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be funding 3 Research Fellows and 3 Young Clinician Investigators starting July 1,


As you may be aware, in 1986 the AANS and CNS established a national head and spinal cord injury prevention program called "Think First". It is aimed at the high risk 15-21 year old population. Each year 10,000 spinal cord and 500,000 head injuries occur causing immense human suffering and staggering financial costs. This year we expect to reach 450,000 students and hopefully influence attitude and behavior about helmets, speeding, daring, careless swimming habits, driving recreational and farm vehicles, wearing seat belts, and using alcohol and drugs. We are encouraged by the results the program has achieved already and hope to reach more than 4,000,000 high-risk young people a year by 1999.

During the next ten years, we fully intend to expand both programs and develop new ones aimed at public education and prevention.

Thank you for your continued interest in and support of biomedical research.

Senator HARKIN. Certainly, Bill. The formal statement will be made a part of the record in its entirety, and I appreciate your taking the time to come here from North Carolina today.

Starting at the end first and the Think First Program that you have initiated, I assume that this is being coordinated with the Centers for Disease Control. I was down in Atlanta about 2 weeks ago. I spent a day down there, and they, as you know, are in the process of changing the name slightly from the Centers for Disease Control to the Centers for Disease Prevention and Control. As they say, they want to be the lead prevention agency, and one of the areas is in preventing disabilities. So I hope that this is sort of a coordinated effort with them.

Dr. PRITCHARD. There are many facets of this problem. It can be approached in many ways. This happens to be the way the neurosurgical community is addressing it in our own little manner, and we certainly encourage all Government entities that might be interested and involved to participate in this growing thing.

A lot of the work is done by volunteers. Many of the people who help put on the programs are victims of injuries, and they are very effective spokesmen in speaking to their peer group in the high school setting.

Senator HARKIN. One other thing. You said in your testimony the incident of brain tumors is increasing. Then you said the current body of knowledge is limited. Do we have any idea why they are increasing?

Dr. PRITCHARD. No; I do not think we understand that. Of course, as time goes on the recognition of diseases may contribute to the apparent increase in incidence.

Senator HARKIN. Diagnosis, you mean.

Dr. PRITCHARD. Yes; but there is probably more than that going


Senator HARKIN. We really do not know why?

Senator HARKIN. We have four brain tumor centers now. You think those ought to be doubled. I assume those are at locations in major universities.

Dr. PRITCHARD. Well, actually I asked about that when the committee developed the material, and they are actually in the planning stage. They have previously been designated to come into being. The choice of those facilities at this point has not been made, to my understanding. We project, however, that we need to increase the number over a period of time.

Senator HARKIN. Let me just say that the things that the AANS has asked for here I think are modest, not a great deal of money, but they are in the areas that can have great payoffs in the future. Since this subcommittee is committed to providing the necessary support for the various goals for the "Decade of the Brain," this is one area that we are going to try to put a major emphasis on. Exactly what that will be, I do not know, but it is high on our agenda. I can tell you that.

Dr. PRITCHARD. Thank you very much, sir.

Senator HARKIN. Bill, thank you. I am sorry about the time and everything. I understand you have to get, but we will get together socially some other time.

Dr. PRITCHARD. Thanks.


Senator HARKIN. Let us see. The next person who has to leave early is Robert Tobias, president of the National Treasury Employees Union. If we could have him come up.

Again, welcome to the subcommittee. I will not repeat myself any more. I will just say that all statements will be made a part of the record in their entirety.

Mr. TOBIAS. Thank you very much, Senator Harkin. I really appreciate your accommodating me.

While the President's budget contains notable increases in funding for some programs, we believe it contains glaring deficiencies for the Department of Health and Human Services. It is neither adequate for the current needs nor for the future.

Let me begin by referencing the Social Security Administration [SSA], which is an agency stretched to the breaking point. The agency experienced a serious collapse in service last year when 105,000 needy beneficiaries on SSI rolls had their benefits suspended for not replying to requests to document their continuing eligibility. According to the HHS inspector general, the benefits were stopped without so much as a phone call and incorrectly stopped in 54 percent of the cases. This was caused, we believe, in large part because of a shortage in the field staff.

