition to covering parents, states also will be given the option to extend
Medicaid coverage to young people ages 19 and 20. If they do, they will also
have the option to cover kids up to age 20 under SCHIP. To further increase
Medicaid and SCHIP enrollment, the President's budget supports new efforts to
simplify eligibility and aggressively expand efforts to enroll eligible children
identified through school lunch programs. To ensure that children are not
overlooked in States that have different rules and procedures for Medicaid and
SCHIP, we also propose to require that States conform certain eligibility rules
between Medicaid and SCHIP. Our budget also proposes $10 million in mandatory
funding for competitive grants to States that develop innovative plans for
outreach to the homeless and the coordination of services across the Medicaid,
SCHIP, TANF, Food Stamps, and Mental Health and Substance Abuse programs. If
they do, they also will have the option to cover kids up to age 20 under SCHIP.
Finally, our budget seeks to reverse some of the inequities that have resulted
from the 1996 welfare reform legislation by giving states the option to provide
Medicaid or SCRIP coverage to legal immigrant children and pregnant women. The
budget also proposes to restore SSI and Medicaid eligibility to legal immigrants
who entered the United States after the enactment of welfare reform, become
disabled and live in the U.S. for five years. Parents of legal immigrant
children would also be eligible for coverage under our FamilyCare proposal. In
addition, the budget seeks to restore Food Stamps eligibility to legal
immigrants who were in the country before the enactment of welfare reform and
either subsequently reach age 65 or have children who are eligible for Food
Stamps. In addition, the budget will take an important step to improve the
health of low-income Americans by ensuring that they have access to drugs that
help them quit smoking. The budget will ensure every state Medicaid program
covers both prescription and non-prescription smoking cessation drugs, removing
a special exclusion now in law, and requiring states to cover these drugs as
they cover all other FDA-approved drugs. Modernizing and Strengthening Medicare
For the last thirty-five years, Medicare has been the cornerstone of our efforts
to ensure that all seniors have access to the quality health care they need and
deserve. However, since its enactment in 1965, much in the health care system
has changed, not only the types of care provided and the setting in which these
services are performed, but also the makeup of the population that receives
Medicare. These changes have dramatically increased the financial strains on the
Medicare program, and current actuarial projections show that by approximately
2015, just as the large baby-boom generation is becoming eligible, Medicare may
be faced with insolvency. The Clinton-Gore Administration budget also dedicates
$432 billion over ten years to Medicare to extend the solvency of the Trust Fund
until at least 2025 and to create a voluntary, affordable prescription drug
benefit. It includes a new, multi-billion dollar reserve fund that can be used
to add protections against catastrophic drug costs to the President's proposed
drug benefit. This financing commitment is part of a comprehensive plant to
modernize and strengthen Medicare to ensure that it can continue to deliver high
quality, affordable care in the 21st Century. These steps include making the
program more competitive; introducing private sector purchasing and management
tools; and continuing our historic fight against fraud, waste, and abuse. Over
the last thirty-five years, the development of new prescription drugs to treat a
variety of conditions has helped Americans to live longer and higher quality
lives. The centerpiece of the President's plan to modemize Medicare is a
voluntary prescription drug benefit that would be affordable and accessible to
all beneficiaries. This benefit, which would rely on market competition to
obtain lower prices, would have no deductible, and would pay half of all costs
up to $2,000 in FY 2003, increasing to $5,000 by FY 2009. The plan would fully
pay for costs for beneficiaries with incomes below 135 percent of the poverty
level, and provide premium assistance for those with incomes between 135 and 150
percent of the poverty level, while providing financial incentives to employers
to continue offering prescription drug benefits to current retirees. The
President's budget also proposes much-needed incentives to increase the
utilization of preventive services by Medicare beneficiaries. Our plan would
eliminate existing coinsurance and deductibles for covered preventive benefits,
