Table 1

SSA Budget Request for FY 1992 and NTEU Recommendation*

FOOTNOTES

a.

b.

C.

For Departmental Management, NTEU includes $1,390,000 to cover 100 percent of the January, 1992 pay raise in lieu of the 50 percent absorption required in the budget.

For Office of Civil Rights, NTEU restores a staff cut of 5 FTE and $126,000, and eliminates a $264,000 absorption of 1992 personnel costs.

For SSA, NTEU adds $55.3 million and 172 FTE to restore the contingency rserve to $100 million and to cover unfunded work in the SSI outreach program. NTEU also adds $183.3 million and 5,650 FTE for a "Service Now" Initiative to restore an effective SSA and provide improvements in several areas of weakness identified by GAO and OIG. These additions are justified in a separate statement which NTEU has submitted on SSA.

d. For Family Support Administration, $5,148,528 and 112 FTE are provided to
strengthen welfare and child support program administration, and strengthen the
Office of Community Service's Administration of the Community Services Block
Grant (this was identified as a significant weakness by OIG). To this is added
$4,235,000 to restore a proposed reduction in reseach and evaluation funds.

e.

f.

g.

h.

i.

j.

For HCFA, NTEU restores a reductions in research, contractor contingency, and
administrative funds totaling $72 million. NTEU adds 200 FTE and $8.9 million
for implementation of the physician payment system, stronger oversight of the
hospital prospective payment system and clinical laboratories, implementation
of OIG and GAO recommendations in areas of significant weakness, and ensure
collection from primary insurers where Medicare is the secondary payer.

For OHDS, NTEU adds 200 FTE and $9.7 million to the budget request in addition
to Administration's proposed increase of 124 FTE. The components of OHDS
remain seriously understaffed and unable to exercise proper Federal oversight
of millions of dollars provided to states to deal with major social problems,
especially the growing child welfare cases. OIG has found OHDS administration
of 1,800 research contracts to be ineffectual and has declared this to be an
area of significant weakness. The additional resources are needed to deal with
the agency's growing responsibilities for Children's Programs including
expansion of Head Start.

For HRSA, NTEU restores reductions totaling $233.9 million and 327 FTE for
Health Care Delivery and Assistance, Bureau of Health Professions, Maternal and
Child Health, Health Resources Development, Buildings and Facilities, Program
Management, Family Planning, Health Services Outreach Grants, and Rural Health.

For CDC, NTEU adds $5.5 million and 100 FTE to overcome weakness in AIDS public
education aimed at the poor and minorities, and to strengthen Federal oversight
of preventive health and health services block grants, immunization program
operations, epidemic services, and environmental disease prevention.

For the Alcohol, Drug Abuse, and Mental Health Administration, NTEU restores
reductions of $113.7 million for general mental health, demonstrations under
the McKinney homeless program, protection and advocacy, clinical training, drug
abuse demonstrations for AIDSprevention outreach, alcoholism demonstrations for
the homeless, treatment capacity expansion, and substance abuse prevention
demonstrations for the community youth activity program. NTEU also adds $3.5
million and 100 FTE to strengthen Federal oversight of grants and research, and
ensure that alcoholism and drug treatment program funds are fully spent to
reach more persons requiring treatment.

For Office of Assistant Secretary for Health, NTEU restores reductions totaling
$385,000 for disease prvention, physical fitness, national AIDS program,
mational vaccine program, and PHS management.

Senator HARKIN. Mr. Tobias, thank you. I can assure you that we have already started that process. I can tell you publicly that I am not satisfied with it, that the things that you have pointed out are coming. There is nothing we can do to stop the aging of Americans and more claims, and this request simply does not address it.

Your statement indicates that the President's budget will require nearly doubling the backlog of disability claims. Is the $25,960,000 you recommend sufficient to prevent a growing backlog of disability claims?

Mr. TOBIAS. Yes; we think it is. We think it will start the process of reducing that backlog and keeping the SSA more current. That is basically what the whole issue is about.

We also believe that the issue of funding is so important, Senator Harkin. The issue of whether or not it is on budget or off budget is subject to the discretionary spending limits or not, and if it is off budget, we believe it will be much easier, of course, for Congress to allocate the necessary funds rather than if it is under those discretionary limits.

