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provided under Medicaid, Head Start and the programs funded through the older Americans Act. CTAA's performance has been appropriate thus far under this project.
Yes, we are complying with the conference report on Fiscal 1991 funds and will continue the current technical assistance program. On March 18, 1991, an announcement of the availability of funds and a request for applications was published in the Federal Register for the continuation of the human services transportation technical assistance project. In keeping with the language of the Appropriations Committee Report, the announcement provides that eligible applicants are "national organization(s) with a record of assisting rural and special transportation needs." We have provided for a 60-day response period and will fund the new cooperative agreement(s) as of July 1, 1991. The Department intends to fund one or more cooperative agreements to continue the provision of technical assistance to the planners, providers and agency consumers of human services transportation. The cooperative agreement(s) will be let to the most qualified organization(s), as determined during the application review process.
Finally, it should be noted that at this time the Department is not able to verify the $1 billion estimate for the provision of human services transportation that is contained in the Committee report. However, we anticipate that the current CTAA study of the Head Start, Medicaid, and older Americans Act programs will provide the Department with an estimate of the transportation costs associated with the major human services transportation programs in HHS that we can confidently share with the Committee and the public.
Question. The Fiscal 1991 bill also provided . approximately $250,000 for a special technical assistance program for rural and special transportation providers on the new requirements of the Americans with Disabilities Act. According to the Senate Committee Report, technical assistance is to be provided to state human services agencies, rural and special transportation providers to ensure that HHS-funded transportation efforts are directed toward the needs of persons with disabilities and that such efforts are coordinated with other public transit services. This program is to be carried out by a qualified national organization with a record of assisting rural and special transportation needs.
The conference report concurred with the Senate position.
1 What is the status of this project? When will . funds be available? Do you intend to comply with the intent of Congress on the selection of a contractor and the implementation of this program?
Answer. Yes, we are complying with the intent of Congress on the selection of a contractor and the implementation of this program. On March 18, 1991, an announcement of the availability of funds and a request for applications was published in the Federal Register, for the provision of targeted technical assistance on the requirements of the Americans with disabilities Act. A 60-day response period has been allowed, and the new cooperative agreement(s) will be funded as of July 1, 1991. The Department intends to fund one or more cooperative agreements to provide targeted technical assistance to the planners, providers and agency consumers of human service transportation on the requirements and anticipated implications of the Americans with disabilities Act. Pursuant to the language of the Appropriations Committee report, the announcement provides that eligible applicants are "national organization(s) with a record of assisting rural and special transportation needs." The cooperative agreement(s) will be let to the most qualified organization(s) as determined during the application review process.
Question. Dr. Sullivan, a great portion of your career has been devoted to improving the health status of minorities, and the number of minorities in the health professions. What are some immediate steps that this subcommittee and the department can take in improving the Federal contribution to this effort?
Answer. Support of the President's FY 1992 budget will provide $485 million for direct programs targeted specifically towards this effort, $47 million (11%) more than in FY 1991. My highest priorities are reflected in this request, including: Health Professions Student Loan recapitalization, extramural construction at minority institutions in order to better enable minority researchers to compete for NIH research grants, and further investment in scholarships through the National Health Service Corps program.
In addition, the Federal contribution to this effort will be greatly enhanced if we endeavor to make programs already in place reach targeted audiences. This means that as managers of Federal programs, it is incumbent upon us to assure that we carefully target grant and scholarship funds in order to meet the Year 2000 objective of improving the health status of our minority citizens.
Question. Dr. Sullivan, I know that you are aware of the severe shortage of family doctors and other primary care providers throughout many areas of the United States. Wouldn't you consider the training of family physicians a priority, too?
Answer. Yes, I do consider the training of family physicians a priority. That is why I am continuing to expand the National Health Service Corps Recruitment Program. Through scholarships and loan repayment programs, we will be able to provide financial assistance to students pursuing careers in primary health care and to ensure that these providers practice in underserved areas. I am also expanding the Health Professions Student Loan Program by $15 million, which provides low cost loans to health professions students.
Question. Dr. Sullivan, you have appeared before our subcommittee before, in support of several programs within the Department of Health and Human Services. How do these programs such as the Health Career Opportunity program, the Research Centers at Minority Institutions program, the Minority Access to Research Careers program, and others have a significant impact on the training of minorities for health careers?
