view of the funding needs of ongoing programs as well as useful new initiatives. You will note that our chart deals with all of the agencies of the Public Health Service, including NIH, ADAMHA, FDA, CDC, and the others. So, it is a very broad look at what is needed generally.

We would like our statement to be included in the hearing record in its entirety.

Senator REID. That will be the order.

Ms. MCCARTER. The coalition's recommendation of $22.4 billion for the Public Health Service is $5 billion above the President's request for 1992 of $17.7 billion. That request of the President is $500 million above the fiscal year 1991 appropriation and $200 million below the CBO baseline for the next fiscal year.

Among the programmatic efforts which would be unfunded or severely underfunded in the administration's budget would be the health professions training, rural health programs, and the Indian Health Service. Other programs would be funded on a no-growth basis. We think that the administration's policy of level funding or below level funding for discretionary health programs is evidence of a regrettable lack of understanding of the importance of biomedical research, health promotion and disease prevention, health services, high quality training of caring health professionals. These efforts are essential to foster and maintain a healthy and productive population and to avoid catastrophic costs of serious illness. The previous speaker spoke so eloquently of the need for prevention in this country.

Mr. Chairman, we applaud the administration's recognition of the importance of seeking innovative solutions to the problems of high infant mortality and uneven access to care across socioeconomic lines, but we disagree with their initial thrust that such efforts can be funded through reductions in existing programs. Indeed, existing programs are addressing these problems and need to be strengthened rather than cut.

PREPARED STATEMENT

I would mention again that our written statement enumerates our recommendations for each of the programs of the Public Health Service, and I will simply conclude by saying that we appreciate this opportunity to testify before the subcommittee and to share our recommendations. On behalf of the coalition, we look forward to working with you in the coming year, and we will support your efforts to provide adequate resources for research, public health initiatives and health professions education.

Thank you very much.

[The statement follows:]

STATEMENT OF KATHERINE MCCARTER

INTRODUCTION

Mr. Chairman and members of the subcommittee: I am Katherine McCarter, President of the Coalition for Health Funding, a twenty year old alliance of national associations organized to foster support for discretionary health programs. I would like to begin by expressing the appreciation of the health community for the subcommittee's ongoing support for health initiatives. We urge the members to continue to demonstrate this commitment to the nation's health.

Attached for your review is a table outlining the Coalition's

recommendations for FY 1992 funding of U.S. Public Health Service agencies. These recommendations are based on our review of the funding needs of ongoing programs as well as useful new initiatives. We hope that the subcommittee will give our recommendations every possible consideration, and we would be pleased to provide any embellishment which is needed.

Mr. Chairman, the President's budget for Public Health Service programs for FY 1992 is $15.7 billion, which is $500 million above the FY 1991 appropriation and $200 million below the Congressional Budget Office (CBO) baseline for next fiscal year. Among the programmatic efforts which would be unfunded or severely underfunded in the Administration's budget would be health professions training, and Indian Health Service programs. Other programs would be funded on a "no-growth" basis.

We think the Administration policy of level funding (or below) for discretionary health programs is evidence of a regrettable lack of understanding of the importance of biomedical research, health promotion and disease prevention, and high quality training of caring professionals, in the effort to foster and maintain a health and productive population, and in avoiding the catastrophic costs of serious illness.

Mr. Chairman, we applaud the Administration's recognition of the importance of seeking innovative solutions to the problems of high infant mortality and uneven access to care across socioeconomic lines, but we disagree with the implication that such efforts can be funded through reductions in ongoing initiatives. Indeed, existing programs are addressing these problems and need to be strengthened, rather than cut.

Following is a partial list of problems and opportunities which could be addressed by the Public Health Service if given the level of resources advocated by the Coalition for Health Funding. In

determining its recommendations, the Coalition has solicited the professional judgements of administrators, health professionals and consumers, health researchers, and others who are concerned about health research, services and education.

National Institutes of Health. The Coalition's budget request would allow an award rate of at least 30% of approved research project grant applications, with no "downward negotiation" of award levels for RPGs or research centers. We also think NIH should have the resources to expand and enhance the research center and clinical trial efforts, to train additional researchers-particularly minoritiesand to begin to address the problem of deteriorating physical plants.

Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) ADAMHA has a vital role to play in virtually all of our nation's major health dramas, including the provision of services to persons with AIDS, the homeless, and substance abusers. The Coalition's budget recommendation recognizes the need for expansion in all areas of ADAMHA's research and training mission. Funding is especially needed to fulfill the promise of the landmark National Plan for Research on Schizophrenia and the Brain. Programs designed to attract greater numbers of researchers and clinicians into the field also need support. The Coalition's recommendation also contains funds to allow ADAMHA to fully participate in the War on Drugs by providing substance abusers with the counseling and treatment they need.

Centers for Disease Control. The CDC is at the forefront of our national effort to insure the public health. Efforts to halt the spread of AIDS and other sexually transmitted diseases, to prevent injuries, and to immunize against crippling and life-threatening diseases are among the current priorities of the CDC. The work of the CDC, like that of its sister agencies in the Public Health Service is at once compassionate and cost-effective it is, after all, far more costly to provide medical care than to prevent or minimize the health care problem early on.

The Administration has proposed a budget for CDC which fails even to keep pace with inflation. Despite the increasing rate of syphilis in our country, the Administration would cut funding for sexually transmitted disease prevention. Despite recurring outbreaks of measles, funds for immunization are totally inadequate. The Coalition's funding recommendation for CDC contains sufficient funds to address these and other important public health concerns.

Health Resources and Services Administration. Important programs of health professions education and health services provision are conducted under the auspices of HRSA. The

Administration budget, which would cut HRSA funding by more than $50 million, is wholly inadequate.

The federal investment in health professions education has paid important dividends in our national effort to insure the availability of care to all who require it. The job, however, is not yet finished. There continues to be severe maldistribution of most health

professionals, and shortages in many. Predictable demographic changes such as the aging of the population, suggest the need to redouble our efforts to assure the availability of well-trained professionals. Modern day health crises such as AIDS and Legionairre's disease put further strains on our health care system and its professional contingent, and we must be prepared to deal with these as they arise. Stifling our effort to train health professionals at this time makes no sense whatever.

Other HRSA efforts to provide health care for the homeless, and other underserved populations address pressing national needs, but would be seriously underfunded or unfunded in the Administration budget.

Mr. Chairman, thank you for the opportunity to testify before the subcommittee, and to share with you our recommendations for funding of the U.S. Public Health Service. On behalf of the Coalition members, we look forward to working with you and the subcommittee in the vital effort to provide adequate resources for biomedical research, public health initiatives, and health professions education.

NATIONAL INSTITUTES OF HEALTH

Senator REID. A week ago Monday, I went to the National Institutes of Health for the first tour of the Institutes in 9 years. It is too bad that all Members of Congress are not forced to go through the National Institutes of Health for a tour because it really is something our country should be proud of. I am glad to see that your coalition has recommended a significant increase in funding of almost $1 billion for the National Institutes. There could not be money that would be better spent. We have a lot of problems there. We are having trouble attracting scientists because of the way they are paid. But we are working on that, and we hope we can maintain our place in the world as a foremost researcher of health problems of human beings.

Ms. MCCARTER. I would agree with what you said and would also add that I would hope that all Members of Congress could also visit the other agencies of the Public Health Service like the CDC and the FDA and be aware of the significant contributions that they all make to the health of this country.

Senator REID. But, of course, as you are aware, medical research in this country starts with the National Institutes of Health. Some 75 percent of all medical research that is done in the country anyplace is started at the National Institutes of Health. And so, while these other agencies are extremely important, the umbrella is the National Institutes of Health for everything that goes on in this country regarding medical research.

Ms. MCCARTER. Right. The other agencies may have different focuses such as services or health training. Undoubtedly, the National Institutes of Health is a premier research agency.

Senator REID. The Indian Health Service. I am on the Indian Affairs Committee, and the problems we have there are so significant that I really am at a loss for words to try to describe what needs to be done. I am not sure anyone knows, but it is going to take a different approach than what we have used because we are simply failing the need of Americans with the way we are administering health care.

Thank you very much for your testimony.

Ms. MCCARTER. Thank you very much.

PREPARED STATEMENT OF JOHN M. RECTOR, NATIONAL ASSOCIATION

OF RETAIL DRUGGISTS

Senator REID. John M. Rector with the National Association of Retail Druggists was unavoidably detained. As a result of that, I would order that his statement be made a part of the record.

[The statement follows:]