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How do you account for this steady increase?

Answer. The increase can be attributed to the following: a projected average annual increase of more than eleven percent in complaint receipts between FY 1989 and FY 1992; a relatively constant level of compliance staff; and the Office for Civil Rights' concurrent effort, beginning in FY 1990, to operate a balanced program of complaint investigations, compliance reviews and outreach activities.

Question. What level of FTE and funding, in your view, would be required to decrease the backlog of unresolved cases? Please be specific.

Answer. It is important to note that the year-end inventories are not unattended "backlogs", since they principally include cases that are being processed, as well as cases received during the last half of the previous fiscal year. In FY 1989 and 1990, the inventories were 29.6 and 31.27 percent respectively of total workload. In FY 1992, that percentage is expected to rise to 33.2 percent of total caseload.

By regulation, OCR is required to promptly address complaints of discrimination and carry out other compliance activities such as periodic compliance reviews. The Department has chosen to maintain a balanced enforcement program of complaint investigations, compliance reviews and outreach activities which, because of resource limitations, has resulted in a small increase in the end-of-year inventory. In FY 1992, should the end-of-year inventory become unmanageable, the agency has the flexibility to redistribute resources as needed.


Question. How many Policy Research Studies are planned for FY 1992? How many of these will be conducted within the Department, and how many contracted out?

Answer. Policy Research will generate approximately thirty studies let through various contracts and grants in FY 1992. We do not conduct studies per se. However, we do utilize the research data gathered by these studies to translate the science of policy research to the development of the Departments planning and policy analysis.

Question. What are the priority areas for Policy Research studies in FY 1992?

Answer. The Policy Research program examines broad issues that cut across agency and subject lines, as well as new policy approaches developed outside the context of existing programs. The research will focus on policy issues in these major areas: services

integration; children and youth; family; long-term care; health care infrastructure and financing; and minorities.

Question. Please provide the Subcommittee with copies of recent studies on the family supported through Policy Research funds.

Answer. The following two examples of studies conducted on the family are being provided to the Subcommittee under separate cover: "Identifying Successful Families: An Overview of Constructs and Selected Measures" and a compendium of "Research on Children, Youth, and Families."

Copies of other studies are available through the Policy Information Center (PIC), a resource center for evaluation, short-term evaluative research, and policyoriented projects for the Department. The PIC is operated by the Office of the Assistant Secretary for Planning and Evaluation. Upon request, PIC staff will conduct searches of its on-line query system and make available copies of final reports and/or executive summaries which focus on the Department's programs and policy issues. The PIC is located in Room 438-F, Hubert H. Humphrey Building, 200 Independence Ave. S.W., Washington D. C. 20201, telephone (202) 245-6445.


Question. The budget requests $5 million for a new clearinghouse on third party liability, which proposes to identify beneficiaries' available health coverage and ensure that secondary payer provisions of law are followed.

As this new clearinghouse is envisioned, beneficiary participation in the clearinghouse appears to be mandatory, likened to providing information to the IRS. What specific information would beneficiaries be required to provide about themselves and their families?

Answer. Under the proposed new legislation, beneficiaries would not be mandated to provide any information to the IRS. Experience has demonstrated that information obtained from beneficiaries is often incomplete and inaccurate. The clearinghouse avoids this problem by going straight to the employer for the necessary information on health care coverage of their employees. The employer would be required, as part of the annual W-2 Form process, to provide information on employee health coverage for the tax year just completed. Although the details of this process need further development, the information provided by the employer would be limited to one of four categories with respect to the potential beneficiary/employee:

employer does not offer health insurance;
employer offers health insurance, but employee
not enrolled;

employee covered, self only; or

- employee covered, family coverage.

Failure to provide this data would carry the same liabilities as failing to report tax information.

Question. Will insurers also be asked to provide information about their clients?

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Answer. The exact nature and level of participation expected from the insurance industry is still under consideration within the Department. enterprise of this nature, however, one could not rule out the possibility that at some point, and for some claims, the insurers will be brought into the process for the purpose of identifying the party or parties responsible for making payment and the nature of coverage.

Question. What steps are being taken to ensure protection of individuals' privacy and the sanctity of computer data about beneficiaries?

Answer. The Administration is currently drafting statutory language to address privacy considerations.



Question. Dr. Sullivan, this marks the 20th anniversary of the National Cancer Act. My friend, Congressman Conte, recently died from complications related to his prostatic cancer and this has prodded me to give some thought to the NCI and the support that cancer research has from the Administration.

