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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?

Answer. The exact nature and level of participation expected from the insurance industry is still under consideration within the Department. In an 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.



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

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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.




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

National Institute of Mental Health's overall research budget, which increased by 43 percent during this same time period.



Question. Secretary Sullivan, last summer, in you speech at the AARP convention, you said that we must "do everything possible to strengthen our ability to protect older Americans from abuse, wherever they are." You rightfully expressed your outrage at this terrible social blight an announced your departmental task force to develop a comprehensive elder abuse strategy, including "new legislative initiatives to deal with the problem. You also called upon Commissioner on Aging Berry to "expand and strengthen efforts" of the Older Americans Act long-term care ombudsman program to investigate and resolve complaints of abuse against our older Americans.


In light of this, I hope that you were pleased that Congress appropriated for FY 1991 the first funding for the elder abuse provisions of the OAA (Title III, part G). The amount is only $2.9 million for the nation, but it is a good start. Also, we provided $2.4 million specifically for the ombudsman program.

I must say that I am disappointed that the President's budget calls for no increase in these small amounts for these critical programs. couple of questions for you about this:

I have a

1) Does the OMB passback reflect your recommendations or views concerning funding for elder abuse and ombudsman activities under the Older Americans Act?

Answer. The FY 1992 President's Budget reflects our recommendations for funding for elder abuse and ombudsman activities under the Older Americans Act.

Question. Do you believe we should increase funding for these activities? If so, what do you believe would be a legitimate level of funding for these efforts?

Answer. We are recommending a total of $5.4 million in FY 1992 to continue programs that provide grants to States to respond to and prevent instances of elder abuse and neglect in both the community and long-term care facilities. A total of $5.4 million is included in for: Long-Term Care Ombudsman

Services to provide States resources to investigate and resolve complaints on behalf of older

individuals residing in nursing homes and board and care homes, funded at $2.4 million; and Grants to States to conduct abuse, neglect and exploitation prevention activities including outreach, education, reporting, and referral of complaints to law enforcement agencies, funded at $3.0 million.

Question. As you know, this year we will reauthorize the Older Americans Act. This provides an opportunity to strengthen these efforts in the Older Americans Act?

Answer. State and Area Agencies on Aging, as well as the Administration on Aging, have broad authorities to conduct elder abuse and ombudsman activities under the existing provisions of the Older Americans Act. There are no legislative changes necessary to continue to carry out these activities.

Further, I want to be clear that States have a major responsibility in efforts to eliminate elder abuse. The Administration on Aging recognizes its obligation to support these State-directed efforts. The Older Americans Act, as currently enacted, provides sufficient authority for AoA to assist States in addressing elder abuse.

Question. What recommendations would you make

regarding legislative initiatives aimed at combatting elder abuse in all its forms?

Answer. I believe legislation already exists

What we need

to address the problem of elder abuse. is enhanced awareness, coordination and responsiveness to the problem of elder abuse at all levels of government and society.

Question. Finally, please update us on the activities of your task force and what is your current expectation as to what the outcome of this effort will be?

Answer. The purpose of the Task Force is to develop a departmental strategy to promote the prevention and improved reporting, investigation and follow-up of elder abuse. Task Force members consist of the heads of the Administration on Aging, the Health Care Financing Administration, the National Institute on Aging, and the Assistant Secretary for Planning and Evaluation.

The task force is currently developing a set of recommendations aimed at increasing the awareness of professionals and practitioners who deal with elder abuse, improving the coordination of federal, state and local entities that respond to complaints of

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