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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 
