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the Secretary requested in the 1990 appropriations bill. will continue to implement joint DHHS/DOT transportation initiatives through the Coordinating Council, and any necessary funding will be sought from the appropriate DOT and DHHS components. Any additional need for direct funding of this initiative will be included in the 1992 budget request.

Question. Would you outline for the Committee the Department's current efforts to improve the overall coordination of Federal transit resources and programs?

Answer. For some time, this Department has been actively involved in promoting improved coordination of Federal transit resources and programs for our constituents. Consequently, on October 24, 1986, DHHS and DOT entered into an agreement to work together to improve the efficiency and effectiveness of human service transportation services through better coordination of transportation services at the Federal, State and local levels. In order to ensure effective and coordinated administration of this initiative, DOT and DHHS established a Federal Council on Transportation Coordination consisting of representatives from staff and operating divisions of the Departments to implement this agreement. The 1990 Council workplan has been approved and adopted, and agency meetings are being held for the development of more detailed action plans.

JOBS TRANSPORTATION

Question. In adopting the Family Support Act of 1988, Congress recognized the importance of mobility in assuring that public assistance recipients have meaningful access to training and employment opportunities. Under the Act, States are required to assure the availability of adequate transportation and other support services needed for access to the mandated JOBS program.

Mr. Secretary, in view of the fact that almost half of the rural counties in this country have no public transit services, what initiatives has the Department taken or is considering to assist States in meeting the basic transportation needs of those families participating in the JOBS program?

Answer. Transportation costs to participate in JOBS are eligible for Federal reimbursement. However, we believe, that the States are in the best position to determine how to meet their individual participants' transportation needs. result, the Department has attempted to provide States with maximum flexibility to decide how they will use available JOBS dollars to meet transportation needs. At this time, HHS has not undertaken specific initiatives that address basic transportation needs of families in JOBS.

Question. Could you provide this Committee with an analysis of State plans under the JOBS program that have been submitted to the Department, outlining their approaches to the transportation problem?

Answer. States are not currently required to include information on their approaches to JOBS transportation problems in their initial JOBS State plans. Therefore, we cannot at this time provide you with the analysis you have requested. States will be required to provide a statement of their transportation policy as part of their final FY 1991-FY 1992 State plans which are now being developed. However, these statements will only contain information on the types of transportation for which States will provide reimbursement and the rates of reimbursement for each type of transportation.

Question. Is your staff exploring ways of cooperating with the Department of Transportation or other agencies to assure the provision of needed transit services? For example, would you consider supporting a joint employment transportation initiative with DOT to demonstrate effective ways of coordinating resources and sharing Federal responsibilities?

Answer. We are always interested in cooperating with other agencies to improve program operations in areas of crosscutting responsibility. In working with States which are implementing JOBS, we have coordinated our efforts closely with those of the Departments of Labor, of Education and of the Interior. However, since the bulk of JOBS dollars go to the States, and because each State's transit problems are unique to that State, we believe that States should have the flexibility and the funding to address these problems directly where possible.

CONTROLLING MEDICARE COSTS

Question. The reconciliation legislation passed by Congress last fall established expenditure targets for Part B Medicare costs in an attempt to control double digit annual increases.

Tell us how this legislation is being implemented, and what it will actually mean for Part B cost containment.

Answer. As you are aware, we published in the Federal Register on December 29 the Medicare Volume Performance Standard (MVPS) for FY 1990. We are currently developing the MVPS for FY 1991, and I will be sending a recommendation on it to the Congress in April.

The MVPS does not in itself reduce the amount that will be spent. It is intended to give us and the Congress an objective criterion against which we can measure and assess the rate of spending for physician services under Part B of

Medicare. Consequently the MVPS helps in determining what the appropriate level of increase in payment for physician services should be.

In the past, attempts to hold down the rate of Part B spending have been in part thwarted by increases in the volume of services provided. Since the MVPS will make the medical community as a whole more conscious of this trend, we anticipate that physicians will exercise restraint in the provision of questionable or unnecessary services.

CHILDREN IN POVERTY

Question. According to Census Bureau statistics, one in five American children lives in poverty: 12.6 million children below the age of 18. Among Blacks and Hispanics, two in five children are impoverished. Many lack health care.

Despite six years of economic expansion, why do so many children remain in poverty in the richest nation on earth?

Answer. The stubbornly high continuing incidence of children in poverty in this country has its roots in such problems as the growing number of teen mothers and single parent households, increased substance abuse, and low educational and job skills.