including colorectal and prostate cancer screenings, pelvic exams,
mammographies, bone mass measurement, and diabetes self- management. The
President also is planning to develop a three- year demonstration for smoking
cessation services. By lowering the cost and expanding the availability of these
services, we will not only save lives, but will minimize the need for more
extensive, and expensive, treatments in the future. While we work to strengthen
Medicare to better serve current beneficiaries, our budget also includes
proposals to expand access to Medicare to groups who face barriers to health
insurance coverage. These proposals will allow Americans ages 62 to 65 to buy
into Medicare by paying a premium, provide a similar buy-in option for displaced
workers ages 55 to 62 who have lost employer-provided health coverage, and
provide COBRA coverage to retirees between the ages of 55 and 65 whose companies
have reneged on their promise to provide health benefits. To make these buy-in
options more affordable, the budget includes a proposal for a tax credit,
available to displaced workers over age 55 as well as all eligible persons ages
62 to 64, that would be equal to 25 percent of the buy-in premiums. As important
as our efforts to modernize the Medicare benefit package are, Medicare
recipients will be able to realize the full benefits of these new services only
when we give equal attention to strengthening and modernizing the management of
our health programs. The President's budget continues efforts to improve the
Health Care Financing Administration's (HCFA) management, building on the
five-part reform plan advanced last year to increase flexibility while also
increasing accountability. Our budget also maintains our commitment to fighting
fraud and abuse, investing in a new Medicare contractor oversight initiative to
address a number of concerns outlined in OIG and GAO reports last year. This
initiative includes funding to improve evaluation of program operations,
establish financial management controls at each contractor, develop an
integrated general ledger accounting system that will ensure clean audit
opinions into the future, and monitor and oversee these changes at all
contractors. These actions will augment our already successful efforts at
combating fraud, waste, and abuse in the Medicare and Medicaid programs. As many
of you may already be aware, the Department of Justice recently announced that,
in conjunction with HHS, it had achieved a $486 million settlement with a
national health provider that had been defrauding the Medicare program. This
action is in addition to results reported in latest Health Care Fraud and Abuse
Control account report that indicated that $490 million had been collected as a
result of successful prosecutions in 1999. Of that amount, $369 million was
returned to the Medicare trust funds. In addition, the Medicare Integrity
Program reported an increase of 25 percent in total overpayments prevented and
identified in the first six months of FY 1999 compared to the same period the
year before. These successful efforts are why the latest Medicare Trustees'
Report included this Administration's fraud and abuse efforts as a contributing
factor in slowing the rate of growth of the Medicare program. Increasing Access
to Health Care for Uninsured Individuals Those who lack health insurance are
often forced to rely on emergency rooms or ad-hoc networks of facilities and
individual health professionals for whatever care they are able to receive, or
to forgo any health care at all. Last year, the President's budget requested $25
million to launch a new initiative to help community health clinics, public
hospitals, academic health centers, and other institutions serving the poor to
create new systems of comprehensive and coordinated care that uninsured workers
and their families could depend on, and this Committee responded by fully
funding this request. To continue this effort, this year the President is
proposing to increase funding for this initiative to $125 million. This increase
will allow as many as 40 to 60 additional communities to receive grants to
improve the capacity of safety-net providers. The President's budget also
continues to provide strong support for the nation's Community Health Centers,
which provide care to nearly 10 million low-income and uninsured individuals in
rural and inner city areas. Our budget requests $1.1 billion to support
Community Health Centers, an increase of $50 million over last year. Long-Term
Care With more Americans now living longer than ever before, one of the most
pressing demands we face is the increasing need for long-term care services.
