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would mean that 8.4 million of a total population of 13.7 million women of all ages would be served! First and foremost this would result in a healthier population and healthier outcomes when a women would choose to become pregnant. And in very real dollars terms, full funding would result in enormous savings. In the Alan Guttmacher Institute's study Public Sector Savings Resulting from Expenditures for Contraceptive Services, researchers conclude that every $1 spent on contraceptive services saves an average of $4.40. The study also finds that through the expansion and improvement of the provision of contraceptive services, reproductive health care consumers could more effectively reduce the incidence of unintended pregnancies and abortions. That study does not address, nor add in, the savings of health care dollars accrued from the earlier detection and prevention of sexually transmitted diseases, AIDS and breast and cervical cancer.

Because each day 115 Americans are diagnosed with AIDS and 110 Americans become infected with HIV, support for AIDS prevention and services remains a high priority for reproductive health care providers. We are concerned with federal support for programs to provide successful interventions in the spread of AIDS and HIV infection, especially for adolescents at risk, pregnant women, children, and people of color. Provision of condoms and education, particularly to young women and adolescents is a vital service that family planning clinics provide to help stem the tide of AIDS. Further, poor can seldom afford preventative health care. However, they can turn to family planning clinics for contraceptive services. Family planning clinics are often the only venue the health care community has to reach this at-risk population.

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The United States also faces a serious crisis with the spread of sexually transmitted diseases (STDs). The number of cases of congenital syphilis has increased from fewer than 300 cases in the early 1980s to nearly 4,000 cases in 1990. If left untreated, this entirely preventable disease causes brain damage, blindness, bone deformities and death in newborns. Family planning and reproductive health care providers are increasingly screening and treating patients for STDs. Yet, federal support for these services has not increased.

We recommend the following: 1. Support the reauthorization of Title X as a categorical grant program, rejecting, once again, the administration's attempt to replace the national program with a block grant. Reauthorization of the categorical Title X program is essential to ensure long-term stability on the provision of an effective range of family planning methods and reproductive health care services for poor women, adolescents, and people of color. Although we strongly urge the full restoration of the program at the $239 million level, we urge the committee to appropriate at least $175 million for FY91 for programs under Title X. 2. Appropriate funds for the administration of the Title X program by the Office of Populations Affairs in addition to, and in a separate line item from, the appropriation for family planning activities, specifically services grants and contracts. Furthermore, we suggest that a clear delineation between funds for program management/program support and family planning services be included in future committee and conference reports. 3. Reject, again, in committee report language the proposal by the Administration to reorganize the PHS regional offices through centralization. We recommend that the Subcommittee include committee and conference report language in the FY92 appropriations bill to prohibit the Administration from centralizing the grantmaking authority for Title X through the reorganization of the ten regional offices. 4. Contraceptive Research should be funded. Norplant is the first new method of contraception to emerge in the last twenty five years. And yet, this method, which could be particularly useful in addressing the contraceptive needs of at-risk populations will be virtually unavailable to Title X programs because of its cost. 5. Appropriate $3 billion for FY92 for federal funding of AIDS/HIV research, prevention, and care related programs that provide services to women, adolescents and children with AIDS. Specifically, we recommend that the Subcommittee appropriate $10 million for grants to the network of Title X clinics for outreach, counseling and family planning services for women who are HIV positive or at risk of infection.

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Despite administration attempts in the past decade to undermine it, the national Title X family planning program remains program of many successes.

These accomplishments are an endorsement for the reauthorization of Title X and for NFPRHA's request that this Congress approve an appropriation for Title X of $175 million for FY92.

Thank you.

Senator HARKIN. Thank you very much for an excellent statement. I agree with everything you have said. It does save money and it saves lives. It is good to hear your testimony.

You requested funding for contraceptive research. Do you have a figure on that at all?

Ms. BRECKENMAKER. I do not have a figure on the exact dollar amount, but obviously, as you know, Norplant is the first new contraceptive method we have had in many, many years in this country. What I have heard some folks say is that Third World countries have better access to new methods than we do here in the United States.

But we can certainly get that dollar amount for you.

Senator HARKIN. How is the Norplant contraceptive impacting family planning clinic budgets?