Over the past decade, funding for cancer research has actually decreased 6% in constant dollars, while other medical research programs have grown. When you make adjustments for AIDS, cancer research funding has actually decreased 18%.

Dr. Sullivan, can you please explain this disparity in funding when cancer is the cause of one out of five deaths?

Answer. I appreciate your concern for the funding level of the National Cancer Institute and assure you that this Administration and this Department remains committed to supporting research which will eventually lead to the elimination of cancer deaths. The funding pattern you have indicated is the result not of a lack of commitment to the cause, but rather a function of

how the NIH research budget is formulated in an environment of increasing competition in biomedical research where research funding is not unlimited. Despite the apparent decrease in NCI's resources relative to the measure you mention, NCI remains by far the largest Institute at the NIH with a budget of $1.8 billion, certainly a significant request for funding.

As you know over the past decade biomedical research has not only advanced but also branched out. Representative of this expanded scope of research is the fact that since 1980, two new Institutes and two new Centers have been established at NIH, thereby increasing competition for research funds. To assure that all research areas are allowed to prosper, NIH seeks to fund the most meritorious research rather than emphasizing any one disease area over another.

Another factor is the emphasis over the past decade on increasing funding for research project grants. In 1981, NIH funded 16,400 RPGs; in 1991 NIH expects to support over 21,000 RPGs. This emphasis on RPGs has not allowed other research mechanisms to grow as quickly. Because NCI does not rely principally on RPGs but instead utilizes a number of mechanisms, the emphasis on NIH support for RPGs has contributed to the slower rate of growth in the NCI budget.

Question. Dr. Sullivan, 76 million Americans alive today will be diagnosed with cancer in their lifetime. In the budget presented to the Congress, the President has indicated that "prevention" is a high priority of his Administration. Can you please explain to me why Cancer Prevention and Control at the National Cancer Institute in the President's Budget is funded $90 million below the level recommended by the By-Pass Budget?

Answer. The NCI By-Pass Budget represents the National Cancer Institute's "professional judgement" regarding all the anticipated scientific opportunities that will be available in 1992 should funds be available. The By-Pass Budget does not take into account competing priorities within the NIH, within the Department of Health and Human Services, or across the Federal Government. Priority setting has become even more important in light of the limitations on growth set by the Budget Enforcement Act.

In formulating the President's FY 1992 Budget request both the President and I provided to NIH flexibility to determine, within a total spending plan, how they would allocate resources to take best advantage of the competing scientific opportunities. NIH in turn provided NCI with some flexibility in determining the allocation of their resources. Within this context, the FY 1992 request of $90 million for Cancer Control and Prevention represents the NIH's best scientific judgement.


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Question. One person dies from cancer every half a million people a year. In addition, over one million people will be diagnosed with cancer this year. Soon, cancer will replace heart disease as the number one killer. Further, the disparity of cancer mortality rates in the minority community cannot be ignored. And yet, from the looks of this budget it is business as usual cancer research is being


treated like every other disease.

What will it take to get the Administration to open its eyes and see that we need to re-establish cancer as a national priority?

Answer. The Administration continues to be committed to the National Cancer Program, and we will continue to do what we can to ensure that NCI has sufficient funding to make progress on cancer. While the budget increase for NCI in 1992 (5.6%) is somewhat lower than the increase for NIH in total (6.0%), NCI remains by far the largest Institute at the NIH with a budget of $1.8 billion 20.6 percent of all NIH funding. Funds for research on cancer still exceeds research funding for any other disease, including AIDS. We know of no greater means of indicating the priority of the National Cancer Program.

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Question. The NIMH has indicated in a report requested by Congress (National Plan for Research on Child and Adolescent Mental Disorders) that a substantial increase in funds in FY 1991 (over $50 million) will be directed to research on children's mental health. This funding was to reach over $257 million by FY 1995. Moreover, there was to be a significant investment in children's services research. It has come to our attention that this program is now in jeopardy of losing its funds to other areas in NIMH and ADAMHA. As indicated in your report to Congress we consider this to be a critical research area that should have the highest priority for funding. What will the Department do to assure us that it will carry out its own plan that was supported by Congress?

Answer. The Department continues to place emphasis on children's mental health research as called for in the National Advisory Mental Health Council's National Plan on Child and Adolescent Mental Disorders. Compared to FY 1989, the FY 1992 HHS budget provides a 63 percent increase in funding for child and adolescent mental disorders. Child and adolescent mental disorders research has increased at a much more rapid rate than the

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