Senator HARKIN. So you are in favor of taking the administrative costs of Social Security and moving it off budget just like the rest of Social Security?

Mr. TOBIAS. And as CBO believes Congress did last year when it took the SSA off budget. CBO believes that. OMB, not surprisingly, says no. We believe that the language is clear on its face. In the statute there is some fuzzy conference language. In the tight fiscal times, if we could solve this problem, I think that it would be easier to meet the needs that we have identified.

Senator HARKIN. A number of groups are asking for $10 million to fund counseling programs to assist older Americans in understanding and purchasing Medicare supplemental insurance. You have a lot of problems out there.

Do you support funding this newly authorized initiative?

Mr. TOBIAS. Yes; we certainly do, and part of our funding initiative is to hire staff in an outreach effort to assist that program. Senator HARKIN. Thank you very much, Mr. Tobias.

Mr. TOBIAS. Thank you very much, Senator Harkin.

Senator HARKIN. We have your testimony, and we will do our best on this.

Mr. TOBIAS. Thank you.

STATEMENT OF KENNETH L. EATON, THE ALCOHOL AND DRUG PROBLEMS ASSOCIATION

Senator HARKIN. Now we have Kenneth L. Eaton with the Alcohol and Drug Problems Association.

Mr. EATON. Thank you very much, Mr. Chairman.
Senator HARKIN. Thank you for your patience.

Mr. EATON. Since my adult and professional life began in the wonderful State of Iowa, I continue to get lots of vicarious pleasure seeing them return the distinguished Senator to Washington, DC, and loan your talents to those of us

Senator HARKIN. What part of Iowa are you from?

Mr. EATON. From Decorah and Des Moines.
Senator HARKIN. Oh, sure.

Mr. EATON. So it has been a long time, but I still have friends and watch and care a lot about things back there.

We are very grateful for the leadership that you provide as a result of your representing them in the United States Senate. Your contributions to the areas of jurisdiction in this subcommittee have been really outstanding.

I would like to focus on a few issues related to the ADAMHA budget, most particularly alcohol and drug prevention and treatment. Before I do, I would like to join several of my colleagues in supporting a recommendation that the research budgets of NIDA and NIAAA be increased by at least 15 percent. This is roughly to commensurate with the increase of the NIH research programs, and we feel it is quite appropriate. Others have elaborated on that, so I will not do the same.

Several years ago, Mr. Chairman, the AIDS Commission recommended an unequivocal commitment to providing drug treatment on demand. This, we believe, is still valid and should not be forgotten. The tragic situation with respect to cocaine, the ongoing but unfortunately seldom recognized epidemic of alcoholism, and the overwhelming burden placed on our criminal justice system and other factors add much to the urgency for more readily accessible substance abuse treatment.

A few important points. Very much tied to alcohol-and drug-related crime, America has now achieved the No. 1 status in the world in its incarceration rate. In the last 10 years this rate has more than doubled. Of every 100,000 Americans today, 426 are behind bars. To provide a frame of reference, South Africa, who used to be ahead of us, incarcerates only 333 out of 100,000, the Soviet Union 268 out of 100,000, Great Britain, a society very much like us, incarcerates only at the rate of 97 per 100,000, Spain 76, Italy 60, the Netherlands 40.

We need to be concerned about this, especially if we look at subpopulations; that is, young black males. It is even more alarming. Fully, 25 percent, one-fourth of all young black males are either behind bars or on probation or on parole.

I noticed an article this morning in the Washington Post which reported that the number of drug offenders serving time in Federal prisons has more than doubled just in the past 2 years and now comprises more than one-half of the inmate population of the Federal prison system.

The same thing is occurring at State and local levels. The simple matter of fact is that our criminal justice system has simply become overwhelmed by drug-related crimes. If crimes related to alcohol abuse were included, the proportions would even be larger.

We propose that a more frequent use of treatment for selected offenders is needed to make our criminal justice system more effective and in some cases to prevent the need for incarceration. This need, combined with the well-established need to provide treatment and prevention of the spread of AIDS and other human tragedies means, in our view, that we cannot relax our efforts to provide treatment for all who need it.

I think the evidence is now clear, Mr. Chairman. Treatment or treatment combined with criminal justice sanctions for those who have committed crimes is the best alternative for breaking the