any other American community.

That's cultural disruption.

If

extending supplemental security income benefits to the needy culturally disruptive,

residents of шу Territory is

indeed

please, I beg you, disrupt us by treating us as equals.

It is te for the U.S. to rectify the inequity imposed on the people CI Quam and treat these loyal Americans as first-class citizens like those in the rest of the nation. The poor elder, disabled and the blind on Guam will truly know that the federal government cares about their health and well-being just as much as for that of their fellow citizens in other parts of the country when the SSI benefits are extended to Guam.

PREPARED STATEMENT OF REPRESENTATIVE CONSTANCE A. MORELLA

MR. CHAIRMAN: I WOULD FIRST LIKE TO THANK DR. SULLIVAN FOR HIS ATTENDANCE AT THIS HEARING. I AM LOOKING FORWARD TO HEARING HIS STATEMENT AND TO HAVING HIM CLARIFY AND DEFINE FOR US THE ADMINISTRATION'S VIEWS ON THE ROLE OF FEDERAL GOVERNMENT IN HEALTH

The

CARE OPTIONS FOR "VULNERABLE" POPULATIONS IN THE UNITED STATES.

IN MONTGOMERY COUNTY, MARYLAND, ALONE, AN ESTIMATED 12% OF THE POPULATION IS EITHER UNINSURED OR UNDERINSURED, ACCORDING TO THE PLANNING AND EVALUATION SECTION OF THE MONTGOMERY COUNTY HEALTH

DEPARTMENT. THIS DOES NOT EVEN REFLECT THE NUMBER OF CHILDREN AND ELDERLY OR ILL INDIVIDUALS WHO ARE "VULNERABLE" DUE TO INABILITY TO GET TO A CLINIC, OR AT RISK BECAUSE OF INADEQUATE NUTRITION OR POOR

LIVING CONDITIONS.

I AM SURE THAT DR. SULLIVAN WILL SHARE WITH US SOME OF THE

ADMINISTRATION'S PLANS. AS I UNDERSTAND, THESE PLANS INCLUDE
ENCOURAGING OPTIONS SUCH AS "MANAGED CARE" AND OTHER ALTERNATIVE
'METHODS OF DELIVERING QUALITY HEALTH CARE IN A COST-EFFECTIVE METHOD,
AS HE MENTIONED IN HIS STATEMENT BEFORE THE COMMITTEE ON WAYS AND
MEANS ON FEBRUARY 6 OF THIS YEAR.

WE MUST BE SURE THAT IN OUR EFFORTS TO CONTROL SPENDING, WE DO NOT INADVERTANTLY LEAVE BEHIND THOSE THAT NEED OUR ASSISTANCE THE MOST: THE ELDERLY, DISABLED, CHILDREN, AND POOR. IT IS CRITICAL THAT WE CONTINUE TO EMPHASIZE SERVICES FOR VULNERALBLE AMERICANS AND PROMOTE ACCESS TO THESE SERVICES.

WE MUST ENSURE THAT ALL OF THOSE

ELIGIBLE FOR SUCH PROGRAMS KNOW OF THEIR EXISTENCE AND ARE INDEED RECEIVING SERVICES.

The CHAIRMAN. I am extremely pleased today to have Dr. Louis Sullivan appear before us. As Secretary of the Department of Health and Human Services, Dr. Sullivan has come face to face with the difficult decisions confronting this Nation. In his role as Secretary, he has brought genuine compassion for, and commitment to, the most vulnerable of Americans. Today's hearing will focus on the health of vulnerable Americans and the health of the Federal commitment towards them.

Dr. Sullivan, it is indeed a pleasure to have you before this committee. Please proceed in any manner that you may desire.

STATEMENT OF LOUIS W. SULLIVAN, M.D., SECRETARY OF
HEALTH AND HUMAN SERVICES

Secretary SULLIVAN. Thank you very much, Mr. Chairman, Mr. Rinaldo, members of the committee. It is a great pleasure to appear before you today because the work of this panel is indeed critical. It's critical in improving the quality of life for all Americans. So I look forward to our dialogue with you today, and please know that my door is always open to you.

As a physician, medical administrator and educator, I have devoted my entire professional life to expanding access to our health care system. I know firsthand that there is room for improvement in health care delivery in our country.

I know that the members of this committee have a particular concern in addressing the problems of those older citizens who must bear the terrible burden of poverty and illness. I want you to know that President Bush and I both share this concern. We must work to assure that our parents and our grandparents who gave us the gift of life, live a life of dignity themselves.

Far too many of our citizens have neither public nor private health insurance. An unacceptable number of these citizens are our children. At the same time, we must also confront the implications of an aging society for our health and long-term care system. Our elderly population is growing faster than any other group in society. We must also be prepared to meet their needs. Finally, we must meet these two complex challenges while remaining committed to bringing the staggering cost of our Nation's health care system under control.

I know that the task ahead is a difficult one. I take note that selected Members of this body, under the leadership of Senator Rockefeller, have just last week completed a similar task. I would like to take this opportunity to commend the Senator and the other commission members for their commitment to achieving a better health system for all Americans. The work of the Pepper Commission is one contribution to the public debate over desirable health policy goals for the 1990s.

