DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 1991 THURSDAY, MARCH 8, 1990. OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH WITNESSES JAMES.O. MASON, M.D., DR. P.H., ASSISTANT SECRETARY FOR HEALTH J. MICHAEL MCGINNIS, M.D., DEPUTY ASSISTANT SECRETARY FOR NABERS CABANISS, DEPUTY ASSISTANT SECRETARY FOR POPULATION AFFAIRS WILLIAM A. ROBINSON, M.D., M.P.H., DIRECTOR, OFFICE OF MINORITY HEALTH KENNETH J. BART, M.D., M.P.H., DEPUTY DIRECTOR, NATIONAL VACCINE PROGRAM WILMER D. MIZELL, EXECUTIVE DIRECTOR, PRESIDENT'S COUNCIL ON PHYSICAL FITNESS AND SPORTS WILFORD J. FORBUSH, DEPUTY ASSISTANT SECRETARY OF HEALTH OPERATIONS AND DIRECTOR, OFFICE OF MANAGEMENT W. HARELL LITTLE, DIRECTOR, DIVISION OF PHS BUDGET DENNIS P. WILLIAMS, DEPUTY ASSISTANT SECRETARY, BUDGET Mr. NATCHER. We take up now the Office of the Assistant Secretary for Health. We have before the Committee Dr. James O. Mason. Dr. Mason, before you give us your statement, tell us who you have with you there at the table. INTRODUCTION OF WITNESSES Dr. MASON. Mr. Chairman, I would be delighted to do that. Thank you for your welcome. Starting on my far left is Nabers Cabaniss the Deputy Assistant Secretary for Population Affairs. Next to her is Dr. Jarrett Clinton, Acting Administrator for the Agency for Health Care Policy and Research. Next to him is Mr. W. Harell Little, Director of the D vision of PHS Budget. On my right side is Wilford Forbush, D Assistant Secretary for Health Operations and Director, O Management. Next to him is Dr. William A. Robinson, Dire the Office of Minority Health. On my far right is D liams, Deputy Assistant Secretary for Budget. I would also like to introduce some of the big-leaguers who are here since we have been talking about baseball. Sitting behind me is Wilmer D. Mizell, Executive Director, President's Council on Physical Fitness and Sports, a former Assistant Secretary in the Department of Agriculture, and as you know, a real pitcher. Also behind me is Art Lawrence, who is with the National AIDS Program Office and Dr. J. Michael McGinnis, Deputy Assistant Secretary for Health who is responsible for disease prevention and health promotion activities. Mr. NATCHER. Thank you very much, Dr. Mason. It is a pleasure to have you before the committee again. You have appeared on many occasions. Dr. Mason, I had the pleasure to say to your successor the other day that if he was just half as good as you were he would be all right. Dr. MASON. That was kind of you. I want you to know that he is excellent. Mr. NATCHER. I hope he is down at the Center for Disease Control. We will be following events down there to see if he is half as good as you were. We will be pleased to hear from you at this time. OPENING STATEMENT Dr. MASON. Thank you. I would like to read my opening statement and insert for the record the separate statements of the Office of Assistant Secretary for Health and the Agency for Health Care Policy and Research. Mr. Chairman and members of the committee, we are pleased to be here today to present the 1991 budget request for the Office of Assistant Secretary for Health and the Agency for Health Care Policy and Research. The Office for the Assistant Secretary for Health is requesting an appropriation of $206 million, which is a net increase of $13.6 million over the fiscal year 1990 level. The increase includes $11.6 million for the Office of Minority Health and is reflective of our efforts to improve the health status of minorities. Since the establishment of the Office in 1985, some improvements in minority health status have been achieved. However, despite numerous efforts, there continue to be large disparities. In almost every category of mortality, death rates for minorities continue to be uniformly higher than for whites. Life expectancy for Black American males is actually declining, and is now six years. shorter than life expectancy for white males. The budget request presented to you today includes $9.4 million to support the Adolescent Family Life Program's demonstration and research program. This is the only federal program solely focused on the complex issues and problems of early adolescent sexuality, pregnancy and parenting. In fiscal year 1991, $139.1 million is requested to support the administration's proposal for a State-administered family planning program authorized under Title X of the Public Health Service Act. This is the same level of support as that provided in fiscal year 1990 for the family planning discretionary grant program. Under the administration's proposal, all Title X funds would be awarded directly to States and territories. Mr. Chairman, since its inception in fiscal year 1988, the National Vaccine Program (NVP) has provided coordination of all PHS vaccine activities and has provided added impetus to activities aimed at developing and introducing safer, improved acellular pertussis vaccines. A comprehensive, long-range National Vaccine Plan is being developed. We are looking forward to submitting the plan to Congress. The fiscal year 1991 request of $6.9 million is an increase of $1 million over the fiscal year 1990 appropriation which provided $3 million for a pertussis vaccine field trial, and $1.5 million for research on the development of new candidate vaccines. In addition to this budget request, $7 million is requested in the PHS agencies to address high priority NVP activities. For the management and direction of the Public Health Service, we are requesting $21.1 million and 274 FTEs. This staff assists me with the development of PHS policy and the coordination of a myriad of management functions. In fiscal year 1989 through the efforts of the debt management staff, $79 million was collected and paid into the U.S. Treasury. The fiscal year 1991 request provides resources to support the current level of management efforts. Retirement pay and medical benefits for commissioned officers: The retirement pay and medical benefits for commissioned officers request of $118.1 million provides retirement payments to Public Health Service commissioned