Answer. As you know, my primary goal regarding minority health improvement includes increasing the deployment of health professionals to minority communities, thereby increasing access to primary care. The programs you mention assist individuals who might not otherwise be able to undertake and complete an education in the health professions, public health, allied health professions and biomedical research. The Health Career Opportunity Program, in particular, supports programs which mentor students during that training through to graduation. I believe that minority health professionals trained as a result of this assistance will serve in the minority community.
In FY 1992, we are proposing certain program changes which will further enhance the effectiveness of the Minority Access to Research Careers program. We propose to expand support to promising undergraduate freshmen and sophomores, where previously only those at the junior class level and above were eligible for assistance. In addition, we plan to expand the predoctoral program to support minority students at nonminority institutions. The budget request for biomedical training support includes increases over FY 1991 of more than 5% for the Minority Biomedical Research Support program, 11% for Minority Access to Research Careers, and 6% for the Minority High School Apprentice program.
Question. Dr. Sullivan, I know that you are an advocate of pristine living, good nutrition and no smoking. What are some the current Departmental activities related to smoking prevention, educations and treatment? How about nutrition?
Answer. In my tenure as Secretary, I have repeatedly stressed the role of personal responsibility in improving health and preventing disease. This is especially true as it relates to both the use of tobacco and in what we eat. We are vigorously pursuing our fight against cigarette smoking and tobacco use, the single most preventable cause of premature death and disability in our country. In FY 1992 we are seeking a 9% increase throughout the OHS agencies for anti-smoking activities including: a request to double the budget for the office of Smoking and Health; increased resources for NCI'S ASSIST (Americans Stop Smoking Intervention Study) program -- a large scale demonstration effort to disseminate information on past success in 20 States and large cities; and through CDC, increasing support for smoking cessation program aimed at pregnant women.
Because of the crosscutting nature of nutrition, nutrition is an element in the programs of all PHS agencies, as well as the office of Human Development Services (Head Start), the Family Support Administration (Office of Community Services) and the Administration on Aging.
Nutrition is an important part of our overall strategy to improve health. In fact, a number of nutrition objectives are included in "Health People 2000: National Health Promotion and Disease Prevention Objectives". In addition, NIH is involved in a wide range of research efforts related to nutrition. NIH spent over $287 million on nutritional research in FY 1989 (the last year for which we have data) and will continue these efforts in FY 1992. One prominent nutrition issue is obesity. In the US, it is estimated that 34 million are affected, with the rates highest among the poor and minorities, particularly women.
Question. Mr. Secretary, I am surprised to see the $5 billion figure you quote in your opening statement as funds focused on infant mortality.
Mr. Secretary, this of course is the broadest possible definition of funds being spent towards the goal of reducing infant mortality. Are you suggesting that the $5 billion is somehow a coordinated program to reduce the infant mortality rate?
Answer. As you know, the problem of infant mortality is the result of many contributing factors -inadequate access to health care services, poor nutrition/diet, the use of tobacco, alcohol, or drugs by the pregnant mother, genetic disorders and a variety of diseases. To fully address the problem requires efforts to be made on a number of fronts. With its exceptionally broad mandate, the Department of Health and Human Services has at its disposal a diversity of tools which can be brought to bear on this problem.
The FY 1992 request of $5 billion for Department efforts to combat infant mortality includes funding for a variety of activities representative of this Department's diverse resources (e.g., targeted health care services, disease prevention, biomedical research, and health care financing). All of these programs have an impact on our ability to provide health care to mothers and their infants, and, ultimately, to reducing infant mortality. The Department's efforts are coordinated by ensuring that each objective (e.g., conducting research on SIDS, immunizing infants against hepatitis B, providing prenatal care to poor or disadvantaged women) is assigned to the agency or program best suited to complete the task.
To exclude any of these programs from our efforts would fail to recognize the extent of the problem of infant mortality, which could hinder our progress on infant mortality.
NATIONAL HEALTH INSURANCE
Question. National health care expenses totalled $604.1 billion in 1989. The health care inflation rate is now over 10% a year. If it continues at the same rate as it has since 1980, costs will double every seven years. Today, we spend 35% more per capita on health care than Canada, 91% more than West Germany, 124% more than Japan, and 173% more than Britain.
Yet the U.S. ranks behind 16 other developed
Maternal mortality rates soared 27% between 1987 and 1988;
Between 5 and 10 million Americans need treatment for drug abuse;
1,000,000 Americans are infected with HIV.
Mr. Secretary, I want to ask you the question the Ronald Reagan asked the American people: Are we better off today than we were 10 years ago? Is it time to abandon the piecemeal approach of the last decade and pursue true health policy reform, such as national health insurance?