As you are aware, President Bush announced in his State of the Union Address that has appointed me to lead a Domestic Policy Council review of recommendations of several health studies, including the Pepper Commission and the Advisory Council on Social Security. Several private sector efforts are also underway. In addition, last year I appointed a task force chaired by HHS Under Secretary Constance Horner, which also is working on this issue.

However, I want to add an important note of caution. We are all wiser after the repeal of the Medicare catastrophic law. The lesson to be learned is that good intentions can have unintended consequences, particularly if they carry a high price tag. We do not want another catastrophic outcome on our hands, and my concern is that the almost $100 million price tag on the Pepper Commission proposals involving public and private dollars could result in just that. As I conduct the domestic policy council review of the Nation's health care financing system, I look forward to working with the members of this committee and with others who are devoted to improving the health of our Nation, to make the American people aware of the significance of this issue, and their stake in it.

I would like to focus my remarks today on my Department's deep commitment to addressing the concerns of the vulnerable elderly, and specifically, improving their access to our health care system. Fortunately, because of a vibrant economy and many of the social service programs under the roof of the Department of Health and Human Services most older Americans no longer are faced with the harsh dilemma of whether they will be able to pay the rent, the doctor, or the food bill. In fact, today most older people are in good health, maintaining active lifestyles, and contributing to all aspects of our society. But we must not forget those who have not yet shared in our Nation's prosperity, particularly our vulnerable older citizens.

President Bush and I are firmly committed to maintaining and indeed to strengthening the critical fabric of service delivery to our older citizens. Let there be no doubt about this in anyone's mind. Accessibility and affordability of health care are issues of particular concern to older Americans who are minorities. The statistics and my own personal experience as a physician in Georgia bear out this fact. That is why one of my major priorities as Secretary is to improve minority health care.

I have initiated action in several areas to begin to address this concern. Assistant Secretary for Health, Dr. James Mason, and the Director of the Office of Minority Health, Dr. William Robinson, are currently developing a plan to address the disparity in minority health status, which in part focuses on local intervention. This effort will involve a broad spectrum of organizations and institutions, and will target health problems faced by minority populations.

The problems of the minority elderly is also a major focus of the Administration on Aging, led by Dr. Joyce Berry. The Administration on Aging has created 11 national aging resource centers. Six of these centers assist State agencies on aging in developing community based long-term care systems for the vulnerable and chronically ill elderly. Five other centers assist the States to meet the needs of the rural elderly, the minority elderly, persons suffering from elder abuse, residents of nursing homes, and to develop health promotion programs for the aging.

The Administration on Aging is also working in joint endeavors with other divisions within the Department of Health and Human Services, including the Social Security Administration, the Public Health Service, the Health Resources and Services Administration,

and the National Institute on Aging to facilitate services and research directed to the health needs of vulnerable persons.

Health service delivery to the minority elderly suffers from a lack of professionals to serve them. I have intimate knowledge of this problem since my entire professional life has been dedicated to improving the health of minority populations through the training of minority physicians and other health workers. Increasing the number of minority health professionals is a major objective of our department, and I want to point out that the administration's budget contains a new initiative in this area.

To further assist in the effort to improve the health of older minority Americans, the Department of Health and Human Services is awarding $600,000 in grants to 10 historically black colleges and universities to develop and implement health promotion programs aimed at improving the health of minority older citizens.

Another important aspect of our efforts to address the health problems of the vulnerable elderly falls in the area of research and research training. Independence of older persons is compromised by a range of biomedical, behavioral, and social factors that adversely affect health and increase the demand on services.

Increased emphasis must be placed on a continuum of studies, from understanding basic aging processes, to conquering later life diseases, as well as understanding the elements of prevention and apply the approaches to rehabilitation of dependent older persons. Training of a new generation of health researchers must at the same time accompany the studies being carried out in those areas. In addition to the major role of the National Institute on Aging at NIH and other components at NIH, the Centers for Disease Control and many other programs within the Department contribute in a significant and coordinated way to these efforts.

An example of the important research underway is the work the National Institute on Aging is conducting to prevent hip fractures, which each year affect 200,000 Americans over the age of 65. Research is also being conducted on how increasing safety factors can reduce accidents among older people.

As I mentioned in my opening remarks, 50 years ago our country began a concerted effort to protect our older citizens from financial insecurity. The cornerstone of that effort was the creation of the Social Security Program.

For me and for this administration, nothing is more important than the proper management and protection of the Social Security Trust Funds. Social Security is certainly not broken and does not need fixing, either by undermining the financial condition of the trust funds or by making ill-advised changes in the structure of the Social Security Administration. I remain firmly opposed to separating the Social Security Administration from the Department of Health and Human Services. Such a proposal would not make sense from a management perspective, nor, more importantly, from the standpoint of our beneficiaries and particularly the vulnerable elderly.

Today, I have described a social service delivery system under the roof of the Department of Health and Human Services that works and that recognizes the interconnected medical and social needs of the elderly. The vulnerable elderly do not need to be

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