STATEMENT OF THE NATIONAL COMMUNITY My name is David Bradley Lam here today on behalf of the National Community Action Foundation, which is the Washington representative of the nation's 900 Community Action Agencies. Mr. Chairman, I am grateful for this opportunity to testify before this Subcommittee The Bush Administration has requested the elimination of the Community Services Block Grant (CSBG)for FY 1992. This is a continuation of former President Reagan's policies As in the Reagan years, the Administration argues that the gap caused by the removal of CSBG monies could be filled by other funds, such as the Social Services Block Crant, Head Start, Low Income Energy Programs, Community Development, and Job Training. However, as the Subcommittee is aware and, I might add, as most communities are aware, tremendous pressures exist to cut out or to reduce funding for some of these programs as well. On behalf of the Community Action Agencies, we request that you consider the following points: There are more than 900 Community Action Agencies (CAAs) across the country CAAS use the Community Services Block Grant (CSBG) to leverage and coordinate federal, state, and private resources to offer a variety of programs in the areas of emergency services, youth, housing homelessness, transportation, nutrition, employment, literacy, energy, child care, substance abuse, etc. Typical are the working poor who face a crisis which threatens their independence. No other program links so many programs and services together CSBG funds constitute a small part of most local agencies budgets, but are used to support and coordinate a multitude of programs and services in low income communities. The flexibility of CSBG funds increases the range of programs available to the poor and makes other categorical programs and local services work more effectively. Community Action Agencies respond to local needs with local initiatives. The flexibility of CSBG gives CAAs the freedom to work with community leaders to determine local priorities and formulate community based responses to unmet needs. CAAs have the ability to design innovative strategies to combat poverty because they can offer a broad, flexible and coherent spectrum of services. Community Action Agencies address individual needs within the context of family and community. CAAs recognize that child, family and community concerns are all interrelated. They work with families to help them identify their own needs and then give them the tools they need to stay strong and nurture their children. CSBG funds leverage considerable additional resources from state, local and private sources. In 1988: $1 of CSBG raised $2. 10 of combined state, local and private sources; and $1 of CSBG raised $.99 of private and volunteer contributions. What's happening now: CAAs across the country have been reporting an increase in the number of clients they serve and, in particular, a large number of new clients. Layoffs have led to a large increase in the need for emergency services, such as food, clothing and rent and fuel bill assistance, as well as for employment assistance. Approximately 2/3 of Community Services Block Grant (CSBG) money is currently being used for emergency services. The CSBG provides critical funding for CAAs providing emergency services to the families and individuals hardest hit by the economic downturn. The GAO told us in 1986 that Community Services Block Grant funds are used for unique and non-duplicative purposes. already available. CSBG funds are used to initiate new local programs and to provide direct services not The HHS-funded report on FY1988 CSBG showed that these monies fund the local distribution and coordination of approximately $3 billion in federal, state, and private funds. The FY1988 report showed that a full 60% of CSBG funds provide direct services which are not otherwise available. 15% of the funds underwrite the raising and coordination of resources from states, local governments, businesses, and charities in low-income communities. CSBG-funded activities generate 1.3 times as much local and private funding for the poor as the CSBG dollars. Also from the FY1988 report, on average nationwide, one quarter of CSBG funds on a local level pay for comprehensive case management. Without CSBG, there would be no way in most counties to assess family needs in a comprehensive manner or to assemble a custom-made package to help families work their way out of poverty. A 1990 survey of the nation's 900 Community Action Agencies conducted for the Nation Association of Community Action Agencies indicated that the typical CAA utilizes 673 volunteers throughout the course of a year. CAAs are one of the largest and most efficient networks for mobilizing volunteer assistance. The role of CAAs is most commonly understood to be that of "program operator" for a variety of federal, state, and locally funded on-going social and economic development programs. Included in these are the programs traditionally associated with CAAs: Head Start, Weatherization, and LIHEAP. In some