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Health Resources and Services Administration (URSA)

In this academic year, over 75 percent of our 8,420 veterinary students will borrow over $43 million dollars in programs funded by or guaranteed by the federal government. For those borrowing money the average annual loan will be over $8,000. In spite of the high debt load our veterinary students are not a part of the student loan default problem.

The Administration has proposed that HRSA funding be cut by more than $50 million in FY'92. This denies the ever expanding need for health profession student's financial assistance. We must plea for more grant programs to enhance the educational opportunities for the disadvantaged. We must also beg your support of the loan programs that sustain the educational opportunities of middle class Americans. Without adequate federal financial aid programs and guarantees, the bulk of our student bodies will not be able to continue their education.

As you work with authorizing committees on Title IV, Title VII and Title VIII programs, it may be necessary to restructure the loan programs. The pressing needs cannot, however, be delayed. For example, the Congressional imposed cap on HEAL programs will begin to deny those "loans of last resort" to many entering freshmen this next September and there is little that the schools and colleges can do to provide other sources of financial aid. During this appropriation process for FY'92, we urge you to delay the imposition of the HEAL cap until the issues can be worked out through reauthorization. We also urge you to fund all HRSA programs at the FY'91 levels and that you increase funding for those programs directed at the financially and academically disadvantaged members of our society.

There are other important and creative programs in HRSA that are improving the educational delivery system of our health professions. Programs such as the Model Education Special Projects are addressing major issues such as "outcome assessment and adaptation of rapidly improving educational technology. However our major concern is for financial aid. Without adequate support for our students, we place the entire higher education process into a state of eroding quality and diminished opportunity. Ultimately, that will lead to a comparable erosion of quality in the health care delivery system and diminished opportunity for health care. We urge that you fund both HRSA and the Department of Education at levels that will assure the availability of federal financial aid for every student who is dependent on it for his or her higher education.

Summary

Thank you for the opportunity to present these recommendations. We urge you to adequately fund those programs that provide the health research that supports the progress of medicine and the health education. This will allow the next generation of young people the opportunity to translate that progress into health care delivery.

STATEMENT OF THE ASSOCIATION FOR GERONTOLOGY IN

HIGHER EDUCATION

Mr. Chairman and Members of the Labor-HHIS-Education Appropriations SubCommittee, the Association for Gerontology in Higher Education (AGHE) appreciates the opportunity to present testimony on the FY 1992 Labor-HHIS-Education Appropriations bill. As you have requested, we shall keep our remarks brief.

Our testimony will focus on two major sources of support for gerontology-related education, training, and research: (1) the Older Americans Act Title IV Training. Research, and Discretionary Projects program; and (2) the National Institute on Aging.

Older Americans Act Title IV Program

The Older Americans Act has now been in existence for a quarter of a century. Title IV has consistently demonstrated its value and worth to our nation, the aging network in the broadest sense, and older Americans--despite being significantly under-funded for much of its history. Currently, Title IV is the only federal program to support applied research concerning the socialbehavioral needs of older adults. It is the only program providing funding for gerontology instruction in two- and four-year colleges. One of its major contributions is to train personnel in non-health professions to work with elderly persons. A high percentage of individuals assisted by career preparation training have remained in the field of aging. Many of these dedicated persons are serving older Americans in a wide range of capacities.

Unfortunately, Title IV has never been able to reach its full potential because virtually all Administrations have recommended insufficient funding requests. Moreover, the Administration on Aging (AOA) has historically treated Title IV as a step child in many respects. Fortunately, Dr. Joyce T. Berry, U.S. Commissioner on Aging, has changed that policy and has taken constructive steps to bolster Title IV's standing and mission.

Fiscal year 1980 was the peak funding year for Title IV, when Congress appropriated $54.3 million. However, this high-water mark was short-lived. The Reagan Administration succeeded in slashing Title IV funds to $ 22.2 million during the arly 1980s, but failed to terminate the program--thanks largely to the efforts of this Subcommittee and other concerned congressional units. Currently, Title IV has a $26.917 million appropriation for FY 1991.

AGHE believes that the time is long overdue to restore funding for Title IV to offset the sharp cutbacks in appropriations, especially during the early 1980s. Consequently, we urge the Subcommittee to approve a $30 million appropriation for Title IV. The need is clearly much greater, and funding above $30 million could be well spent and yield impressive dividends. We are recommending $30 million, though, because we fully recognize that our enormous budget deficit necessitates constraint.

AGHE further urges the Subcommittee to approve report language to call upon AoA to increase funding for education and training activities to emphasize the need for qualified personnel trained and educated in the field of aging. The Subcommittee approved this language for FY 1991. We believe that it would be helpful if the Subcommittee would adopt identical or similar language to provide guidance and direction for AoA.

We further urge the Subcommittee to approve the following language adopted by the House Appropriations Committee for the FY 1991 Labor-HHS-Education Appropriations Act:

"The Committee finds the pool of trained personnel to provide services to a dramatically increasing number of dependent elders has failed to keep pace. Major initiatives are required to train individuals for effective, skilled service to the nation's elders. The Committee believes the Administration should emphasize education and training programs both at universities and at community colleges. The Committee intends the training and education funds should strengthen the capacity of higher education and associate degree programs to provide gerontological training, thereby assuring long-term commitments to personnel development in the aging fields."

National Institute on Aging

The Research on Aging Act created the National Institute on Aging (NIA) in 1974. NIA is responsible for conducting and supporting biomedical, social, and behavioral research and training concerning the aging process, as well as diseases and other special problems and needs of older Americans.

NIA is now funded at $323.752 million for FY 1991. The Administration's budget request calls for $348.558 million. We support a $358.558 million funding level, $10 million above the Administration's request.