NTEU has analyzed changes in SSA's work load and staff. From inspection reports by GAO and the inspector general, there are numerous indications of declining quality and accuracy. Between December 1988 and December 1990, the pending backlog of initial claims in field offices grew 34 percent, yet the staff declined 2 percent. The average processing time for SSI aged claims doubled from 11 to 22 days, and by 1990 the pending disability claims stood at 384,000 and are projected to climb to 703,000.

In addition, by the year 2025 there will be 80 million beneficiaries on the roll instead of the current 40 million. Yet, we continue to look at SSA in a piecemeal, nonfuture oriented action. The budget that has been proposed by the administration is eaten up totally to fund pay raises, retirement, and pay reform. There is very little left over to mind the store.

NTEU has prepared a realistic budget for SSA based on the growing work loads and deteriorating service levels which we would certainly recommend to this committee because it would

strengthen the community-based service delivery system, improve telephone services, reduce SSI and DI processing times for initial claims, improve processing of overpayment cases, and prevent overpayments.

We believe that this service budget will start to meet the needs, and we also believe, Senator Harkin, that in the Budget Enforcement Act, Congress removed Social Security from the Federal budget. Now CBO interprets this as moving SSA salaries and expenses off budget and, therefore, not subject to the spending ceilings of the budget agreement. OMB disagrees and has retained SSA under the ceiling for domestic discretionary spending. We, of course, agree with CBO and urge Congress to clarify the matter at the earliest opportunity. SSA's budget must be based on the needs of the American people, not on arbitrary budget caps.


Mr. Chairman, we thank you very much for your continuing interest, and we urge you and the committee to really look at the HHS budget and particularly the SSA budget in your upcoming deliberations.

Thank you very much.
[The statement follows:]


Mr. Chairman and Members of the Subcommittee:

I am Robert M. Tobias, National President of the National Treasury Employees Union. NTEU is the exclusive representative of over 144,000 Federal employees, including workers in the Office of the Secretary, SSA's Office of Hearings and Appeals, Office of Human Development Services, Family Support Administration, and the ten regional offices of the Department of Health and Human Services.

I am pleased to appear before you to present NTEU's recommendations on the Administration's budget proposals for HHS for FY 1992. In my prepared statement, I will discuss the budget for the Social Security Administration in detail. We have submitted to the Subcommittee longer statements on both HHS and SSA, and NTEU's recommendations for other operating divisions are summarized in the table attached to this statement.

Under the President's budget, HHS staff will rise to 125,103 average positions next year, an increase of 3,378 over the current level. From 148,373 positions in 1981, HHS fell to a low of 117,817 positions in 1990, but has been recovering since then.

While the President's budget contains notable increases in funding for some programs, it also contains glaring deficiencies--too many, in our judgement, for it to serve as a blueprint for the Department. This is a complacent, "more will than wallet" budget, lacking vision and purpose. It is neither adequate to the current needs of our people, nor to the challenges that lie ahead. It is our strong recommendation that Congress craft an alternative budget for the Department. To this end, we have prepared an alternative plan that we believe is responsive to present needs and, more importantly, points a clear direction to the future.

Let me illustrate these points by reference to the situation at the Social Security Administration. SSA is an agency stretched to the breaking point--an agency that experienced a serious collapse in service last year when 105,000 needy beneficiaries on SSI rolls had their benefits suspended for not replying to requests to document their continuing eligibility. According to the HHS Inspector General, the suspensions resulted from the field staff not allowing beneficiaries enough time to respond to notices. In many cases, people lacked the capacity to reply because of serious mental and physical impairments. For these beneficiaries, SSI is a lifeline, and coping with government forms is not easy. Yet their benefits were stopped without so much as a phone call, and incorrectly stopped in 54 percent of the cases at that. To correct the suspensions and return the person to pay status sometimes took more than six months.

