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HEALTH RESOURCES AND SERVICES ADMINISTRATION

STATEMENT OF DR. ROBERT G. HARMON, DIRECTOR
ACCOMPANIED BY:

DR. JAMES A. WALSH, ASSOCIATE ADMINISTRATOR FOR OPER

ATIONS AND MANAGEMENT DR. G. STEPHEN BOWEN, ACTING DIRECTOR, BUREAU OF HEALTH

RESOURCES DEVELOPMENT DR. FITZHUGH S.M. MULLAN, BUREAU OF HEALTH PROFESSIONS DR. MARILYN GASTON, DIRECTOR, BUREAU OF HEALTH CARE DE

LIVERY AND ASSISTANCE DR. VINCE L. HUTCHINS, ACTING DIRECTOR, MATERNAL AND

CHILD HEALTH BUREAU DENNIS WILLIAMS, DEPUTY ASSISTANT SECRETARY, BUDGET, OF. FICE OF THE SECRETARY, DEPARTMENT OF HEALTH AND HUMAN SERVICES

BUDGET REQUEST Senator HARKIN. Our next witness is Dr. Robert Harmon, the Administrator of the Health Resources and Services Administration.

Dr. Harmon makes his second appearance before the subcommittee today to testify on the budget proposal for HRSA in fiscal year 1992. The administration requested $2.025 billion for HRSA programs, about $72 million less than in fiscal year 1991. The budget includes some funding increases for essential priorities such as reducing infant mortality. However, no funds or major cuts are proposed for other important priorities such as training doctors, nurses, and other health professionals.

AIDŚ programs would be level-funded in fiscal year 1992. This is disturbing, giving that AIDS cases continue to mount, as does the evidence that early intervention and treatment is critical. I am concerned that all the funds proposed for the healthy start infant mortality initiative in fiscal year 1991, and some from fiscal year 1992, would come from other maternal and child health programs. As I said earlier today, I simply cannot support that.

It is equally troubling to note that only some major urban areas appear to merit the attention, while no funds are proposed for the rural health outreach grants program to assure a healthy start to Americans living in the smaller communities and more rural areas of America.

I believe we need to take a comprehensive, national approach to reducing infant mortality, and Dr. Harmon, I want to hear your view of how we might best accomplish that goal. Certainly the Public Health Service has been in the forefront of this effort, and you know that better than I do.

So, Dr. Harmon, we are looking forward to your testimony. Your testimony will be made a part of the record in its entirety, and please provide as you so desire.

SUMMARY STATEMENT
Dr. HARMON. Thank you very much, Senator Harkin.

I would like to introduce the people up here at the table with me. On my far right is Dennis Williams, Deputy Assistant Secretary for Budget in the Office of the Secretary.

Next to him is Dr. Stephen Bowen, the new Director of our Bureau of Health Resources Development. To my right is Dr. Jim Walsh, who is the Associate Administrator for Operations and Management. On my left is Dr. Marilyn Gaston, the new Director of our Bureau of Health Care Delivery and Assistance. On her left is Dr. Vince Hutchins, Acting Director, Maternal and Child Health Bureau. And on my far left, Dr. Fitzhugh Mullan, who is the Director of our Bureau of Health Professions.

Mr. Chairman, our fiscal year 1992 budget for HRSA continues the agency's important role in providing health care and professional training for the underserved, disadvantaged, and minorities. This budget of over $2 billion will meet our commitments through community and migrant health centers, the MCH block grant, treatment programs for persons with HIV and AIDS, black lung, Hansen's disease, support for health professions students and institutions, and a wide variety of other activities dealing with organ transplantation, vaccine injury compensation, health care for the homeless, and the healthy start infant mortality initiative.

There are several major new or expanded activities in our 1992 budget, among which we are seeking to reduce the infant mortality rate in this country, which remains far too high, especially among minority populations.

Over 40,000 American babies die every year before their first birthday. To address this problem, our request includes a total of $171 million for high infant mortality areas, to be devoted to ag, gressive outreach and counseling of pregnant women, to be followed by intervention services, such as smoking cessation, drug and alcohol abuse treatment, nutritional assistance, and quality prenatal care, to achieve improved pregnancy outcomes.

Through these services and utilizing the recent Medicaid expansions, our goal is to reduce the infant mortality rate by 50 percent in these areas over 5 years.

We are also seeking an increase of $5 million for the National Health Service Corps (NHSC) recruitment program. This will continue our revitalization of the NHSC, providing primary health care practitioners in urban and rural areas of need.

We are seeking $88 million to continue the minority health programs authorized in the Disadvantaged Minority Health Improvement Act of 1990. These activities are designed to increase the number of minority health professionals, and to reduce the health disparities between minorities and nonminorities.

We are seeking $554 million to maintain the MCH block grant. In fiscal year 1992, $9 million of the special projects of regional and national significance will be directed to the communities in the healthy start initiative.