states, these services have been expanded to include commodity food distribution, elderly nutrition programs, and welfare reform programs. However, the most important role CAAs play is that of the agent for social and economic development in their communities. CSBG is the catalyst to that process. The ongoing identification of unmet needs of low income households in local communities and facilitation of the planning, development, and implementation of strategies to meet those needs is a process which is dependent on the CSBG. These activities are not only what the CAAs must do, but are what they do best and are what they were intended to do when the Economic Opportunity Act was signed into law in 1964. These strategies can include improving the coordination of existing programs, initiating new or expanded programs, or assisting other institutions in becoming more sensitive to the needs of their low income constituents so that they can modify or initiate programs to better meet those needs. Mr. Chairman, every year CSBG must undertake three significant battles in order for Community Action Agencies to survive. First, because in nine of the last eleven years the Reagan and Bush budgets have requested the termination of the Community Services Block Grant, we have to fight the perception that somehow the program is not working just because the OMB doesn't want to fund it. Second, every year the Community Services Block Grant faces a difficult time in the Appropriations process. One leading member of this committee told me that he has never had to work harder for an increase in any program's funds. Finally, HHS is always slow to release the funds, reluctant to provide the necessary data, and unwilling to include CSBG and Community Action Agencies in its agenda. Mr. Chairman, I would hope that, given the demonstrated importance of CSBG and its nearly flat funding for ten, long years, the Subcommittee will look favorably at a funding level close to the authorized amount of $460 million for the entire program, including the discretionary programs. I also continue to recommend full funding for the Demonstration Partnership Program ($10 million) and, very importantly, full funding for the community services portion of the McKinney Act. As STATEMENT OF THE AMERICAN ASSOCIATION OF the professional association that represents over 24,000 certified registered nurse anesthetists (CRNA), the American Association of Nurse Anesthetists (AANA) appreciates the opportunity to provide testimony regarding the need for continued federal funding for nurse anesthesia programs under the Nurse Education Act (NEA). The AANA requests that the nurse anesthetist programs in the NEA be reauthorized and funded at $6 million in Fiscal Year 1992 in order to accomplish the following objectives: To provide funding for the expansion and start-up costs of new nurse anesthesia educational programs ($3 million request). To continue traineeship support for nurse anesthesia students ($2 million request). To increase the number of nurse anesthetist faculty with advanced degrees ($1 million request). Background of Current CRNA Shortage for There is currently a severe CRNA shortage three primary reasons. First, clinical training resources in some academic health centers have been shifted from nurse anesthesia educational programs to anesthesiology residency programs. Second, there is a lack of clinical faculty to teach in nurse anesthesia programs. Third, there is an increased demand for anesthesia services. A February, 1990 Health Economics Research study, mandated by the congressional appropriations committees, reported a shortage of 6,000 CRNAs for 1990, or a 13.6 shortfall. It further reported the need for 30,000 CRNAs by the year 2000, and over 35,000 CRNAS by the year 2010. To meet that need, the educational system for nurse anesthetists would have to graduate 1,800 students yearly between now and the year 2000, and 1,500 a year thereafter. Unfortunately, increasing the number of graduates to such levels would be difficult under current conditions because in 1990 there were approximately 650 nurse anesthesia graduates. However, current data indicates that there are 3 qualified applicants for every 1 available student space in a nurse anesthesia program. The peak number of nurse anesthesia educational programs has been almost cut in half. In 1983, there were about 160 nurse anesthesia educational programs; in 1990 there were only 82. As evidenced by the Division of Nursing announcement in the February 28, 1991 Federal Register, the FY91 appropriation of $450,000 for new nurse anesthesia educational programs will only fund three grants, at an average of $150,000 per grant. Although the application deadline for the new program grants extends until May 31, 1991, the AANA office has already received almost 20 requests for information regarding submitting a grant application. The educational costs of preparing CRNAs are less than those of preparing anesthesiologists. Becoming a CRNA takes a minimum of 78 years: 4 years of undergraduate education to become a