DEPARTMENTS OF LABOR, HEALTH AND HUMAN Printed for the use of the Committee on Appropriations ? COMMITTEE ON APPROPRIATIONS JAMIE L. WHITTEN, Mississippi, Chairman EDWARD P. BOLAND, Massachusetts SIDNEY R. YATES, Illinois BILL CHAPPELL, JR., Florida JOHN P. MURTHA, Pennsylvania JOSEPH D. EARLY, Massachusetts LINDY (MRS. HALE) BOGGS, Louisiana MARTIN OLAV SABO, Minnesota JULIAN C. DIXON, California VIC FAZIO, California W. G. (BILL) HEFNER, North Carolina LES AUCOIN, Oregon DANIEL K. AKAKA, Hawaii WES WATKINS, Oklahoma WILLIAM H. GRAY III, Pennsylvania BERNARD J. DWYER, New Jersey BILL BONER, Tennessee STENY H. HOYER, Maryland BOB CARR, Michigan SILVIO O. CONTE, Massachusetts JOHN EDWARD PORTER, Illinois JIM KOLBE, Arizona ROBERT J. MRAZEK, New York RICHARD J. DURBIN, Illinois RONALD D. COLEMAN, Texas ALLAN B. MOLLOHAN, West Virginia FREDERICK G. MOHRMAN, Clerk and Staff Director DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 1988 WEDNESDAY, FEBRUARY 18, 1987. DEPARTMENT OF HEALTH AND HUMAN SERVICES WITNESSES HON. OTIS R. BOWEN, M.D., SECRETARY, HHS THOMAS K. BURKE, CHIEF OF STAFF, HHS S. ANTHONY MCCANN, ASSISTANT SECRETARY FOR MANAGEMENT AND BUDGET, HHS RON DOCKSAI, ASSISTANT SECRETARY FOR LEGISLATION CHAIRMAN'S INTRODUCTORY REMARKS Mr. NATCHER. The committee will come to order. At this time we have before the committee the Secretary of the Department of Health and Human Services. Mr. Secretary, as you have heard me say before, many of us here in the Congress_consider your department to be the most important agency of our Federal Government. The programs you administer affect virtually every family in this country. They provide income security for the elderly and disabled and health and social services for the poor. Research activities at the NIH provide the hope that we can one day cure and prevent the dread diseases of our time, like cancer-diseases like heart disease, schizophrenia, and acquired immune deficiency syndrome. This is an awesome responsibility. Mr. Secretary, I want you to know that I believe the Department is in good hands under your leadership. Several months ago before the full Committee on Appropriations when we were presenting a matter pertaining to our subcommittee-I said to them, in the full committee, Mr. Secretary, that I believed that you would make an excellent secretary. I said to them that you are a politician and a doctor and the right kind of a politician, and there is nothing wrong with that. I think the committee generally accepted what I said to them. From time to time, we may differ a little, Mr. Secretary, on some of your specific proposals, but I, as one member, believe that you are committed to the health and welfare of our people. The budget request for 1988 for your department includes over $360 billion for the programs which mean so much to the people of this country. This is more than one-third of the total Federal (1) budget. Mr. Secretary, we intend to work with you and to produce a good appropriations bill, which moves us closer to our common goal. Now, Mr. Secretary, again, I want you to know that I, as one member of this committee, believe that you are an excellent secretary. HISTORY OF BILL Mr. Secretary, this bill has an unusual history. You go back and check this bill from 1969 up to 1974, and you will find it was vetoed seven times in six years. A little unusual, seven times in six years. One time, we took the education money out of this bill, and made a separate bill out of it. The President just vetoed both of them. We overrode four times; failed three times. President Reagan has signed this bill every time it has gone down to him as a bill, an individual appropriations bill, and that speaks well not only for the administration, but for our subcommittee. As I have said a lot of times, Mr. Secretary, when I first became a member of this committee, we had $77 million in the appropriations bill for the National Institutes of Health. Now we are a little over $6 billion and that is the way it should be. Mr. Conte, as you know is unable to be with us, but as the ranking minority member on this subcommittee, he and I together with the other subcommittee members work together. We like each other, Mr. Secretary. We like this bill. We took this bill two years ago over on the House floor and passed it in an hour and 53 minutes. This is the same bill that used to require five, six, seven days. Every member in the House regardless of politics, knows that this is the people's bill. We believe that, Mr. Secretary. We will be glad to here from you. Secretary BowEN. Thank you very much, Mr. Chairman, Members of the Committee. I am pleased to have the opportunity to testify before you today on the fiscal year 1988 budget of the Department of Health and Human Services. As you requested, I have already submitted for the record a detailed statement. I will now summarize that statement and share with you my thoughts on the issues and challenges that it poses. BUDGET SUMMARY This budget calls for an outlay of $361 billion for a wide variety of health, income security and social services programs and amounts to 35 percent of the Federal budget. It is $13 billion higher than 1987's, reflecting increases in benefits, more beneficiaries, and the growing cost of health care. But our new budget request also achieves outlay savings of $9 billion, while still meeting legally mandated deficit reduction targets. In addition, I would like to highlight a major initiative of the administration which is soon to be introduced to Congress. This legislation would protect 30 million elderly and disabled Americans from the threat of catastrophic illness. Under this proposal, Medicare beneficiaries would receive catastrophic illness coverage by |