Ms. BRECKENMAKER. Right now, Norplant, in fact, in my area, I cover 24 counties of central Pennsylvania, mostly rural areas, there are many woman who would be very interested in the Norplant method. However, the cost of Norplant is outrageous, as I am sure you have heard.

Senator HARKIN. How much is it?

Ms. BRECKENMAKER. It is somewhere in the neighborhood of $350 just for the Norplant itself. And the insertion is estimated at another $150. So we are talking about an average of about $500 per patient. For a poor woman, it is absolutely not accessible.

What we are working on right now, in fact, we are doing estimates in our council. Just thinking of $25,000, which sounds like a lot of money in central Pennsylvania in 24 counties, it would only provide this service to 50 woman. And it is a crime.

The good news is that many States are approving this method to be funded through Medicaid. So that does take care in some instances of medical assistance patients. However, there is a large number of patients, as you well know, between the fee payer and the medical assistance patient. And the title X program takes care of most of those women.

However, we have not had an increase in many, many years at least not in line with inflation. Today, our funding should be somewhere in the neighborhood of $239 million if we had stayed within inflation. And what we are asking for today is $180 million at least. But basically Norplant is causing some very serious questions in our program.

Ms. JUNE. The bitter irony, Senator Harkin, with Norplant is, and in Iowa we have done research on delivery on how to make this new contraceptive method available to the women in Iowa, but the bitter irony is that this first new contraceptive method available now is more expensive to women than an abortion is. And that simply is unjustifiable.

Senator HARKIN. That is a good point.

Ms. JUNE. I sat here all this morning listening to the testimony and you know that for many years I worked with disabled children, children in day care, foster care, and I purposely left that career and came into family planning in Iowa because I wanted to do what I thought was the most moral preventative act possible. And that was help women plan the birth of their children.

The year that I came in to the family planning program, the Federal budgets were slashed for family planning by more than 25 percent. And I sit here a dozen years later still not looking at that funding level from those early days.

It strikes me after listening to the testimony this morning that the family planning request to this subcommittee and to Congress are incredibly moderate. These are modest dollars that we are asking for that promises to deliver great economic advantage for those individual families in particular, for the Federal Government.

More importantly, the humane aspects of this program are really unparalleled.

Senator HARKIN. Thank you both. Jill, I have known for a long time and she is always a great spokesperson for Family Planning and Reproductive Health. It is good to see you again.

Thank you both for being here again. This is a high priority of this subcommittee, and of this Senator, I can assure you.

Thank you very much. STATEMENT OF SUSAN SCOTT, THE NATIONAL REHABILITATION CAU.

CUS Senator HARKIN. Next is Susan Scott representing the National Rehabilitation Caucus.

Welcome to the subcommittee. Your statement will be made a part of the record in its entirety.

Ms. Scott. Thank you for the opportunity, Senator Harkin, to be here on behalf of the National Rehabilitation Caucus. We are a coalition of organizations representing health care professions, consumers, and institutional home and community-based providers of medical rehabilitation services.

The purpose of our testimony this morning is to urge the subcommittee to support appropriations necessary for the funding of allied health education and training initiatives authorized under title VII of the Public Health Service Act.

It is also to thank you and members of the subcommittee for your support of allied health education in the past.

However, Mr. Chairman, the country continues to face serious shortages of medical rehabilitation professionals. I believe you heard this from earlier witnesses this morning.

Hospitals, nursing facilities, home health, and rehabilitation agencies and other service providers are increasingly unable to recruit sufficient numbers of qualified occupational therapists, physical therapists, respiratory therapists, speech/language pathologists, and other medical rehab professionals to provide essential services.

The skills and services of these professionals are especially important in the provision of care to the elderly, the chronically ill, and people with disabilities.

The personnel shortages in these professions are going to intensify in the years ahead unless congressional action is forthcoming to assure the availability of an adequate number of these people.

A recent study by the American Hospital Association conducted among hospitals nationwide reveals for the second year in a row serious difficulties recruiting and retaining medical rehabilitation professionals. The highest staff vacancy rates nationally are 16.4 percent for physical therapists and 13.6 for occupational therapists. Other professions classified as personnel shortage categories include speech/language pathologists at 9.9 percent and respiratory therapists at 8.9 percent.

