are appropriate and that we are getting value for our dollars, but I also believe that, overall, it has worked very well so far.

When I was a medical student, I treated patients with paralytic polio. At the same time, back in the mid-1950's, that I was doing that in Boston, Thomas Endes had a grant from NIH for around $150,000 which he used to learn how to grow this virus in the laboratory on slices of monkey kidney tissue. That brings in another thing, the animal research issue, and is one of the reasons I have been outspoken against those who are arguing against animal research.

Because of that investment of $150,000, where we learned how to grow this virus which was then used to make a vaccine by killing the virus, or altering it, last year in the United States we had no reported cases of paralytic polio. We still have some cases around the world, but we are now talking tentatively, but I think very definitely, about possibly eradicating polio from the world. This is a disease that cost us hundreds of thousands of dollars and changed the lives of people who were infected by it.

That is just one example of the benefit of research-dollars saved, lives preserved. People are able to continue to be independent, productive citizens, as opposed to being in an iron lung or in a wheelchair, undergoing tendon transplants attempting to retain some mobility.

As we look at this issue, we should try to make adjustments in ways that do not compromise our biomedical research effort, because it has been so productive over the years.

INDIRECT COSTS

Senator HARKIN. I appreciate that, and I have used that example myself in the past, but there is a problem out there and it has got to be looked at, and just because we both support biomedical research-and I happen to be one of the strongest supporters of NIH and what they are doing. I think my record shows that—that does not mean that we can say well, whatever the indirect costs are we will pick up the tab.

We have got to have some accounting principles in there. We have got to find out how we can perhaps reduce this increase. $1.9 billion is quite a bit for indirect costs, and staff just informed me that a 1-percent reduction of the average would save $30 millionjust 1 percent. What is the average? Forty-seven percent. It could be a lot of money we could save.

So again, when we are looking at places to save money, and we are looking at maternal and child health care programs and things like that, I think maybe there is something here that we have got to take a look at. But you are right, we have to be careful, because we cannot shut off the biomedical research.

Well, you have been very generous with your time. We really appreciate your being here. It was a good session, and as I said, hopefully not confrontational at all but trying to answer these questions in the best way that we can achieve the goals that we both want to see.

So again, Mr. Secretary, thank you. We look forward to working with you this year on a whole broad range of issues, and perhaps we can start the process toward meeting those health objectives in

2000 and get something worked out that will work with this infant mortality initiative.

Secretary SULLIVAN. Thank you, Mr. Chairman. I look forward to working with you.

QUESTIONS SUBMITTED BY THE SUBCOMMITTEE

Senator HARKIN. There will be some additional questions from various Senators which we will submit to you for your response. [The following questions were not asked at the hearing, but were submitted to the Department for response subsequent to the hearing:]

QUESTIONS SUBMITTED BY THE SUBCOMMITTEE

TRANSPORTATION TECHNICAL ASSISTANCE

Question. In 1989 it came to the attention of the Committee that the Department of Health and Human Services spends up to $1 billion for transportation. HHS funds are used for transporting Head Start children, the elderly and persons with disabilities. The non-profit organizations which provide this service in rural areas are often the only source of public transportation in their communities. Yet, these organizations are not eligible to receive technical assistance provided through the Department of Transportation.

To alleviate this problem, the Committee provided approximately $250,000 in the Fiscal 1990 bill for a technical assistance program for rural and special transportation providers funded by HHS, along with a study of ways to improve coordination between federal DOT and HHS. This project was implemented through an inter-agency agreement with DOT.

The Committee provided funds in the Fiscal Year 1991 bill to continue this effort. The House report concurred with the Senate regarding the use of Fiscal 1991 funds.

What is the status of the current program? Have you been satisfied with the work of the technical assistance contractor? Do you intend to comply with the conference report on the Fiscal 1991 [funds] and continue the current technical assistance program and contractor?

Answer. As a result of the FY 1990 appropriation, HHS has funded a human services transportation technical assistance project from July 1, 1990 through June 30, 1991. Community Transportation Association of America (CTAA) is the project awardee..