Studies show that the great majority of individuals who need long-term care
prefer to remain in their own homes and communities rather than receive care in
institutional settings, but this places a heavy burden on the family members and
friends who must provide supports for them. More than half of these caregivers
are women, and one-third have full time jobs. Our budget seeks to address the
pressing need for new long- term care solutions through a multi-faceted
initiative designed to help both the millions of Americans who require long-term
care and those who care for them. Our budget invests $125 million to support
family caregiver activities in the Administration on Aging (AoA). This
initiative will provide States and local communities with the flexibility to
design and provide caregiver support activities to approximately 250,000
families nationwide who are caring for elderly relatives with chronic diseases
and disabilities. Services provided will include quality respite care,
information about local services, counseling, and training for complex care
needs. The budget also proposes $140 million over five years to expand access to
home and community- based care services under Medicaid through an option to
equalize income eligibility standards for those who need institutional care but
choose to live in the community. This long-term care initiative also includes a
$3,000 tax credit to provide support for those with long term care needs and
those who care for a disabled or elderly relative; an innovative housing
initiative to integrate assisted living facilities and Medicaid home and
community based care settings; and a program to provide Federal employees and
their families with the opportunity to purchase private long- term care
insurance though a group plan. Nursing Home Quality Initiative As we begin to
develop a support system for those who choose to receive long term-care in home
and community-based settings, we must also continue to ensure that nursing home
residents are receiving the highest quality care possible. The FY 2001 budget
includes $71 million for continuing quality monitoring activities in last year's
budget to improve federal and state oversight of nursing homes. Now in its third
year, this initiative supports the efforts of states to strengthen enforcement
and oversight of nursing home quality and to crack down on those who repeatedly
violate program standards. Expanding on activities already underway, funding
will support increased surveys of repeat offenders, improved training for
surveyors, and enhanced legal services including resolution of the backlog of
appeals. RENEWED SUPPORT FOR CHILDREN AND FAMILIES Mr. Chairman, these
investments in health care access and quality, in improving our public health
system, and in broadening our scientific knowledge, are all fundamental to
making sure that the new century is a time of good health and prosperity for all
Americans. But just as we honor our commitments in the health arena, we also
keep our commitments to improving the lives of the nation's children and
families. The President's budget keeps our promise to work toward an America
where every child, and every family, has the opportunity to succeed at work, at
school, and at home. Improving Access, Affordability, and Quality of Child Care
For the millions of American families in which parents must work to support
their children, the availability of child care is often the difference between
self- sufficiency and dependency. But even though funding for child care has
doubled under the Clinton Administration, recent studies showed that in FY 1998
only ten percent of the children potentially eligible for federal child care
subsidies received them. As we have said before, no parent should be forced to
choose between the job they need and the child they love. We must take steps to
close this gap and help all parents find child care that is safe, reliable, and
affordable. As we close this gap, we also must continue to improve child care
quality. Study after study has shown that safe, quality child care is essential
to the healthy development of our children. But the lack of quality care has
forced too many parents to place their children in less than desirable settings,
and even low quality care can place a heavy financial burden on low-income
families. The President's budget builds on our ongoing efforts to remedy these
deficiencies with a comprehensive initiative designed to not only make child
care more affordable but also to improve the quality of care. Our FY 2001 budget
requests an additional $817 million, for a total of $2 billion, for the Child
Care and Development Block Grant. This increase will provide child care
subsidies to almost 150,000 additional low-income children. Also included in the
$2 billion total is $223 million to improve the quality of care, of which $50
million is for infant and toddler quality care efforts; $19 million is for
school-aged care and resource and referral activities; and $10 million is for
ongoing research, demonstration, and evaluation programs. Our budget also
proposes an increaseof$3billioninmandatoryfundingoverfiveyears,including$600m
illioninFY200l, to establish an Early Learning Fund. This fund will provide
money to states to offer community level challenge grants for programs that
improve childhood development and school readiness and the quality and safety of
care. The President's Child Care Initiative also includes critical increases for
activities in the Departments of Treasury and Education. Enhancing Head Start
Since its enactment thirty-five years ago, the Head Start program has been one
of our greatest success stories, ensuring that millions of low-income children
start school ready to learn. In 1993, the Clinton Administration set the goal of
enrolling one million children in Head Start by FY 2002. The President's $6.3
billion request for FY 2001, an increase of $1 billion, will keep us on track to
realize this goal, increasing the number of children enrolled to nearly 950,000.
