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Congressional Testimony
February 10, 2000
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 6254 words
HEADLINE:
TESTIMONY February 10, 2000 DR. CLAUDE EARL FOX ADMINISTRATOR HEALTH RESOURCES
AND SERVICE ADMINISTRATION HOUSE APPROPRIATIONS LABOR, HEALTH
AND HUMAN SERVICES, AND EDUCATION LABOR HHS APPROPRIATIONS
BODY:
DEPARTMENT OF HEALTH AND
HUMAN SERVICES Statement by Dr. Claude Earl Fox Administrator,
Health Resources and Services Administration on Fiscal Year
2001 President's Budget Request for the Health Resources and
Services Administration Mr. Chairman and Members of the Committee: I am pleased
to appear before you today to discuss the Fiscal Year 2001 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 despite our efforts, economic, social and
environmental events have created a greater need for the kinds of programs and
services HRSA supports. In 1998 more than 44 million Americans had no
health insurance, according to the U.S. Census Bureau, and with
the delinking of Medicaid and welfare, among other factors, that number is
growing. In addition, during the 1990s, the number of uninsured
increased at a rate of 28 percent for the Nation. 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. We continue to work 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. This
landmark program has already enrolled 2 million low income children, reducing by
20 percent the number of American children with no health
insurance. In FY 2001, 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 strengthening their resources
and infrastructure and filling workforce gaps; - develop partnerships with
States, communities and the private sector to promote effective, integrated
systems of care for underserved people and those with special
health care needs; and - recruit, train, and retain a
culturally and linguistically competent, racially and ethnically diverse
health care workforce to serve in underserved communities. To
continue this important work, HRSA requests a total of $4.8 billion.
HEALTH CENTERS Health centers comprise HRSA's
Community Health Centers, Migrant Health
Centers, 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 over 9 million people, including 3.5
million children, who live in medically underserved rural and urban communities.
The request for health centers is $1.1 billion, an increase of
$50 million over the FY 2000 final appropriation. This increased support for
CHCs is one way that the Administration's health care
initiative will strengthen programs servicing the uninsured.
More than half -- 64 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 1999, HRSA grants to
health centers totaled $925 million - less than one-third of
the total $3.5 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 1999, 40 percent of the Corps' 2,526 health care
providers cared for patients in health centers. The remaining
60 percent provided essential primary care at similar, 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 more than 4,000
communities nationwide. HEALTH CARE ACCESS FOR THE
UNINSURED Last year Congress made in initial investment of $25
million in this program. This year as part of the Administration's new
health care initiative, this increased funding will continue
our support of community providers of services to the
uninsured. This program is designed to address the problem of
uninsured individuals. The increase of $100 million will enable
public, private, and non-profit health entities to assist
safety-net providers develop and expand integrated systems of care and address
service gaps within integrated systems which focus on primary care, mental
health and substance abuse services, with the result that more
uninsured individuals will have access to a continuum of core
health care services. These grants will allow providers to
deliver services with greater efficiency and improved quality, permitting more
clients to be served. In 2001 additional systems development efforts will take
place in 40 to 60 new communities, with a small potion devoted to filling
service gaps in the new communities. Continuation funding will be provided at
the initial 10-20 sites for filling identified service gaps. 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 Resources Emergency (CARE) Act programs. The FY 2001 budget builds on this
impressive record, continues the President's Investment Initiative for Care Act
programs, and requests $125 million above the FY 2000 final 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 reduce the burden of HIV/AIDS in
communities of color. The FY 2001 request includes the following: for HIV
Emergency Relief Grants to 51 eligible metropolitan areas to increase their
capacity to serve persons with low income, uninsured or
underinsured, a $40 million increase, for a total of $587 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 $40 million increase, including $26 million for AIDS
Drug Assistance Programs. The total request is $864 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 $554 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 $33 million, for a total of $171 million. With this
increase we can f1md early intervention services program targeted at minorities
in the 60 communities provided with planning grant support in FY 2000 and 60 new
planning grants in communities of color. We can also fund 27 new EIS programs
and 34 planning grants in rural and underserved areas. - for Pediatric/HIV
services an increase of $9 million, for a total of $60 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. - for the AIDS Education and Training
Center program an increase of $2.5 million to intensify efforts to train and
provide ongoing support for health care providers in HIV/AIDS
treatment. HEALTH PROFESSIONS TRAINING The President's budget
for HRSA's health professions training programs provides
increases for two programs which address 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
underrepresented 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 Universities,
Hispanic Serving Institutions, and other institutions that train substantial
numbers of minority students. Although less than one 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 unable us
to quantify this yield far into the future. Our FY 2001 request for these
targeted health professions programs is $298 million. Included
in this total are increases of $5 million for the Centers of Excellence Program
and $5 million for the Health Careers Opportunity Program. 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, for a total of $80
million, 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 aged either 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
2001'budget request for the block grant is $799 million, the same as the
comparable amount provided in FY 2000. The FY 2001 budget includes appropriation
language to incorporate the Healthy Start program into the MCH Block grant as a
separate provision of the Social Security Act. 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. Block grant funds help support the State's
ability to identify and meet the needs of its mothers and children, through the
development of innovative methods and strengthening their resources to better
serve them. The FY 2001 request includes: - $587 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; - $109 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 - $13 million for Community-Integrated Service
Systems, a set- aside that develops and expands successful models of service
delivery. - $90 million for the Healthy Start program will support grants to
States to strengthen and enhance State and community-based systems of prenatal
health. 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 for
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. TELEHEALTH
Telehealth program was established two years ago 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 2001 request is $6 million, a reduction of $15
million below the FY 2000 comparable amount because the budget does not fund
one-time earmarks included in the FY 2000 final appropriation. FAMILY PLANNING
HRSA requests $274 million, a $35 million increase over FY 2000, for Family
Planning. The increase will enable the Title X program to support key
Departmental initiatives, including encouraging a healthy start for children 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 2001 program management request is $124 million, a decrease of
$413,000 below the FY 2000 final appropriation. This level includes a reduction
of 60 FTEs to cover the costs of mandatory increases as well as reductions to
health professions programs. ANNUAL PERFORMANCE PLAN Our budget
request for FY 2001 also 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 HRSA, 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 HRSA initiatives of the past few years
in areas such as expanded primary care services for the underserved and
uninsured, improved services for mothers and children and
better access to a full range of HIV services. 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 set of four long-term strategies to guide the development of its Annual
Performance Plans. Each individual performance goal is supportive of one of the
four HRSA strategies: - Eliminate Barriers to Care - Eliminate
Health Disparities - Assure Quality of Care - Improve Public
Health and Health Care Systems This year's performance plan
includes targets and/or results for three years: - the Final FY 2001 Annual
Performance Plan, based on the President's Budget; - the Revised Final FY 2000
Annual Performance Plan, based on the appropriation; and - the FY 1999 Annual
Performance Report. 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. In addition, to achieve greater
standardization and consistency in Department performance plans, we are
utilizing a standard outline that Health and Human Services
components are using in presenting annual performance plans and reports in
response to the requirements of GPRA. We have strengthened the quality of data
sources and information used to measure performance goals. To the extent data is
available, we have reported on the results for FY 1999 for the various
performance goals. In those cases in which data are not yet available, we have
identified a target date when we believe they will be available. Two new program
areas are included in this version of the performance plan: the Ricky Ray
Hemophilia Relief Fund, and Health Care Access for the
Uninsured. 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. 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.
LOAD-DATE: February 12, 2000