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Washington, DC.

The subcommittee met at 2:08 p.m., in room SD-126, Dirksen Senate Office Building, Hon. Harkin (chairman) presiding.

Present: Senators Harkin, Burdick, Bumpers, Specter, Hatfield, and Gorton.





Senator HARKIN. Good afternoon. The Subcommittee on Labor, Health and Human Services, Education, and Related Agencies will come to order.

I want to welcome Secretary Sullivan this afternoon to review with us the fiscal year 1992 budget for his Department. The 1992 total request for Department programs under the jurisdiction of this subcommittee, is $160.6 billion, of which $22.8 billion is for discretionary programs and $137.8 billion is for mandatory pro


Again, as in the past years, we see mandatory spending increasing by 10.6 percent, well over the rate of inflation, while discretionary programs are increasing by only 0.9 of 1 percent, well below the rate of inflation. The request would permit mandatory programs to grow by $13.2 billion and discretionary programs have a net growth of only $200 million.

In addition to these requests, the Department will have an estimated $448 billion available from the permanent trust funds. This will result in total 1992 spending authority available to the Department to be an estimated $609 billion, or 41 percent of the entire Federal Government.

This afternoon's hearing will be followed by five additional hearings to examine in greater detail the requests of the various agencies in the Department of Health and Human Services. This hear

ing will permit us to discuss a number of broad policy questions with the Secretary.

Mr. Secretary, over this last year I want to especially compliment you on speaking out against the marketing plan of R.J. Reynolds to target new cigarettes for use by young women. And I could not help but notice the button you have on your coat, and I appreciate that.

[The button worn was a picture of a cigarette with the universal slash signifying NO].

This kind of leadership is to be applauded and I applaud you for it. However, I would note for the record that R.J. Reynolds has continued their efforts at marketing research or testing the market for the introduction of the cigarettes that are targeted toward young women I guess-the Dakota cigarette. Evidently they are going ahead with it. Whatever else you can say about it, please continue to take the great leadership you have in the past on that issue.

I also want to compliment you on the several initiatives included in your budget that provide a 7.8-percent increase for programs focused on health promotion and disease prevention. I believe that is going in the right direction. Last month I, along with some of my colleagues, introduced a package of seven bills to increase the focus on existing and new programs for health promotion and disease prevention. And this year with your support, and hopefully the support of the subcommittee, I hope to give priority funding attention to the many programs in your Department that are focused in this area of prevention and health promotion.

At the same time I must admit that I am not overenthused with the budget for programs of rural health. You propose to discontinue funding for the Rural Health Transition Grant Program, Mr. Secretary, and we will be discussing that as we go along. It is something that, I cannot speak for other States, but I know in Iowa, these small hospitals have used these rural hospital transition grants to great effect. No funding is requested for the Essential Access Community Hospital Program or the Rural Primary Care Hospital Program. Again, these are not big programs, but they are very meaningful programs to small hospitals in rural areas of America.

Again, Mr. Secretary, I am not going to go through all of this. I will just submit a lot of this for the record. However, some of the numbers that we see in here, we will be going through that with you today.

Again, I want to compliment you on your concern and support for an expanded infant mortality initiative. I must tell you as I have in private-now I will say it in public-that I have serious concerns about the way that we have proposed to finance this initiative by retargeting some of these moneys. And we will discuss that, I am sure, in our question and answer period. As someone who has worked long and hard to fund the Maternal and Child Health Care Program, there has to be some other way of funding this new initiative, which I am all for, other than going after the Maternal and Child Health Care Block Grant Program.

And not to mention the problem in rural America for infant mortality also, and we do have a problem in rural America. In fact, the incidence of infant mortality between 1 month and 12 months is higher in rural areas, I am told, than it is in the cities. And, so,

if you are just going to target the cities, that leaves a lot of the rural areas out.

But again, Mr. Secretary, as I said to Secretary Martin this morning, I do not look upon these hearings in any way as being confrontational. We have worked together in the past. We both share a number of the same concerns. I look upon this as a way of sort of conversing with you about the goals of your Department for the next fiscal years, our goals that each of us have or collectively that we might have here, give you an idea of some of the directions that we may be taking, and to get from you a policy outline of where you want to take the Department over the next couple of years so that we can mesh your requests with the budget that we have to work under.

