group is very difficult to achieve because of the lifestyle, language, culture, and economic status of most migrant and seasonal farmworkers. Services to approximately 500,000 individuals will be supported. The request also includes funds for improving the compensation for center physicians. Infant Mortality In 1991 we are expanding the Infant Mortality Prevention Initiative to $36 million, an increase of $4 million above the 1990 appropriation. This request will support an additional 22 community and migrant health centers to provide case managed services to 75,000 high-risk pregnant women. It also will expand overall perinatal capacity in community and migrant health centers to approximately 190,000 pregnant women per year. This will be accomplished through a proven case-managed, comprehensive approach that will focus on the coordination of appropriate services throughout the high risk mother's child bearing years. Minority Health Initiative The FY 1991 budget includes $107 million to launch a Minority Health Initiative. This initiative is made up of several programs designed to increase the number of minority health professionals and to reduce the health disparities between minority populations and nonminority populations as outlined in the 1986 Report of the Secretary's Task Force on Black and Minority Health. These programs are designed to increase the number of health practitioners serving minority/disadvantaged populations. components include: о 0 Key the revitalized NHSC loan repayment/scholarship program a new program, Health Services in underserved The Health Professions Institutional Development program ($12 million), providing funds for faculty development and general institutional support to maintain minority enrollment levels, and Community Based Recruitment ($5 million), to support Maternal and Child Health The Maternal and Child Health block grant allocates funds to States to provide a wide range of health services to mothers and children, including preventive and primary care and rehabilitative services which help alleviate infant mortality problems and provide better access to health care. Our 1991 request is for $579 million, an increase of $25 million above the 1990 current estimate. The request includes: 0 0 $471 million for State Block grants, $83 million for special projects of regional and and $25 million for One-Stop shopping to improve the delivery of health care services for pregnant women and infants. National Health Service Corps The National Health Service Corps program is designed to improve the capacity to provide health services in Health Manpower Shortage Areas (HMSA) and improve access to health care in these areas through the placement and support of health professionals. This program, and the related recruitment effort play a critical role in the attempt to reduce physician shortages in the most difficult to staff areas throughout the country. The budget request of $42 million will continue the program at approximately the 1990 level. National Health Service Corps Recruitment The budget request for NHSC recruitment is $64 million to support scholarships and loan repayments to health professionals and health professions students in exchange for service in a HMSA. The request includes an increase of $55 million associated with the Minority Health Initiative to support scholarships and loan repayments for disadvantaged and minority students. Homeless The 1991 budget provides $34 million in new budget authority for a total program level of $46 million for health care to the homeless. This request will support a broad range of primary care, alcohol and substance abuse, and mental health services to approximately 335,000 homeless individuals in approximately 92 health care for the homeless programs. Emphasis will be placed on providing preventive as well as curative services to a broad sector of the homeless including runaway adolescents, homeless pregnant women and children, and individuals with chronic substance abuse and mental health problems. Grants will be made to applicants demonstrating broad community participation and linkages with other community providers of critical support needs of the homeless and effective and efficient provision of care. Health Professions At the end of fiscal year 1990 the cumulative Federal investment in Health Professions will total nearly $9 billion. This investment has increased the supply of health professionals. Also, beginning in the late 1970's and through the 1980's, it has addressed more targeted objectives such as primary care, disadvantaged assistance, and improvement in advanced and specialized nurse training. In recognition of these successes in programs the Administration proposes to shift the emphasis from health professions training to other targeted HRSA priorities such as reducing infant mortality, increasing the number of minority health professionals, providing health services to underserved populations, and supporting AIDS HIV programs. HRSA will continue to administer the health professions and nursing revolving loan funds which will make available approximately $86 million for loans to about 32,500 students. The budget also includes $185 million in loan guarantee authority for the HEAL program to begin