Page images

gram, a proposal for $500 million increase in that program which would allow an increase of some 180,000 children in the Head Start Program which would bring us within striking distance of the President's committed goal of bringing all eligible 4-year-olds into a Head Start Program or a Head Start-like program.

We would have some 70 percent of the eligible 4-year-olds in the Nation covered by this program if indeed it is approved, so I certainly solicit your support for addressing this program.

I would also add that at the Governors' meeting with the President in Charlottesville a few months ago, the Head Start Program was uniformly cited by the Governors as a program that works, that is successful, helps meet the goal of having all children in the Nation ready to begin school. The Head Start Programs helps tremendously not only with its educational benefits, but it is health, nutrition, and other benefits as well.

We were also disappointed last year that the funds that we had requested for the human genome project were not fully funded. That program is funded, I believe, at $60 million this year. We have requested an increase of $108 million for this. This represents a major scientific undertaking, one which has been identified by scientists. It is probably the highest priority, major, big science effort that we should undertake.

This will help us map the 3 billion genetic bases in the human chromosomal complex and will give us a handle for greater understanding of the more than 3,500 genetic diseases and, more importantly than that, give us information that we can use to bring forward new therapeutic developments to improve the health of our citizens.

Now, in fiscal year 1991 we are committed to improving the health of the American people, and our program that we have submitted, our budget, will focus on helping children, strengthening families, investing in the future through our biomedical research effort, improving access to health care, promoting good health, fighting AIDS, combating drug abuse and, as you noted, we do have the lead responsibility for the demand reduction activities for drug abuse. That includes treatment, research, prevention activities, and education, and we are fully committed to that.


We are also committed to prudently managing the entitlement programs which we are supervised to really hold in trust those for the American people. I speak of, of course, not only our Medicare trust funds, but also our Social Security trust funds as well.

In addition to the Head Start Program that I have already discussed, we are requesting the full authorized ceiling for our JOBS Program; that is $1 billion that we have requested. This program, which was passed by the Congress in 1988, will give individuals on welfare, on AFDC, a real opportunity to develop job skills and educational skills that they can enter the market, become self-sustaining, and this is not only important economically, but it is also important in terms of how our citizens view themselves as directing their lives. We are proud to say that program was implemented with our regulations on time last year. We have some 27 States that have implemented the JOBS Program, and the increase in our budget will help us meet the goal of having all States having implemented JOBS Program by October 1 of this year.

We also are requesting increased support for our AFDC related child care. That will increase by some $283 million for a total of $489 million.

We are also requesting a $47 million increase in child welfare services. This increase would represent a 19-percent increment, and this would help communities manage increasingly more difficult caseloads.

We are proposing in addition a 10-percent limitation on annual increases in foster care administrative costs. This proposed limitation will help to keep these costs in check which have escalated by some 2,800 percent over the last several years, but this will not interfere with the payments to foster families or training of parents and staff.

We are also back to request significant funding for the homeless. We are requesting a total of $233 million, $27 million of which was provided in fiscal year 1990. As you know, the President voiced his commitment in February of last year to full funding of the McKinney Act homeless programs.

On January 24 of this year the President announced his new national drug control strategy. As I mentioned, my Department has the lead responsibility for the demand reduction efforts and in our budget we have requested some $1.7 billion to help us meet our goal of better treatment and better research and prevention and education activities.

We will also have several new initiatives in our drug control strategy including a $50 million community prevention grant program and a $6 million project providing nonmedical services for infants born addicted to crack. We are seeing an increasing problem in our cities with crack babies.

Our budget also includes funds to increase access to quality health care, particularly for disadvantaged pregnant women and their infants. Clearly the fact that our Nation ranks 18th among the industrialized nations in infant mortality is a disgrace. We feel that we should not be No. 1, as you pointed out, Mr. Chairman, in per capita expenditures for health care and 18th in infant mortality. This is a problem. We know what to do. We simply have to focus our resources on doing it. The initiatives in our budget focus $63 million to target programs which address infant mortality. In addition to an overall spending of some $3 billion in different programs that assist in infant care. This improves our outreach activities in a variety of strategies for pregnant women.

We also are pleased that the Medicaid expansions that were enacted as a result of the President's request last year bringing women with incomes up to 133 percent of the poverty levels into the Medicaid Program as well as their children up to age 6 will help significantly to address the health programs of our citizens.

Now, our death rates for our minority populations, as you know, really are significantly higher. This includes not only cancer, but also heart disease, a variety of other disorders as well and because of the fact that the life expectancy of black Americans is some 6 to 8 years less than white Americans as a result of this health gap,

we are proposing a special minority initiative of $117 million which includes funds to support more training of minority health professionals, health programs for housing projects in conjunction with housing and urban development and other initiatives there as well.