Also, to continue our strong involvement in fighting the HIV and AIDS epidemic with programs authorized under the Ryan White Care Act of 1990, this 1992 budget continues those programs, which have been successfully initiated in fiscal year 1991, including $88 million for HIV emergency relief grants to high-incidence metro areas; $88 million for HIV care grants to States for the delivery of HIV services; and $45 million for early intervention service grants to entities that provide primary care to populations at high risk.

PREPARED STATEMENT Other HRSA AIDS programs will be continued at fiscal year 1991 levels. So in fiscal year 1992, HRSA will continue to work closely with other Federal agencies, the States, localities, and the private sector to help the disadvantaged. I believe the budget we are presenting to you will enable us to take advantage of opportunities and meet our challenges.

Mr. Chairman, I will be pleased to address any comments or questions you may have.

[The statement follows:)

STATEMENT OF DR. ROBERT G. HARMON

Mr. Chairman and Members of the Committee:

I am pleased to appear before you today to discuss the fiscal year (FY) 1992 budget request for the Health Resources and Services Administration (HRSA).

HRSA's clients are the disadvantaged, the underserved, minorities, poor mothers and children, the homeless, migrant workers. We also serve health professions students, persons with AIDS and HIV infection, those in need of organ transplants, those who are too sick to leave their homes.

HRSA programs are very diverse. They:

combat infant mortality;
provide health services to the underserved;
support community, migrant, and homeless health centers
improve the training, supply, distribution,
and quality of the Nation's health professionals;
support health facilities. improvements; and
help care for persons with HIV and AIDS

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Since HRSA's inception in 1982, its mission has continued to rapidly adapt to a changing environment. While our agency has continued to focus on assuring primary health care services to the underserved it has developed new and innovative approaches to providing that care. At the same time, HRSA has accepted responsibility for new programs to meet pressing public health needs.

In FY 1992, we are requesting over $2 billion and 1,430 full-timeequivalent positions. Our partners in this effort are State and local health departments, universities, private non-profit organizations, and many other participants in our nation's public health system.

Project Healthy Start

The infant mortality rate in this country remains far too high, especially among minorities. Currently, 40,000 American babies die every year before their first birthday. To address this problem, our request includes a total of $171 million for high incidence areas to be devoted to aggressive outreach and counselling of pregnant women to be followed by intervention services smoking cessation, drug and alcohol abuse treatment, nutritional assistance and quality prenatal care to achieve improved pregnancy outcomes. Through these services and utilizing the recent Medicaid expansions, our goal is to reduce, by 50 percent, the infant mortality rate in these areas over five years.

Community Health Centers

The FY 1992 request includes $478 million to continue support of approximately 530 community health centers providing primary health care services to over 5.5 million medically underserved people. These underserved individuals include those without access to care because they lack insurance, live in communities without sufficient health delivery capacity, have health concerns not met by traditional medical care, or face other barriers to care. In 1991,

we are proposing increased funding levels over the FY 1990 appropriation be directed to ten areas with the highest rates of infant mortality. The request also includes funding for the case management initiative providing a comprehensive approach to perinatal care designed to reduce infant mortality.

Migrant Health Centers

The FY 1992 request for Migrant Health Centers includes $52 million to continue support of services to migrant and seasonal farmworkers and their families. Access to health care for this group is difficult because of lifestyle, language, culture, and economic barriers. Services will be provided to approximately 500,000 individuals.

Minority Health Assistance

The FY 1992 budget includes $88 million to continue the Minority Health Programs authorized in the "Disadvantaged Minority Health Improvement Act." These programs are designed to increase the number of minority health professionals and to reduce the health disparities between minorities and the non-ninority population as outlined in the 1986 Report of the Secretary's Task Force on Black and Minority Health.

These programs include:

Exceptional Financial Need Program ($17 million),
providing nonservice conditional scholarship aid to
disadvantaged students. This level of funding also
includes the Financial Assistance for Disadvantaged
Health Professions Student program. This level of
funding will provide scholarships to approximately 2,700
students.
Health Careers Opportunity Program ($26 million),
providing grants and contracts to health professions
schools and other health or educational entities to
assist individuals from disadvantaged backgrounds to
undertake and complete education in health professions,
public health and allied health professions. This level
will support 175 projects.
Excellence in Minority Health Program ($12 million),
this program serves as the principal Federal activity
supporting certain predominately minority institutions
which train a disproportionate number of minority health
professionals. The request will support 4 schools in
this effort.
Minority Health Education programs ($28 million),
providing assistance to increase minority representation
in the health professions. Included in this initiative
is $15 million to capitalize the Health Professions
Student Loan program to meet the financial needs of
minority/disadvantaged health professions students.
This program establishes an alternative mechanism to
assist disadvantaged health professions students
previously served by the Health Education Assistance
Loan program which is proposed for phasedown.
Nurse Education Opportunities from Disadvantaged
Backgrounds ($4 million) supports projects to increase

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