A portion of these funds will be reserved for grants to unserved and
under-served populations. Consistent with the focus of the 1998 reauthorization
of Head Start to improve the quality of services, $418 million of the proposed
increase will be targeted for reducing class size, improving facilities, staff
training, and school readiness; obtaining safer and better equipment; and
attracting and retaining top-quality staff. Finally, our Head Start budget
request includes $564 million for the Early Head Start program, which will
provide 54,000 infants and toddlers and their families with continuous and
comprehensive child development and family support services. Increasing Parental
Responsibility through Child Support Enforcement One of the key underpinnings of
this Administration's support for working families is the idea of encouraging
personal responsibility. Nowhere is this more evident than in our actions to
step up child support enforcement, which is a critical support for children and
families. Child support collections have almost doubled since 1992, reaching an
estimated level of $15.5 billion in FY 1999. Our package of child support
enforcement proposals is self- financing and it increases collections to
families by more than $1.8 billion over five years. These proposals build on our
success in the program through changes designed to give states new options to
get more money to families and to improve enforcement tools to increase
collections. These actions are part of a comprehensive Administration initiative
to promote ensure that non-custodial parents who can afford to pay child support
do so, and helping low-income non- custodial parents go to work so that they can
support their children through "Fathers Work" grants in the Department of Labor
is budget. Under one proposal, we would match State efforts to allow families
still working their way off welfare to keep a portion of the child support they
are owed, increasing payments to these families by $388 million over five years.
A second proposal provides States the option to simplify their rules for
distributing child support to a system where families that have left welfare
will keep all the child support paid by the non-custodial parent, resulting in
increased payments to families of $815 million over five years. Both of these
proposals build on our Family First distribution policies. Our package also
includes proposals for better enforcement techniques and program improvements
that will save the Federal government nearly $600 million over five years while
increasing payments to families by over $650 million. Ensuring Continued
Educational Excellence in the Nation's Children's Hospitals As we move to
increase the number of children with health insurance, we also must continue our
efforts to ensure that all children receive the highest quality care. Expertly
trained pediatricians are a critical ingredient in providing high quality care
to children, and children's hospitals play an essential role in their education,
training over 25 percent of all pediatricians and the majority of pediatric
specialists. Last year, the President proposed, and this committee funded, a new
$40 million program to support the vital role children's hospitals play in
training physicians. This year, our budget proposes to double this amount,
providing $80 million to raise support for approximately 60 free-standing
children's hospitals to a level more consistent with other teaching hospitals.
Advancing Innovative Treatments for Asthma Approximately 5 million of our
nation's children suffer with asthma, and children from low- income families are
disproportionately affected. What makes this particularly disconcerting is that
the number of children afflicted has doubled over the past 15 years, with the
sharpest increases in rates among children under age 5. Asthma is a leading
cause of school absenteeism, and children who suffer from asthma are often
forced to limit their activities. To address this growing health problem, our
budget proposes $ 100 million over two years in demonstration grants to states
to test innovative asthma disease management techniques for children enrolled in
Medicaid and SCHIP. Through appropriate clinical disease management, these
programs will attempt to reduce asthma related incidents and keep children with
asthma out of emergency rooms and in school. Expanding Substance Abuse
Activities Even with all our efforts over the last few years to expand the
availability of services to those addicted to drugs and alcohol, there continues
to be a significant gap between the need for substance abuse treatment and the
capacity available to provide treatment. Estimates by the Office of National
Drug Control Policy show that less than half of the five million individuals who
need substance abuse treatment actually receive these services. To further close
this gap, the President's budget includes a total of $3.3 billion in HHS for
substance abuse treatment and prevention, including $2 billion to support
SAMHSA's substance abuse prevention and treatment activities. Included in this
request is an additional $54 million for Targeted Capacity Expansion grants to
support rapid and strategic responses to emerging areas of need. The request
also includes an increase of $31 million for the Substance Abuse Block Grant,
which will provide funding through the states for over 10,500 community-based
treatment and prevention organizations. In all, our budget request will enable
more than 16,000 additional individuals to access treatment services. Providing
Heating and Cooling Assistance to Low-Income Families While we are enjoying an
unprecedented wave of economic prosperity, and on average the country has
experienced a relatively warm winter season, one area of continuous concern has
been the impact that heating and cooling costs have on the lives of the poor.