registered 8 years: 4 years of undergraduate education to become a registered nurse, 1-2 years of experience in an acute care nursing unit, and 2 years of anesthesia education. Becoming an anesthesiologist takes a minimum of 12 years: 4 years of undergraduate education, 4 years of medical school, and a 4-year residency in anesthesiology. CRNAS Provide Quality Health Care CRNAs have administered anesthesia for over a century. Data in a 1988 Center for Health Economics Research study demonstrated that there is no difference in anesthesia outcomes based on whether the provider is a CRNA or an anesthesiologist. CRNAS Increase Access to Health Care CRNAs increase access to health care by administering more than 65% of the 26 million anesthetics given to patients each year in the U.S. CRNAS are the sole anesthesia providers in 85% of rural hospitals, affording these medical facilities obstetrical, surgical, and trauma stabilization capabilities. CRNAs Provide Cost-effective Health Care A 1990 Health Economics Research study found that increased use of CRNAs to deliver anesthesia could save the nation $1 billion annually by 2010. CRNAs had a 1990 average pretax income of $60,000; the 1990 average net income for an anesthesiologist was $180,000. CRNAs save Medicare beneficiaries money by accepting mandatory assignment. Anesthesiologists can balance bill Medicare beneficiaries; only approximately 30% of the anesthesiologists in the United States are Medicare participating physicians. Fiscal RECENT HISTORY OF NURSE ANESTHESIA FEDERAL FUNDING Total #Traineeships # Faculty (Funding) 19,000 New Education 476 The AANA would additionally recommend that funding for the National Center for Nursing Research at the National Institues of Health be increased from the FY91 level of $43 million to $58.8 million in FY92. The purpose of the Center is to foster nursing research and to ensure an adequate supply of qualified nurse researchers. STATEMENT OF WILLIAM O. McMILLAN, JR., M.D., AHEC PROJECT DIRECTOR, AND ASSOCIATE VICE PRESIDENT FOR HEALTH SCIENCES, WEST VIRGINIA UNIVERSITY HEALTH SCIENCES CENTER; J.S. REINSCHMIDT, M.D., AHEC PROGRAM DIRECTOR, AND ASSOCIATE DEAN, SCHOOL OF MEDICINE, OREGON HEALTH SCIENCES UNIVERSITY; AND CHARLES O. CRANFORD, D.D.S., M.P.A., EXECUTIVE DIRECTOR, ARKANSAS AHEC PROGRAM, AND ASSOCIATE DEAN, COLLEGE OF MEDICINE, UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES Mr. Chairman and members of the Subcommittee, we are pleased to have the opportunity to submit this testimony concerning the National Area Health Education Centers Program, or AHEC, as we call it. We are representing 27 AHEC projects in 27 states that are receiving federal AHEC funding through the Health Resources and Services Administration. AHEC projects receiving federal funding include West Virginia, Oregon, Arkansas, Washington, Texas, California, Oklahoma, Kentucky, Georgia, Florida, Louisiana, and Maine and many others from all sections of the nation. As we have indicated in previous appearances before the Subcommittee, we appreciate the support that we have received through the years from this Subcommittee. We believe it is essential that the National AHEC Program continue. We urge the full appropriation of $20 million authorized for the fiscal year that begins October 1, 1991. We also support the appropriation of $8 million for the new Health Education and Training Centers within the AHEC authority (SEC 781 (f)). As a supplement to the AHEC mission, Mr. Chairman, the newly authorized Health Education Training Centers (HETC) are focusing on the most severe health problems among populations which have been somehow overlooked. In West Virginia, for example, a remote area HETC is being established in the coal fields of southern Appalachia; along the U.S.-Mexico border HETC will serve the needs of Hispanic populations. HETC or AHEC, Mr. Chairman, the concept is the same: Americans deserve the best health care available. Throughout the United States we continue to attack the problem that led to the establishment of the National AHEC Program--that problem being the maldistribution of physicians and other health practitioners in rural and inner city areas. We are happy to report, Mr. Chairman, that we are making important progress. In Arkansas, for example, 50 of 75 counties have received Family Practice physicians trained in the AHEC. The AHEC Program has evolved into an effective partnership involving the federal government, state governments, local governments, health science schools, community hospitals and health practitioners. For example, in the newly created statewide Oregon AHEC Program which received federal funding in October of 1990, the first AHEC has been established in the northeast area of the state where continuity of health services is a serious and escalating problem. Expansion of Family Practice residency training has been initiated with funding assistance from the state legislature which enthusiastically supports the AHEC concept in addressing the health care needs in rural areas of this predominantly rural state. |