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Senator ADAMS. Thank you very much, Doctor.

I notice on page 2 of your testimony that we really have extended new responsibilities under the Clean Air Act, but these have not been funded in the administration's proposal. You can submit this in writing if you want, but do you have any recommendations as to what type of funding is needed or necessary for that? The committee will have to look at that, also.

Dr. BILLINGS. I can submit specifics in writing if you like.
Senator ADAMS. I would appreciate that.
[The information follows:

LETTER FROM RUTH E. BILLINGS

May 3, 1991. Hon. BROCK ADAMS, Senate Committee on Appropriations, Subcommittee on Labor, HHS, Education and

Related Agencies, Washington, DC. DEAR SENATOR Adams: During my testimony as a public witness before the Labor, HHS, ED Subcommittee on April 17, 1991, you asked me to provide my recommendations on funding for the National Institute of Environmental Health Sciences (NIEHS).

With respect to the NIEHS Clean Air Act research program, I recommend an increase of $ 10 million to be targeted primarily to university grants which are targeted toward providing health effects information. This information is needed by the regulatory agencies in their risk management decisions. Important research areas include acid de position, acid aerosols, ozone, air toxins, and global warming. The development of better methods for assessing exposure and effects, studies of health effects of specific chemicals and mixtures, and new studies in epidemiology would greatly enhance our risk assessment capabilities.

In addition to an increase for this specific initiative, I would strongly recommend increases in two additional programs. Specifically, I enthusiastically endorse increases of $14 million over the fiscal year 1991 appropriation for the National Toxicology Program (NTP) and $25 million for the NIEHS research grants program. The former provides essential information on the toxic effects of environmental agents on the nervous, reproductive and immune systems, and on the initiation or promotion of cancer. The number of NTP chronic studies of environmental substances has declined sharply from a high of 54 in fiscal year 1981 to 13 in fiscal year 1991 as the NIEHS contract budget declined in constant dollars. Studies of 18 substances found at home, on the farm, or in our factories are designed, but cannot be started at the President's Budget level.

I believe that an increase in funding for the grants program is a critical national need. The current and projected funding rate for grants is less than 20 percent and this low rate negatively impacts on our ability, as university-based scientists, to at. tract talented students into environmental health sciences. In addition, discouraged scientists are abandoning research careers in this important field. In fact, there is a need to increase the science base related to environmental health and to provide the trained manpower from technicians to cutting-edge researchers.

I appreciated the opportunity to take part in the appropriations hearings and would be pleased to answer any additional questions that you or your staff might have. Sincerely,

RUTH E. BILLINGS, PH.D. Dr. BILLINGS. In general, though, I think that the programs which have been outlined by the EHS administration cover those aspects. I can look into that and submit more in writing.

Senator ADAMS. Would you, please?

Thank you very much for your testimony. We are very concerned about the degree of toxicity in the atmosphere and in our water supply. Thank you.

STATEMENT OF PETER TOLAND, PRESIDENT, NATIONAL COUNCIL OF

SOCIAL SECURITY MANAGEMENT ASSOCIATIONS, INC. Senator ADAMS. The next witness is Peter Toland, Social Security Management Associations, Inc.

Mr. Toland, welcome to the committee.

Mr. TOLAND. Thank you, Mr. Chairman. My name is Peter Toland, and I represent the Social Security Management Associations an organization of some 4,000 managers and supervisors who manage the 1,300 field offices of the Social Security Administration around the country.

Mr. Chairman, this is the first time, I believe, that our organization has testified before an Appropriations Committee in Congress, and we thank you very much for hearing us. We do have a prepared statement that we have already submitted.

Senator ADAMS. Without objection, your statement will appear in full in the record.

Mr. TOLAND. Thank you, Senator.

Senator, we are here to testify on a number of points, and we recognize that you have already heard testimony from Commissioner Gwen King on the administrative budget proposal for fiscal year 1992. We fully support that budget proposal, and we appreciate the advocacy of our Commissioner, who by the way has not asked me to come here today to also ask for the same thing.

Our concern is based upon the fact that we have undergone a period of 6 years of downsizing that has affected our ability to provide the services to the American people that they have paid for and deserve. We have reached the point where we believe that we are providing services that we think the American people will tolerate and not what they deserve.

There have been a number of indications lately of the service derogation. In February of this year, our ability to answer the phone was very suspect. We could only answer about 68 percent of the calls on peak days and barely one-half of the calls for the whole month in its entirety. We cannot provide the kind of outreach to the neediest clientele that we have had a tradition of providing. As a result of this downsizing, we have cut 50 percent of our field representatives and over 30 percent of our contact stations, and those remaining contact stations have cut back service tremendously.

As a result, we have visited a form of de facto discrimination against the public that is most needy; that is, people who are handicapped, disabled, functionally illiterate, the elderly poor who cannot cope with modern technology, and the non-English-speaking claimants in helping them to complete their claims.