The Low-Income Home Energy Assistance (LIHEAP) program helps protect the health
of low-income families by providing assistance in meeting heating and cooling
costs to approximately four million households each year. Those households
receiving assistance include some of our most vulnerable populations: 35 percent
include an elderly member; 28 percent include a person with a disability; and 48
percent include a child under age eighteen. Last year, the Congress recognized
the importance of the LIHEAP program to low-income families and provided $ 1.1
billion in advance appropriations for FY 2001 for the program, and also provided
$300 million in contingency :funding to meet unexpected needs due to unusually
high or low temperatures or natural disasters. Our budget continues to support
the LIHEAP program, requesting an advanced appropriation of $1.1 billion in FY
2002, as well as $300 million in contingent emergency funds. GREATER SCIENTIFIC
ADVANCEMENT As we enter the new millennium, we stand on the cusp of an era of
that promises unprecedented scientific advances. However, these breakthroughs
will only be realized if we continue to make the necessary investments in
biomedical research. Our budget continues along the path we set several years
ago by investing in basic biomedical research as well as in research that will
lead to improvements in the quality of care, thereby moving important scientific
discoveries from the laboratory into our hospitals and clinics. Investing in
Biomedical Research Biomedical research has been at the center of the
unprecedented gains we have made in improving the health and quality of life for
all Americans. Breakthroughs that we did not think were possible only a few
years ago are now within our reach, but it will require a sustained investment
for these endeavors to bear fruit. The President's FY 2001 budget includes
almost $19 billion, an increase of $1 billion over last year's funding level,
for biomedical research at NIH. This increase will support research in such
areas as diabetes, brain disorder, cancer, disease prevention strategies, and
development of an AIDS vaccine, and eventually lead to a revolution in our
ability to detect, treat, and prevent disease. This request will enable NIH to
fund 31,524 research project grants, the highest total in history, and enhance
activities in critical areas such as research on racial and ethnic health
disparities, biomedical information and technology, clinical research, and
genomics. Using Science to Improve Quality of Care and Reduce Medical Errors As
we make new breakthroughs in biomedical research, we must also work to see that
these scientific advances result in better quality health care. Even with all
our scientific innovations, a recent study by the National Academy of Sciences'
Institute of Medicine estimated that as many as 98,000 Americans die each year
due to medical errors. To address this problem, the President's budget makes new
investments in error prevention, patient safety research, and information
technology. Our budget invests $250 million in the Agency for Healthcare
Research and Quality (AHRQ) to support research activities that will improve
quality of care, reduce medical errors, and produce better health outcomes.