officers, payments to survivors of officers who elected to receive a reduced annuity, and for medical care of active duty and retired officers, their dependents and survivors. With regard to the Agency for Health Care Policy and Research, the budget request includes $110.2 million in obligations. The Agency for Health Care Policy and Research was formerly known. as the National Center for Health Services Research and Health Care Technology Assessment. The purpose of the new agency is to enhance the quality, appropriateness, and effectiveness of health care services and access to such services through scientific research, promotion of improvements in clinical practice, and in the organization, financing, and delivery of health care services. The Medical Treatment Effectiveness Program is a Presidential initiative to improve our understanding of the effects of health care practices on patient outcomes. The ultimate goal of the program is to provide information to patients and practitioners that will improve the health of our population and optimize the utilization of scarce health care resources. In fiscal year 1991 $48.5 million in obligational authority is requested for the Medical Treatment Effectiveness Program, an increase of $11 million over fiscal year 1990. The increase for this important Presidential initiative will continue the momentum given to the program in 1990. The budget request for general health services research and health care technology assessment is $51.2 million in obligations. Specific research activities include health care services in rural areas, clinical practices, health care technologies, health care costs, productivity and market forces, primary care, long-term care, delivery of health services to minorities and the disadvantaged, and medical liability. We are also requesting $10.5 million for health services research on AIDS and HIV related illnesses, an increase of $2 million over 1990. The Agency for Health Care Policy and Research will support research to study the availability, cost, and utilization of services for different HIV risk groups, populations, geographic areas, and stages of illness and treatment modalities. The increase of $2 million will expand the AIDS Cost and Service Utilization Survey to address the health resource utilization of the asymptomatic population. Mr. Chairman, I will be pleased to answer any questions you may have. [The information follows:] JAMES 0. MASON Assistant Secretary for Health Department of Health and Human Services James O. Mason, M.D., Dr. P.H., w was sworn in April 21, 1989, as Assistant Secretary for Health, Department of Health and Human Services. Dr. Mason was nominated by President Bush April 7, 1989, and confirmed by the Senate April 19, 1989. Before assuming responsibility for the U.S. Public Health Service, Dr. Mason had served, since 1983, as director of the Centers for Disease Control and administrator of the Agency for Toxic Substances and Disease Registry. During his tenure at CDC, Dr. Mason also served as acting Assistant Secretary for Health from February to December 1985. Dr. Mason served as executive director of the Utah Department of Health, with responsibility for health and health care financing, from 1979 to 1983. He was associate professor and chairman of the Division of Community Medicine, Department of Family and Community Medicine, at the University of Utah College of Medicine from 1978 to 1979. He directed a multiple-hospital health care corporation owned by The Church of Jesus Christ of Latterday Saints from 1970 to 1975. As Assistant Secretary for Health, Dr. Mason directs the activities of the Public Health Service, which includes eight agencies: the Alcohol, Drug Abuse and Mental Health Administration; the Centers for Disease Control; the Agency for Toxic Substances and Disease Registry; the Food and Drug Administration; the Health Resources and Services Administration; the National Institutes of Health; the Indian Health Service; and the Agency for Health Care Policy and Research. Dr. Mason provides policy guidance as well for HHS programs outside of PHS, and maintains relationships with other government and private agencies concerned with health. He advises and assists the Secretary on health policy and on all health-related activities of the department. Dr. Mason was born June 19, 1930, in Salt Lake City, Utah. He received his B.A. and M.D. degrees from the University of Utah in 1954 and 1958. He received his master of public health and doctorate of public health from the Harvard School of Public Health in 1963 and 1967. Dr. Mason served his internship at Johns Hopkins Hospital in Baltimore from 1958 to 1959, and was an internal medicine resident at Peter Bent Brigham Hospital, Harvard Medical Service, in Boston from 1961 to 1962. He has received numerous honors and awards. Among these are the Public Health Service Distinguished Service Medal (1988) and the University of Utah's Distinguished Alumni Award (1973). He is a member of a number of honorary and professional societies including the American Medical Association, the Institute of Medicine of the National Academy of Sciences, and the American Public Health Association. He has served on many national and international committees, councils, boards and task forces, including the United Nations Development Program/World Bank/World Health Organization Special Program for Research and Training in Tropical Diseases, Scientific and Technical Advisory Committee; and the National Institutes of Health Recombinant DNA Advisory Committee. Dr. Mason is certified by the American Board of Preventive Medicine. He has written numerous articles and book chapters on a wide range of subjects related to the prevention and control of disease. He is a national spokesperson on the prevention and control of infectious disease, chronic disease and injury, and a leading architect of public policies concerning these health problems. Dr. Mason and his wife, the former Marie Smith, have five sons and two daughters: James, Susan, Bruce, Ralph, Samuel, Sara and Benjamin. |