Mr. Chairman, numerous other studies which are described in our full statement have revealed the same problem. Studies by the Medicare Perspective Payment Commission, the VA, the Department of Health and Human Services, the Institute of Medicine, the Administration on Aging, just to name a few, all underscore the shortage of rehabilitation personnel and the problems associated with it.

This year Congress will be reauthorizing the title VII health profession's training programs for fiscal year 1992 and subsequent years. The rehabilitation caucus is urging authorization of $24 million in fiscal year 1992 for title VII allied health initiatives. We strongly urge this subcommittee to consider full funding at whatever levels are ultimately authorized.

Our specific recommendations are: $7 million to assist in the development, expansion, and improvement of allied health education programs; $7 million for programs to increase the availability of qualified faculty, which is a big problem for us; $10 million in direct student assistance.

PREPARED STATEMENT

We further urge that in light of limited resources, funds appropriated be targeted to those professions that have substantial shortages and which play a significant role in the care and rehabilitation of the elderly and people with disabilities. With this targeted effort we can begin to address the most serious existing shortages and position ourselves to meet the health care requirement of those rapidly growing segments of our population who are most in need of medical rehab services.

Again, Senator Harkin, on behalf of the National Rehab Caucus, I thank you for this opportunity to share our views on this important issue.

[The statement follows:

STATEMENT OF SUSAN SCOTT

Mr. Chairman and Members of the Subcommittee:

On behalf of the National Rehabilitation Caucus. a coalition of organizations representing health care professionals, consumers and institutional, home and community-based providers of medical rehabilitation services, I want to express our appreciation for the opportunity to appear before you today.

The purpose of our testimony this morning is to urge the Subcommittee to support appropriations necessary for the funding of allied health education and training initiatives authorized under Title VII of the Public Health Service Act.

As you know, Mr. Chairman, the nation continues to face serious shortages of key medical rehabilitation professionals. Hospitals, nursing facilities, home health and rehabilitation agencies and other service providers are increasingly unable to recruit sufficient numbers of qualified occupational therapists, physical therapists, respiratory therapists, speechlanguage pathologists and other medical rehabilitation professionals to provide essential services. The skills and services of these practitioners are critically important in the provision of care to the elderly, the chronically 111 and individuals with disabilities.

The personnel shortages in these professions will intensify in the years ahead unless concerted effort is forthcoming to assure the availability of an adequate number of practitioners.

The most recent American Hospital Association (AHA) human resource
survey conducted among hospitals nationwide reveals, for the second year
in a row, serious difficulties recruiting and retaining medical
rehabilitation professionals. The highest staff vacancy rates nationally
are 16.4 percent for physical therapists and 13.6 percent for
occupational therapists. Other professions classified as personnel
shortage categories include speech-language pathologists (9.9 percent)
and respiratory therapists (8.9 percent). These shortages are being
experienced by rural and urban hospitals alike. Vacancy rates in many
individual states have reached such serious levels that hospitals are
responding by reducing services, closing beds or units and diverting
patients to other facilities when medically appropriate. These staff
shortages are also confirmed in a staff study conducted by the
Prospective Payment Assessment Commission (ProPAC).

The U.S. Department of Veterans Affairs (VA) medical system is
experiencing even more severe recruitment and retention difficulties.
The most recent fiscal year 1991 data show vacancy rates for physical
therapists at 27.3 percent and vacancy rates for occupational therapists
at 18.8 percent.

The U.S. Department of Health and Human Services' 1990 Annual Report to the President and Congress on the Status of Health Personnel in the United States noted that "... the allied health field is faced with growing shortages of personnel in a number of critical professional categories, reductions in program enrollments, closures of training

The U.S. Department of Health and Human Services' 1990 Annual Report to the President and Congress on the Status of Health Personnel in the United States noted that " the allied health field is faced with growing shortages of personnel in a number of critical professional categories, reductions in program enrollments, closures of training programs, underrepresentation of minorities and shortages in faculty and trained researchers".

Additional reports from the Institute of Medicine, the U.S. Department of Education, the Institute on Aging, and others all underscore the growing threat these shortages represent to our nation's ability to provide important health and rehabilitation services.

A principle factor contributing to these shortages is the escalating demand for services from a population with more individuals surviving into old age, frequently with chronic conditions or multiple disabilities. According to the 1990 HHS report, "As the number of elderly increases, the demand for

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