Although a strong economy is a necessary ingredient to fighting poverty, economic expansion has a reduced effect on individuals and their families who lack the training and job related skills to be competitive in our technologically complex marketplace. As a result, even though we have shown great success in the past twenty years in reducing poverty among other groups like the elderly and the disabled, we have had noticeably less success in raising children out of poverty.

Question. Do you think a lack of child care is a major impediment to helping children out of poverty, by keeping single parents from working?

Answer. Reflecting its concern that lack of child care might impede helping children to get out of poverty, Congress, in enacting the Family Support Act of 1988 (P.L. 100-485), provided both for child care to AFDC participants in the JOBS work and training activity, and for up to 12 months of transitional child care for AFDC recipients who leave the welfare rolls due to increased earnings. Funding for these two types of care is projected at $206 million in FY 1990, and $489 million in FY 1991; funding for both types of care is openended.

Question. What needs to be done to get children out of poverty in the United States?

Answer. Children need to receive support from both parents, and especially from an absent parent. The Family Support Act embodied a new consensus between the Congress and the Administration that the well-being of children depends not only on meeting their material needs, but also on the parents' ability to become economically self-sufficient. Selfsufficiency and family responsibility are critical to reducing the number of children in poverty in the United States. To help to get children out of poverty several fundamental needs must be met.

Basic education is one of the most important tools an individual needs to achieve independence and self sufficiency. Programs like Head Start can give poor children a boost an additional chance to overcome the educational deficits which currently hold so many children in poverty.

Women and their children represent the overwhelming proportion of AFDC recipients; within this group the most dependent are never-married mothers who did not finish high school and who had their first child at a young age. Work and training programs like the recently enacted JOBS program can help to address the needs of this group.

A strong commitment to programs such as Child Support Enforcement help insure that parents retain the primary responsibility for the support welfare of their children.

Finally, Aid to Families with Dependent Children and related income maintenance programs are being tailored both to meet the income needs of individuals served and to help these individuals achieve economic self-sufficiency.

Question. Can we realistically expect programs of the Department of Health and Human Services to make a dent in reducing poverty?

Answer. Programs supported by the Department of Health and Human Services address several of the fundamental problems that result in poverty-illness, disability, aging, limited job skills, and parents abandoning their financial responsibility to their children. HHS programs provide services for those most in need through programs such as Aid to Families with Dependent Children (AFDC), Medicaid, Child Support Enforcement, Supplemental Security Income (SSI), Head Start, and the Social Services Block Grant. As a recent report by the House Select Committee on Children, Youth, and Families noted, "of the 25 percent of all children who are considered to be in poverty before receiving public transfers, 21 percent are lifted out of poverty as a result of this assistance." This represents a sizable reduction in poverty that we are quite proud of. The programs administered by the Department of Health and Human Services target a wide variety of problems which face families in poverty.

HEALTH INSURANCE

Question. What proposals do you have to extend health insurance to all workers in this country?

Answer. The problem of the uninsured is one of the major health policy issues facing our country today. The Department budget does not contain any specific proposals related to health coverage for uninsured workers because I am waiting for recommendations from a number of groups which are studying this issue. In his State of the Union address, the President instructed me to lead a Domestic Policy Council review of recommendations on the quality, accessibility and cost of our nation's health care system.

In June, I appointed the Quadrennial Advisory Council on Social Security. The Advisory Council is a bi-partisan group representing business, labor, health care providers, politicians and private citizens. The group will study the issue of the uninsured and will submit their report and recommendations later this year, with interim recomendations relating to the uninsured as soon as possible.

In addition, Under Secretary Horner is chairing a Department task force that is examining the problem of those lacking insurance. The task force will look very carefully at different approaches to this problem, including extending Medicaid to the uninsured, and will provide a report recommending reasonable and cost effective approaches later this year. Finally, the Pepper Commission is expected to report its recommendations on health insurance for the uninsured in March.

Once we receive the recommendations of these various distinguished groups we can begin to asses the options that are available for addressing this most pressing and very complex issue.

MEDICAID

Question. Do you favor expansion of Medicaid to cover the unemployed who are currently not eligible and without health insurance?

Answer. As part of OBRA 1989, States are mandated to extend Medicaid coverage for pregnant women and infants with family incomes up to 133% of the Federal poverty level. States must also add mandatory coverage for children ages 1 to 6 with family incomes up to 133% of the poverty level. We have not proposed an additional Medicaid eligibility expansion this year because we feel that we need to give the States some time to implement the many new Medicaid expansions that have been recently enacted. We continue to encourage States to use existing authority for optional coverage of pregnant women and infants with family incomes up to 185% of poverty.

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