SSA took prompt action to require field staff to phone or speak in person to the beneficiary before cutting off benefits, but it was the shortage of field staff that created the breakdown in the first place. We have the further irony that field staff are supposed to be engaged in a major outreach effort to potential SSI beneficiaries, because studies indicate that as many as 35 percent of the eligible population are not participating. We were bringing one group on the rolls while dropping others off, because our overworked staff were falling behind in their basic workloads and unable to handle post-entitlement work promptly.

In the judgement of GAO, SSA lacks the capacity to keep accurate wage records for Social Security. More than 178 million wage reports containing $138 billion in uncredited earnings are sitting in SSA's suspense file, awaiting action to determine the proper account to be credited. According to GAO, this backlog has grown by 24 million reports over the past five years and is still growing. If these reports aren't properly credited, many people will be short-changed when they retire. A few years ago, Congress required reconciliation of $58 billion in wage reports, and when the job was done SSA could not say how much it had credited to worker's accounts, or how much additional tax monies were owed to the trust funds.

NTEU has analyzed changes in SSA's workload relative to staff. What we have found is an alarming rise in the backlog of pending work as the agency falls farther and farther behind. From inspection reports by GAO and OIG, there are numerous indicators of declining quality and accuracy of case dispositions. Between December 1988 and December 1990, the pending backlog of initial claims in field offices grew 34 percent while staff declined 2 percent. The average processing time for SSI-aged claims has doubled from 11 to 22 days. While staff has fallen 22 percent in Program Service Centers since December 1986, the backlog of RSHI claims has jumped 44 percent and pending RSDI and SSI overpayments cases have risen 23 percent. At the end of FY 1990, pending disability claims stood at 384,900 and are projected to climb to 703,000 by the end of FY 1992--at a time when state Disability Determination Services are taking on the additional workload of Zebley claims.

Let us base our budget strategy for SSA on common sense. By the year 2025, there will be twice as many beneficiaries on the rolls than today--80 million citizens to serve rather than 40 million. We cannot halt this growth or repeal its consequences. From now until the middle of the next century we must live with it. Common sense dictates that in budgeting for SSA we should aim to steadily expand the system's capacity. We will thus be prepared for the demands we know we must confront. This will require stable, regular investments in technology and our work force.

The Administration has proposed neither a realistic nor responsible budget for SSA. Its 9 percent increase is dictated by the need to fund the 1991 and 1992 pay raises, retirement, and pay reform. Some $312 million of the total $375 million increase goes for these mandatory costs. Another $42 million is spread among restoring depleted supplies, facilities maintenance, and training. This $42 million is a wholly inadequate sum, as the budget admits. It continues risking the health and well-being of SSA's workers by investing only minimal amounts for asbestos removal, indoor pollution, and safety. It provides $13.3 million for basic training of SSA's employees--an amount that, in a budget of $4.5 billion, is truly disgraceful. Only funds for 758 new positions and $57 million in new ADP investments were conceded by OMB. The new positions are for processing growing workloads, but the budget admits they will be inadequate to bring these workloads under control. Five hundred additional positions are provided for Zebley claims.

We think the Administration's game plan is to buy time, let the system deteriorate, and then propose consolidating local offices, as it did in 1985. As proposed by the Grace Commission, the plan was to reduce the number of local offices from 1,300 to 500. Such a policy would deliberately dismantle our community-based service delivery system.

NTEU has prepared an alternative budget for SSA that we urge this Subcommittee to consider. This budget is based on an analysis of the growing workloads and deteriorating service and quality in SSA's príncipal offices. NTEU's alternative budget aims to accomplish the following:

(1) strengthen the community-based service delivery system of field offices; (2) improve telephone service by answering one-half million more calls; (3) reduce SSI and DI processing times for initial claims, which have been growing rapidly;

(4) improve processing of overpayment cases and prevent overpayments;

(5) improve processing of post-entitlement actions that are not being given enough priority with today's staff shortages; and

(6) reduce processing times in Hearings and Appeals by appointing more ALJ's from qualified OHA staff attorneys.

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