We have taken shortcuts to accommodate this downsizing, shortcuts that have resulted in a serious impact on the quality of our product. In fact, one of our OIG reports shows that for every additional dollar of money spent on SSI initial claims, we will save $7 in misspent benefits.

In terms of our disability program, our program is almost in total disarray. As a result of our failure to conduct the disability reviews that we have mandated by law, we are losing tantamount to $100 to $200 million per year in terms of forgone revenues and at the same time that we are spending money for people who should not be on the rolls we are not able to take the claims from many people who are filing initial claims.

Back in 1988 we had a processing time of about 58 days. Now that is up over 115 days. Now all of this speaks to the need for the administrative funds to run the SSA, and we have a solution for you, Senator Adams; that is, to perfect the Budget Enforcement Act provision that took the old age, survivors and disability insurance trust funds off the Gramm-Rudman guidelines but to go further and take the administrative spending out of the domestic spending caps. We think that that is going to solve many of the problems

have in terms of the contention for the limited funds that We are asking for 9 percent this year, and we realize that you have only a 4. to 5-percent margin for all of the worthy programs that have come before you here today. By taking us off the spending cuts, you provide more money proportionately for all the other worthy causes that are contending for the limited funds that you have. At the same time, we believe that the committee retains jurisdiction and solves the problems that we will have in Social Security for years to come.

that you

you have.

PREPARED STATEMENT

We would also like to ask that you consider against the enormous contingency fund that you enacted last year. Given the recent history of difficulty in our achieving the $150 million contingency fund, would ask that you restrict that to the minimum $50 million that has been proposed in the budget.

Senator, I would like to thank you for hearing our testimony, and if you have any questions I would be glad to answer.

[The statement follows:)

STATEMENT OF PETER TOLAND The National Council of Social Security Management Associations (SSMA) appreciates the opportunity to present testimony in support of the Administration's fiscal year 1992 Budget request for the Social Security Administration. SSMA was founded 22 years ago to represent the views of the Social Security field office managers and supervisors across the country. Our more than 4,000 members hold the most publicly visible and accountable jobs at SSA. We provide direct service, in person and over the telephone, to the 39.8 million Americans already receiving Social Security, benefits, the 4.8 million Americans receiving Supplemental Security Income (SSI), and the 125 million taxpayers and their employers who contribute Social Security payroll taxes.

SSA's field office managers are no longer confident that SSA can provide the service the public has a right to expect. Six years ago, SSA began a process of downsizing the workforce, which has cost us 17,000 FTE's, a cut of 22 percent. SSA is now operating on a bare bone budget which has forced field managers to devise innovative ways to shorten work processes. While we streamlined and automated the work processes and improved productivity, we also cut back on service levels. We spend less time interviewing people. We have shut down many of our remote contact stations. We have eliminated over half of our field representative positions-removing a significant outreach presence in the community.

In short, we have reached the point where we are providing the American public with the service we think they will tolerate-instead of the service they paid for and deserve.

For fiscal year 1992 Commissioner King and Secretary Sullivan have made an effective case for a nine percent increase in administrative funding to allow for an increase of about 1,000 FTE's, bringing total staffing to about 64,000. We fully support this budget request and believe that it represents a good first step toward restoring SSA service levels. However, this will mean granting SSA a nine percent increase while the total domestic spending rise must be no more than 4.1 percent. Even if SSA receives this full amount at the expense of other domestic programs in fiscal year 1992, can it depend on similar largesse in fiscal year 1993 when the cap is at 3.3 percent? With such tight limits, we do not believe that the additional $200 to $250 million a year needed to reach the 70,000 FTE's necessary to restore services will ever be available to SSA.

In preparation for fiscal year 1991, Commissioner King and Secretary Sullivan fought hard to introduce a budget increase of nine percent over fiscal year 1990 levels. In final Appropriations Conference, we took a last-minute 2.41 percent acrossthe-board cut. Apparently, other worthy programs had to be funded at the expense of the SSA administrative budget. That was all before Congress enacted the Budget Enforcement Act and the limitation on domestic spending. If SSA's experience during last year's appropriation process is an accurate predictor of things to come, we are in serious trouble.

Due to past downsizing, we are already substantially understaffed, unable to answer our phones, significantly backlogged in disability claims, and unable to provide outreach to our neediest clientele. Failure to appropriate the entire amount of the SSA budget request is a blueprint for disaster in one of the oldest and most solid Federal programs in our nation's history. We therefore advocate removing the administrative expenses from under the domestic spending caps.