Concerning rural health care, our budget includes some $357 million to provide access to rural health for our citizens; 92 percent of this amount or $327 million, will be spent on services given in rural communities. This includes the continuation of those activities initiated by the Congress last year for disease prevention and information outreach.

Some $30 million is earmarked for research on the special conditions impeding access to quality care in rural settings. We also plan to spend some $9.4 million to support research by the Alcohol, Drug Abuse, and Mental Health Administration on projects that specifically focus on mental health services in rural areas.

As I indicated previously, we are committed to strengthening our Nation's biomedical research enterprise. Thus, in this fiscal year, we propose to provide a total of $8.9 billion for biomedical and behavioral research at NIH as well as ADMHA. This is an increase of $436 million to strengthen basic research and development efforts of NIH and ADMHA.

Included in this, of course, is the human genome project that I discussed previously. We hope that you will agree with us that it is a high priority that should be funded.

We also include in our budget funds, $89 million for infrastructure improvements on the campus of NIH itself. Over the years we have delayed structural improvements and maintenance, and we can no longer do that, so that we hope that you will support our effort to provide some $89 million for needed improvements in our physical facilities on the NIH campus. NIH is a premier biomedical research institution, which has not only been central to the many achievements we have made in improving the health of our citizens over these last several decades, but also is unequalled around the world as a facility that brings together on one campus a number of outstanding scientists. We have a number of Nobel laureates on that campus, and we want to do everything that we can to preserve and enhance the productivity of NIH, not only for the advancement of knowledge, but also for the advancement of health as well as the importance of its advances to our biotechnology programs.

As you know, biotechnology represents one of the few areas where as a nation we have a very strong positive balance of payments. Biotechnology is in its infancy and represents tremendous potential not only for the advancement of our medical capabilities, but also from an economic perspective, it represents a tremendous opportunity for us to extend our lead in comparison with other nations and will have tremendous economic benefits as well.

So, from all of those perspectives NIH is important, and we hope that you will support our request.

Concerning AIDS we, in fiscal year 1991, for all AIDS including treatment, propose to spend $3.1 billion. Of that $1.7 billion is for activities of the Public Health Service for research, education and prevention activities. In addition, within this amount there is a $780 million increase for Medicare and Medicaid services for AIDS and HIV-infected individuals.

In our budget we also propose to support our new agency for health care policy and research at the level of $110 million. This includes funds for our medical effectiveness research or outcomes research that we commented on last year when we appeared before this committee.

This is an important part of our strategy to improve the quality of care given our citizens as well as to help us contain costs by knowing which treatments we give to our citizens are effective and which are not.

I am committed to ensuring the quality of services provided to the public through our large entitlement programs administered by our department: Social Security, Medicare and Medicaid.

In fiscal year 1991 we are requesting increases for the Social Security Administration and for HCFA which will enable us to continue managing these programs effectively and efficiently. For Social Security we request full funding for our supplemental security income for Social Security and for black lung benefits.

In addition, we are requesting $4.2 billion or an increase of some $330 million for our Social Security Administration to run these programs.

I am pleased to say that our budget proposes to support some 63,000 employees in previous years that Social Security number of employees has declined from 80,000 to 63,000. We have had tremendous improvements in productivity because of automation, and better management practices, but we feel that we now are at a level that we cannot and should not go below that, and our budget stabilizes the number of employees in SSA so that we can continue to provide quality services to our citizens by maintaining the necessary number of employees.

Our budget also proposes to stress managed care or health delivery for our citizens. We are proposing changes to our Medicare Program which will save some $5.5 billion from projected increases in our Medicare budget.

These changes are designed to make our Medicare Program a prudent purchaser of services and to assure that current inequities in physician payments are not built into the new reimbursement system to be implemented in fiscal year 1991. With our proposals Medicare expenditures will increase by some 4.6 percent over fiscal year 1990. Without these restraints on our growth in spending, we would be facing a 9.9-percent rate of increase in our Medicare expenditures and such a rate is not sustainable.

Also in our budget you will note that we propose to finance some of the services by user fees. For example, we request approval for $510 million or an increase of $312 million over our 1990 budget for survey and certification of health facilities to ensure the safety and quality of care provided with our Medicare and Medicaid funds. Following the lead of the Congress in the Clinical Laboratory Amends of 1988, we propose funding all activities including those previously funded by Medicaid through user fees.

PREPARED STATEMENT Finally, Mr. Chairman, our budget honors the 1983 bipartisan agreement on Social Security to ensure that we have a sound pro

gram, not only to provide benefits for today's citizens, but also for those of our children and our grandchildren. We urge you not to contemplate any sort of action which will ultimately endanger the economic future of our citizens today and tomorrow. That completes my statement. I will be pleased to respond to your questions.

[The statement follows:]

« PreviousContinue »