We

As a part of this project, CTAA recently conducted two regional training conferences, entitled "Integrated Client Transportation", to provide a forum for the exchange of experiences and new information among State and local human services transportation providers. were pleased with the attendance at both conferences and have received positive comments from many conference participants. Under the current project, CTAA has also expanded to HHS providers the existing transportation information clearinghouse, hotline and electronic bulletin board that were developed under the Rural Transportation Assistance Program (RTAP) of the Department of Transportation's Urban Mass Transportation Administration. In addition, CTAA is tasked to provide, by this summer, a report to Secretary Sullivan on the transportation services

provided under Medicaid, Head Start and the programs funded through the Older Americans Act. CTAA's performance has been appropriate thus far under this project.

Yes, we are complying with the conference report on Fiscal 1991 funds and will continue the current technical assistance program. On March 18, 1991, an announcement of the availability of funds and a request for applications was published in the Federal Register for the continuation of the human services transportation technical assistance project. In keeping with the language of the Appropriations Committee Report, the announcement provides that eligible applicants are "national organization(s) with a record of assisting rural and special transportation needs." We have provided for a 60-day response period and will fund the new cooperative agreement (s) as of July 1, 1991. The Department intends to fund one or more cooperative agreements to continue the provision of technical assistance to the planners, providers and agency consumers of human services transportation. cooperative agreement(s) will be let to the most qualified organization(s), as determined during the application review process.

The

Finally, it should be noted that at this time the Department is not able to verify the $1 billion estimate for the provision of human services transportation that is contained in the Committee report. However, we anticipate that the current CTAA study of the Head Start, Medicaid, and Older Americans Act programs will provide the Department with an estimate of the transportation costs associated with the major human services transportation programs in HHS that we can confidently share with the Committee and the public.

Question. The Fiscal 1991 bill also provided approximately $250,000 for a special technical

assistance program for rural and special transportation providers on the new requirements of the Americans with Disabilities Act. According to the Senate Committee Report, technical assistance is to be provided to state human services agencies, rural and special transportation providers to ensure that HHS-funded transportation efforts are directed toward the needs of persons with disabilities and that such efforts are coordinated with other public transit services. This program is to be carried out by a qualified national organization with a record of assisting rural and special transportation needs.

The conference report concurred with the Senate

position.

What is the status of this project? When will funds be available? Do you intend to comply with the intent of Congress on the selection of a contractor and the implementation of this program?

Answer. Yes, we are complying with the intent of Congress on the selection of a contractor and the implementation of this program. On March 18, 1991, an announcement of the availability of funds and a request for applications was published in the Federal Register for the provision of targeted technical assistance on the requirements of the Americans with Disabilities Act. A 60-day response period has been allowed, and the new cooperative agreement(s) will be funded as of July 1, 1991. The Department intends to fund one or more cooperative agreements to provide targeted technical assistance to the planners, providers and agency consumers of human service transportation on the requirements and anticipated implications of the Americans with Disabilities Act. Pursuant to the language of the Appropriations Committee report, the announcement provides that eligible applicants are "national organization(s) with a record of assisting rural and special transportation needs." The cooperative agreement (s) will be let to the most qualified organization(s) as determined during the application review process.

MINORITY HEALTH

Question. Dr. Sullivan, a great portion of your career has been devoted to improving the health status of minorities, and the number of minorities in the health professions. What are some immediate steps that this subcommittee and the department can take in improving the Federal contribution to this effort?

Answer. Support of the President's FY 1992 budget will provide $485 million for direct programs targeted specifically towards this effort, $47 million (11%) more than in FY 1991. My highest priorities are reflected in this request, including: Health Professions Student Loan recapitalization, extramural construction at minority institutions in order to better enable minority researchers to compete for NIH research grants, and further investment in scholarships through the National Health Service Corps program.

In addition, the Federal contribution to this effort will be greatly enhanced if we endeavor to make programs already in place reach targeted audiences. This means that as managers of Federal programs, it is incumbent upon us to assure that we carefully target grant and scholarship funds in order to meet the Year 2000 objective of improving the health status of our minority citizens.