Erosion of public services due to short-term budgetary pressures means erosion of beneficiary protection. Protecting beneficiaries can only be accomplished when all who are entitled to Social Security benefits first are informed about and understand those benefits, and then are paid accurately and timely. Without the full nine percent increase in next year's budget, followed by adequate funding increases in subsequent years, the agency cannot work to restore these protections. Following are examples of inadequate protections resulting from budgetary pressures: -The number of disability cases pending a decision in our offices has reached an

all time high, with an increase of almost thirty percent in new disability claims alone this past fiscal year. In many states we no longer have the ability to proc

ess the continuing reviews of disability eligibility required by law. -We do not have the resources to conduct effective outreach programs to ensure

that everyone who is entitled to benefits receives them. A November 1990 report from GAð found that over one-half the managers surveyed spend less than ten hours a month on outreach activities. Many of those we cannot reach are among the least well off individuals in our country. Many of those who do eventually

contact us have lost benefits because they made the contact too late. -We can no longer offer to the handicapped, disabled, and functionally illiterate,

or to those for whom English is a second language, sufficient time and personal assistance to ensure that their forms are properly filled out, their reporting re

quirements complete. -Lack of funds for staff training jeopardizes our ability to get and give complete

information for claimants and to process accurate benefits payments. Even able, educated, and articulate beneficiaries are unprotected when inadequately

trained employees are responsible for handling their questions and claims. -Despite Congress' mandate to restore local phone access to our beneficiaries, we

do not have sufficient staff in the field to both handle walk-in traffic and answer the telephone. Busy signals for the national 800 service were at 74 percent on peak days in February and 64 percent on other days. Field offices continue to process almost ninety percent of the beneficiary-initiated actions that they did

before our staffs were cut to man the 800 number. -The quality of the work we process continues to suffer. Over forty-three percent

of the managers surveyed by our Association last year reported that they have been forced to routinely use short cuts to process work. Forty-nine percent of our managers surveyed reported they cannot handle all of the work they have to do. In January, 1989, an internal audit found that seventy percent of the disability claims processed were deficient in some regard. Delays and errors compound our workload problems and cause inaccurate payments. If the budget treatment of the administrative expenses is not corrected, the beneficiaries will find themselves faced with longer waits for same day service or appointments, more busy signals, more forms to fill out without help from a fully trained professional and more mistakes and delays in processing. We are subjecting the public to increased inconvenience at best, and at worst the possibility of lost benefits. Improper payments from the Trust Funds will surely result, but more importantly, we will be doing irreparable damage to the confidence of the people in the most important social program of this century.

In removing the Trust Funds from the budget, Congress' intent was clear--to protect the integrity of the Trust Funds and the beneficiaries of those funds. The Trust Funds belong to the contributors, the working people of this country, and we at the Social Securty Administration have been charged with the responsibility of holding those funds in trust for the owners. In order to properly carry out our fiduciary responsibilities as administrators of a trust, we must spend only what is needed to provide the owners with the full benefits of their property. We must not, however, be restricted from spending whatever is needed by any consideration other than the best interests of the Trust's beneficiaries. Thank you for considering our views.

Senator ADAMS. Thank you very much. I appreciate your testimony. I have to think some on your proposed solution because you indicate you support the budget that has been submitted, but then you give a number of horror stories. So I have to balance one off against the other. Thank you very much.

Mr. TOLAND. Thank you, Senator. STATEMENT OF DR. T. JAMES GALLAGHER, UNIVERSITY OF FLORIDA

COLLEGE OF MEDICINE, ON BEHALF OF THE SOCIETY OF CRITI

CAL CARE MEDICINE Senator ADAMS. The next witness is Dr. T. James Gallagher, University of Florida College of Medicine, president of the Society of Critical Care Medicine.

Doctor, welcome. We are pleased to have you before the committee this morning.

Dr. GALLAGHER. Thank you, Mr. Adams.

As indicated, I am appearing today as president of the Society of Critical Care Medicine to present our views on funding for the National Heart, Lung, and Blood Institute. The society is particularly concerned with the current rate of awards for approved grants, the lack of full funding of awards selected for Federal funding, and the lack of research generally in the emerging field of critical care medicine.

Critical care medicine involves life-threatening or severe illnesses which often include interaction and involve more than one organ system. Care often requires many combinations of high technology support.

The Society of Critical Care Medicine is a multidisciplinary organization formed by specialists from anesthesiology, internal medicine, pediatrics, and surgery. It is the only professional organization devoted exclusively to critical care and has more than 5,000 members.

Mr. Chairman, our testimony this morning includes three principal parts. First, the society recommends appropriations sufficient to allow awards of research grants up to the 35th percentile of approved research grant applications with full funding of the awards, thereby eliminating the so-called downward negotiation of 7 to 10 percent typical after approval.

The funding of additional competing investigator-initiated research projects will allow the Heart, Lung, and Blood Institute to pursue several initiatives in both basic and clinical research.

Second, the society is also concerned about the proposal to reduce the duration of grants to 4 years and instead supports the HLBI proposal to stabilize the proportion of 5-year grant awards at a fixed level. This will create a balance of stabilization of funding especially for clinical studies and an opportunity for new investigators in terms of the competing pool of grants.

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