These resources will be used to step up research efforts on the uses and tools
of health information technology; sponsor clinical prevention research and
research to enhance patient safety and reduce medical errors; and expand
research on issues of workers' health. These activities will help us to learn
how best to translate knowledge into daily practice and improve health care for
all Americans. Our budget also invests $20 million to implement a new Health
Inforinatics Initiative designed to improve patient care and health outcomes
through the efficient and effective use of data and information. This request
will :fund a set of cross-cutting and agency-specific investments in information
systems and health data, thereby enabling HHS to assume a greater national
leadership role in the establishment of health data standards while also
strengthening the information base for decision-making, improving the uniformity
and ease of transmission of health care data, and protecting the confidentiality
of health information. In addition, our budget includes $45 million to enhance
the Food and Drug Administration's post-market activities. This includes funds
to expand their adverse-event reporting system and to allow FDA to investigate,
identify and prosecute those selling prescription drugs over the Internet
without proper certification. Food Safety Enhancing our capabilities to conduct
surveillance will also help us in our ongoing fight against the threat of food
borne diseases. Estimates show that food- related hazards are responsible for as
many as 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths each
year. To combat these outbreaks, the budget seeks a $ 1 0 million increase for
CDC's Food Safety programs. These funds will support enhanced public education
efforts and the continued expansion of the PulseNet network of health labs. This
award-winning network preforms DNA "fingerprinting" of disease causing bacteria,
enabling public health agencies to identify and respond more rapidly to disease
outbreaks. In addition, the Food and Drug Administration (FDA) is seeking an
increase of $30 million for its food safety activities. These funds will be used
to increase inspections so that all high risk food establishments are covered,
expand the number of examinations of imported foods, increase laboratory
capacity, broaden efforts to work with states and the industry to make standards
more consistent, and in conjunction with the Department of Agriculture and the
states, begin to implement the Egg Safety Action Plan prepared by the
President's Council on Food Safety. CREATING A HEALTHIER AMERICA Expanding
access and improving the quality of health care are crucial steps toward
ensuring that all Americans live long, healthy lives. But new threats to public
health continue to emerge, and many long standing health problems still pose
considerable risks. From AIDS prevention and treatment to food safety and the
control of infectious disease, our FY 2001 budget continues our work to
vigorously safeguard the public health. HIV Prevention Initiative As a nation,
we have made substantial progress in our fight to prevent the spread of HIV and
AIDS. Thanks to the use of combination anti-retroviral therapy, the AIDS death
rates in the United States continue to decline. But in some parts of the world,
and in some communities in the United States, the virus continues to spread
rapidly. Domestically, the impact of HIV among certain segments of the
population, especially minority communities, continues to be severe. In 1997, 45
percent of those newly diagnosed with AIDS were African American and 20 percent
were Hispanic. Globally, the AIDS pandemic continues to be a major threat,
particularly in developing countries. In sub-Sahara Africa, for example, it is
estimated that four million people each year are newly infected with HIV.
Internationally, the President's budget includes an increase of $26 million for
the Centers for Disease Control and Prevention to continue the initiative
undertaken last year to prevent the spread of HIV in developing countries.
Domestically, our budget request supports our ongoing initiative to reduce the
spread of HIV and AIDS in minority communities. It provides an increase of $50
million (including $10 million in reallocated funding) for CDC's domestic
prevention programs to encourage individuals at risk to avoid behaviors that can
result in the transmission of the disease. These funds will be directed to
community based interventions designed to reduce the rates of HIV infections,
with special emphasis on vulnerable populations including racial and ethnic
minorities, women, injection drug users and their partners, and young gay men.
Internationally, the President's budget includes $61 million for Centers for
Disease Control and Prevention (CDC), an increase of $26 million, to continue
the initiative undertaken last year to prevent the spread of HIV in developing
nations. Ryan White Up to one-third of the 750,000 Americans living with HIV are
currently not in care. As we step up our efforts to prevent the spread of AIDS,
we must also continue to help those who already suffer from this deadly disease.
The President's budget keeps this commitment by providing $1.7 billion for the
Ryan White Program, an increase of $125 million. These additional funds will
provide primary medical care, pharmaceuticals critical to treatment, and other
critical support services for those living with HIV and AIDS. This includes an
increase of $26 million for the AIDS Drug Assistance Program (ADAP), which will
allow a total of approximately 141,000 individuals to receive combination drug
therapy. Reducing Racial Health Disparities . One of the long-standing
priorities of this administration has been making sure that all people receive
the highest quality health care, regardless of their race or ethnicity.