There is a great need for increased support for social/behavioral research and training, since NIA is the major federal agency concerned with basic (not applied) agingrelated research and training in the social and behavioral behavioral disciplines. NIA has historically not had the funds to support these programs more than at a minimal level.

This appropriation could expand research concerning new treatments focusing on the causes and earlier diagnosis of Alzheimer's disease, which costs our nation about $90 billion a year in a variety of ways. Some experts believe that a realistic possibility exists for our nation to develop treatment for this disease within five to ten years. This development could yield a $45 billion dividend to our nation in terms of increased productivity, reduced institutionalization costs, and other savings.

Our proposal could also lead to additional research concerning problems associated with frailty and independence. Frailty costs our nation an estimated $54 billion a year.

Thank you for this opportunity to testify. We look forward to working with you to secure equitable and realistic funding for gerontological education, training, and research. STATEMENT OF THE LEGAL ACTION CENTER

Thank you for the opportunity to submit testimony on appropriations for programs within the Department of Health and Human Services. The following testimony is submitted by the Legal Action Center, a not-for-profit law and public policy office that focuses on issues surrounding alcohol and other drug treatment and prevention and AIDS, and fourteen state treatment and prevention associations from across the country. (See attached list). These associations represent the individuals on the front lines of treatment and prevention activities who, on a daily basis, confront the dramatic need to expand drug and alcohol services. We urge you to adopt the following funding requests.

1. Alcohol. Drug Abuse and Mental Health Services (ADMS) Block Grant

A. Increase Funding for the ADMS Block Grant

The ADMS block grant provides the foundation for community-based alcohol and drug treatment and prevention services and community mental health services. We urge the Subcommittee to increase the block grant to $2 billion as a way to move the nation closer to providing appropriate treatment to all who request it and to placing an equal emphasis on demand reduction (treatment and prevention) and supply reduction (law enforcement and interdiction) activities.

The President's budget, which would lund the ADMS block grant at the FY 1991 level of $1.268 billion and below current services of $1.319 billion, is inadequate to (1) meet the treatment needs of underserved populations, such as women and children, adolescents, homeless individuals and persons with HIV infection, and (2) attract and retain qualified staff.

B. Limit Administrative Expense Set-Aside

We also urge the Subcommittee to explicitly limit the block grant statutory set-aside for data collection, services research and technical assistance to 5% and to direct the Administrator to use a greater portion of the funds for technical assistance, particularly targeted to providers as well as the States.

11. National Institute on Drug Abuse (NIDA)

A. Expand Treatment Services Research

The proposed FY 1992 budget makes medications development a top research priority, requesting $55 million, an increase of $15.5 million (39%) over FY 1991. While medications development is important, the treatment and prevention field has a far greater need for treatment and prevention services research. The congressionally mandated Institute of Medicine study. Ireating Drug Problems, noted "the prospects for maintaining and improving treatment quality as well as continuing to develop more effective treatment methods depend to a great extent on treatment services research." (treating Drug Problems at 193).

We urge you to appropriate $25 million of the research funds requested for medications development for services-related research so that we can better determine how to get people into treatment and keep them there, make treatment even more effective and prevent relapse.

B. Maintain AIDS Qutreach Projects

The NIDA AIDS Outreach Demonstration Program has demonstrated its effectiveness in getting injection drug users and their sexual partners to seek and enter treatment and modity risky injection and sexual practices. This critical program is being phased out with little prospect of states or other entities continuing this work which will save lives and millions of dollars in long-term health care costs. We urge you to provide $:0 million above the President's request to maintain the current funding for these programs.

III. National Institute on Alcoholism and Alcohol Abuse (NIAAA)

Maintain Homeless Demonstration Project

The NIAAA Homeless Demonstration Project, which has developed innovative programs for homeless alcohol and drug dependent individuals, is slated to be replaced by a new "Consolidated Research Program" that will combine the NIAAA and NIMH homeless demonstration projects. The consolidated program would reduce total funding for the two programs and would impose new requirements that will disquality many of the alcohol and drug dependent individuals who are currently receiving services. Eliminating funding for current projects before the third and final year of their work will waste much of the $30 million already invested in these programs.

We urge you to provide funding for the NIAAA demonstration project at the current services funding level of $17.1 million.

IV. Office for Substance Abuse Prevention (OSAP)

Expand OSAP's Demonstration and Communications Projects

We urge the Subcommittee to add $100 million to OSAP for the High Risk Youth, Pregnant Women and Infants and Communications programs. At a minimum, $20 million, above the President's request, should be added to both the Pregnant Women and Infant demonstration program to support residential services for pregnant addicted women and their children and $20 million to the High Risk Youth program. In addition, the Community Youth Activity Program should not be eliminated but rather retained at the current services level. OSAP does not have sufficient resources to fund qualified High Risk Youth applications and should not be forced to spread those funds to support projects that reach this important population.

V. Office for Treatment Improvement (II)

Capacity Expansion Program

While we support the proposal to increase treatment funding for alcohol and drug problems by $99 million, we strongly urge that that funding be added to the ADMS block grant, which provides a foundation for comprehensive services, rather than diverted to another one-time categorical program, as proposed with the Capacity Expansion Program. If the ADMS block grant is increased, we would suggest that the Capacity Expansion Program be funded on a multi-year basis and provide funding for both alcohol and drug treatment.

Alabama Alcohol and Drug Abuse Association

Arizona Association of Behavioral Health Programs

California Association of County Drug Program Administrators

Florida Alcohol & Drug Abuse Association

Illinois Alcoholism & Drug Dependence Association

lowa Substance Abuse Program Directors' Association

Massachusetts Alcoholism & Drug Abuse Association

New Jersey Association for the Prevention and Treatment of Substance Abuse

New York State Association of Substance Abuse Programs

Association of Ohio Substance Abuse Programs

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