So, in that spirit, I welcome you again to the subcommittee. I look forward to working with you.

I would yield to my distinguished colleague, ranking member of the committee, Senator Specter, for any comments that he has.


Senator SPECTER. Thank you, Mr. Chairman.

Mr. Secretary, I join my distinguished colleague, Chairman Harkin, in welcoming you here and congratulate you on an outstanding record. I think back 2 years ago to about this time and the confirmation process and the achievements of the past 2 years. And you have hit the ground galloping and have accomplished a great deal in a very, very difficult Department.

When the time comes for a markup, this subcommittee has enormous difficulties because of the very heavy competition on so many items of major importance. And as I look down the summary sheet of some of the items that we have to concern ourselves with on the issues of drug treatment, the issue of substance abuse for the homeless, and AIDS, and low-income home energy assistance, and the National Institutes of Health, and the various programs there, research on diabetes or cancer or mental health, it is an extraordinarily difficult job which we have with such a limitation of funds in these critical areas.

When Chairman Harkin comments about rural health, I would echo his concerns. Pennsylvania is a State with an enormous rural population. People are sometimes surprised to hear the statistic that there are more people living in rural Pennsylvania than live in the rural part of any other State in the United States, some 2.5 million people, so that is a matter where I would echo what Senator Harkin has expressed his concern about.

The issue of infant mortality is a matter of grave concern, and I applaud the initiatives which you have made. And this is something we discussed earlier, and I recollect studies which came out of Pennsylvania's city of Pittsburgh, about a very high-one of the highest in the country of infant mortality among blacks and activities which were undertaken in the early to mid 1980's on the subject. And while I am with you on the need for funding there, it is going to be a matter of finding where we can determine the offsets so that we can move ahead on those programs.

But this subcommittee has worked very cooperatively with your Department and I am sure we will do so in the future. And some

how we seem to make the accommodations necessary-at least we have in the 2 years that I have been the ranking Republican on this subcommittee working with Senator Harkin. And we follow a path blazed by our distinguished ranking member of the full committee, the former chairman, Senator Hatfield. So I look forward to working with you.

I want to say that I will be in and out today. We have Secretary Brady in another subcommittee meeting at 2:30 and I have to be on the floor, but I will return a little later.

Thank you, Mr. Chairman.

Senator HARKIN. Thank you, Senator Specter.

Senator Bumpers.

Senator BUMPERS. I have no opening statement.

Senator HARKIN. Senator Gorton. Senator Hatfield.

Senator HATFIELD. No opening statement.


Senator HARKIN. Thank you, again, very much. I would like to insert Senator Cochran's statement in the record.

[The statement follows:]


Mr. Secretary, it is a pleasure to see you again. Yours has become a familiar face in Mississippi, and we appreciate the fine remarks you have made at graduation ceremonies and other events in my state.

I am pleased to see so much emphasis in your budget request placed on infant mortality and minority health issues. As you well know, those are two of the greatest health concerns in Mississippi. I want to work with you in whatever ways I can to address those issues in a productive way. I am concerned that the infant mortality initiative is aimed at urban areas, and that funding would be redirected from community health centers, where much of the success in reducing infant mortality has occurred. But I am sure we can work through those differences.

I also appreciate your efforts to find ways to battle the escalation of health care costs. I think the two most important domestic issues facing our nation are the access, quality and affordability of education, and the access, quality and affordability of health care, especially long-term care for our elderly and disabled population. As our population ages, this problem will be magnified. There are no quick-fixes, and I appreciate your efforts to study this problem so that we don't end up just throwing money at the problem, but that we develop a long-term, sensible strategy for addressing the health care needs of our country.

I look forward to working with you this year, and I hope you will call on me for any assistance I can provide.


Senator HARKIN. Dr. Sullivan, thank you for being here. And welcome back again, and the floor is yours. Please proceed as you so desire.

Secretary SULLIVAN. Thank you, Mr. Chairman, Mr. Specter, and members of the committee.

It is a great pleasure for me to have this opportunity to appear before you to discuss my Department's priorities and our proposed budget for fiscal year 1992. I have already submitted for the record a reasonably detailed overview of our proposals. You are very familiar with these figures, and, therefore, I would like to utilize my time to emphasize a part of my written testimony with you.

I would like to specifically focus my comments on programs and initiatives on behalf of the Nation's children. And by doing that to

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