Unfortunately, members of minority groups, including American Indians and Alaska
Natives, continue to bear a disproportionate burden of the nation's disease and
illness. The President's budget continues the effort to eliminate these health
disparities. A targeted response to this problem is the request of $35 million
to expand CDC's program of demonstration projects in six identified areas of
health disparities: infant mortality, cancer, heart disease, diabetes, HIV/AIDS,
and immunizations. Funds will support the continuation of ongoing projects and
the development of projects in two new communities. The budget also proposes
increasing finding for the Office for Civil Rights by nine percent, including
new program resources to ensure that our racial health disparities initiative
has as strong civil rights nondiscrimination component. We also request an
increase of $229 million for the Indian Health Service, the largest finding
increase in two decades, to implement a multi-pronged effort to improve the
quality of care for Native Americans. Improving Mental Health Services The
Surgeon General's Report on Mental Health, released in December 1999, has
focused new attention on the plight of those who suffer from mental illness.
While about one in five Americans experiences a mental disorder in the course of
a year, many of them will not receive the treatment they need. To address this
problem, the President's budget proposes an increase of $100 million for mental
health services provided by the Substance Abuse and Mental Health Services
Administration (SAMHSA). This includes an increase of $60 million for the Mental
Health Block Grant, to support state efforts to create comprehensive, community
based systems of care for both adults and children. It also proposes to create a
new $30 million Targeted Capacity Expansion Grant program to support prevention
and early intervention services, as well as local service expansion.
The
budget request also continues funding of $78 million for projects provided by
the Congress in FY 2000 for Youth Violence Prevention activities. This includes
$50 million for the Safe Schools/Healthy Students program which supports
activities to increase school safety, mental illness prevention and treatment,
and school violence prevention and early intervention services. Family Planning
Support for family planning services has been a key factor in preventing over
one million unintended pregnancies each year. Family Planning Clinics provide a
range of valuable services including sexually transmitted disease and cancer
screening and prevention; HIV prevention and education; and contraception
services and counseling. As part of our strategy to prevent teen pregnancies,
these services have also contributed to reducing the teen pregnancy rate to its
lowest level on record (since 1976). Our FY 2001 budget request continues our
strong commitment to family planning services, providing an increase of $35
million over FY 2000. These Rinds will support grants to family planning clinics
which will enable approximately 5.75 million low- income clients to receive
reproductive health services and clinical care. Preventing Emerging Infectious
Diseases Thanks to the extraordinary advances in transportation and other
technologies and the expansion of international commerce, we truly live in a
global community. While these advances have resulted in numerous economic and
cultural benefits, they also have placed increasing strains on our public health
system. Since 1970, more than 35 new infectious diseases have been identified.
More recently, we have begun to see the emergence of drug- resistant bacteria
and viruses, and the spread of older diseases to areas where they were
previously unseen, such as the recent outbreak of West Nile encephalitis in the
New York City area. To combat these threats, our budget requests a total of $202
million to support infectious disease prevention activities at the Centers for
Disease Control and Prevention. This includes an increase of $25 million to
fight emerging infectious diseases, of which $20 million would be used to
support the development of a national electronic disease surveillance system,
which will enhance the ability of state and local health offices to respond to
multi-state outbreaks of diseases and to share information, both among
themselves and with CDC. Combating Bioterrorism The recent arrests of suspected
terrorists at the Canadian border has reminded us all of the serious threat that
terrorism poses to the peace and prosperity of our nation. The threats posed by
bioterrorism are particularly deadly because of their communicability and their
ability to remain undetected for long periods of time. Continuing our efforts to
prepare for and respond to the consequences of a bioterrorist event, the
Department's budget includes $265 million for activities across agencies to
mount a comprehensive public health effort to combat this deadly threat. This
strategy includes four major components. First, our budget strengthens critical
components of our public health infrastructure, including our surveillance
systems, epidemiological and laboratory capacity, and communications technology.