a phase-down. In addition, the FY 1991 request continues funding for Exceptional Financial Need scholarships, Excellence in Minority Health, and the Disadvantaged Assistance programs which were included in President Bush's amended budget. National Practitioner Data Bank The President's FY 1991 Budget proposes to enhance the collection of user fees to cover the full cost of operations of the National Practitioner Data Bank. User fees collected in 1991 will fund the remaining cost of the first phase of the contract and to begin to implement Section V of P.L. 100-93, which will add other health professions to the databank. A primary objective for FY 1991 is to develop a system to monitor and assess compliance with the reporting requirements of the law and to report instances of noncompliance to the Secretary and to the Office of the Inspector General for field investigations. Organ Transplantation We believe that the allocation of organs for transplantation is more fair and equitable since the establishment of the national Organ Procurement and Transplantation Network. For example, the number of organs procured but not transplanted has decreased markedly. Also, fewer organs are being shipped overseas and, as a result, more U.S. residents, nation-wide, are receiving transplants. The 1991 budget request includes $3 million to continue support of the Network as well as the Scientific Registry used to track the scientific and clinical status of organ recipients. In additions, the request includes funds to continue support of the agency's Organ Transplantation staff. Rural Health The budget request includes $4 million for the Office of Rural Health Policy to fund a total of seven Rural Health Policy/Research Centers. These centers will provide an information base and a policy research capability on a wide range of rural health concerns including access to care, financing systems, alternative delivery systems, and occupational health issues. The request provides funding for a national rural health information center and to staff the National Advisory Committee on Rural Health. Funding to provide technical assistance for hospitals in fiscal trouble is also included. AIDS HRSA AIDS/HIV activities continue to be an important part of the battle to control this dreaded disease. In 1991, HRSA is asking for a total of $73 million for AIDS projects. The funds will be used as follows: O O $19.4 million to continue 7-11 of the HIV health service $21 million to expand the Education and Training Centers $13.3 million to continue the program to provide care in $4.1 for AIDS facilities renovation grants to support Vaccine Injury Compensation Program The National Childhood Vaccine Injury Act of 1986 established a program to provide compensation for vaccine-related injury or death. HRSA maintains the fiscal records of the claims trust fund and provides medical advice to the court. The 1991 HRSA budget estimates obligations of $222 million for claim payments and other costs to be disbursed from the Vaccine Compensation Trust Fund. Conclusion In conclusion I can assure the members that we at HRSA see the coming year as one with many opportunities and numerous challenges, and we are looking forward to working with you in moving the public health agenda forward. Mr. Chairman and members of the Committee, my associates and I will be pleased to address any questions you may have on the specifics of this budget request. Present BIOGRAPHY OF DR. ROBERT HARMON Previous Administrator and Assistant Surgeon General Department of Health and Human Services Director, Missouri Dept. of Health, Jefferson Clinical Professor, Dept. of Family and Community M.D. 1966-70, Washington University School of M.P.H. - 1975-77, School of Hygiene and Public Post Graduate Professional Specialty Certification: Internship and residency internal medicine, Certificate, Program for Senior Executives in University, John F. Kennedy School of Medical officer in PSRO program, Division of Peer Director, MEDEX Northwest Division and Assistant August 1977-November 1980. Deputy Director of Public Health, Maricopa County December 1980-November 1982. Director of Public Health and Health Officer, Adjunct Associate Professor, Dept. of Family and General Preventive Medicine, 1979. Internal Medicine, 1973 Specialty Eligibility: Organizations and Memberships: Association of State and Territorial Health Officials; Executive Committee, 1987-1990. National Association of County Health Officials; President, July 1983-Dec. 1985. Physicians National Housestaff Association; President, 1974-76. HIV/AIDS Senator HARKIN. Thank you very much. Thank you all very much for very succinct and to the point statements. I just have a few questions that I will ask initially, and then we will go down the order in which Senators appeared. Dr. Mason, the administration's request was $1.695 billion for AIDS in fiscal year 1991. That is about a 7-percent increase over last year; $66 million is for CDC, $67 million for National Institutes of Health. Several other small increases are offset by a $40 million cut in the Health Resources and Services Administration. So could you just basically give us an update on AIDS? What are the projections for new cases? What progress has been made in |