Second, it continues funds for the purchase of a stockpile of the
pharmaceuticals needed to treat the most likely biological agents. Third, it
provides funds for research, development, and regulatory review of new vaccines
and new diagnostic screens for chemical agents. Finally, it would support the
establishment of an additional 25 local area health care response teams,
bringing the total number of teams around the country to 97. Investing in HHS
Laboratory and Health Infrastructure To successfully overcome the public health
challenges of the 21st century, we must invest now to modernize the
infrastructure that provides the foundation for our public health and biomedical
research systems. Many of the laboratories at CDC and FDA are overcrowded and
outdated, while at the National Institutes of Health (NIH) the fragmentation of
laboratory space delays the pace at which new discoveries are made. Our budget
requests substantial increases to solidify this foundation and construct
state-of-the-art facilities. For CDC, we are requesting a total of $127 million,
an increase of $70 million, for laboratory construction at three sites. First,
our budget includes $85 million in FY 2001 and additional funding in FY 2002 and
FY 2003 to construct a laboratory to handle the most highly infectious and
lethal pathogens studied at CDC, as well as housing important work on antibiotic
resistant diseases, AIDS, sexually transmitted diseases, and tuberculosis.
Second, we request $20 million to complete and equip the Edward R. Roybal
infectious disease laboratory. Third, we request $4 million to design a facility
to replace our antiquated environmental health laboratory. The remainder of the
request will be used for security improvements and maintenance of existing
facilities. For NIH, we are requesting $149 million for intramural buildings and
facilities. Intramural projects include $73 million over two years to construct
a new facility to house the new National Neuroscience Research Center, and $24
million to begin design and construction of a new centralized animal facility.
Our budget also includes $20 million for new lab construction at FDA, as well as
$65 million for health facilities construction in the Indian Health Service
(IHS). RIGOROUSLY EVALUATING PROGRAM PERFORMANCE Our budget request for FY 2001
presents the annual performance information required by the Government
Performance and Results Act (GPRA) of 1993. Notably, this includes the first
GPRA performance report of HHS and its components, which compares FY 1999
results to the goals in our FY 1999 performance plan. Although GPRA reporting
must mature before its full value will be realized, our performance report for
this year shows improvements for critical HHS initiatives of the past few years.
SAMHSA reports that retailers in more States have complied with rules
prohibiting tobacco sales to youth than we had projected in our 1999 performance
plan. HCFA achieved its 1999 goal for reductions in Medicare payment errors a
year early, and pursues increasingly rigorous goals in FY 2001 and FY 2002. ACIF
and its program partners, including states, exceeded performance expectations
when they moved 1.3 million welfare recipients into new employment. Information
like this demonstrates that GPRA can be a valuable tool that will enhance our
efforts to improve programs that serve the American people. As our performance
measures continue to mature and performance trends emerge, the GPRA data will
serve as important program indicators to support the identification of
strategies and objectives to continuously improve programs across HHS. A ROAD
MAP TO A BETTER AMERICA Mr. Chairman, as I look back at the journey we have
taken, I feel tremendous pride in what we have been able to accomplish. While
there were occasional bumps in the road and we did not reach every destination
we set out for, we have made great advances in improving the nation's health and
well being. Today I have placed before you a road map for the destinations we
have charted - improving health care access, coverage, and quality; making
America a healthier and safer place; expanding our scientific knowledge, and
giving all our children and families the opportunity for success - and these are
destinations we all wish to reach. Thanks to the unprecedented economy, our
fiscal discipline, and a new age of scientific breakthroughs, the conditions
under which we set out on this road have never been more favorable. Chairman
Porter, Congressmen Obey, and members of the Subcommittee: I would like to thank
each of you for all of the hard work you have done to make everything we have
accomplished a reality, and I look forward to working with all of you to meet
the challenges before us in this budget. The journey is not ending, it is just
beginning. I would be happy to address any questions you may have.
LOAD-DATE: February 8, 2000