required to achieve these goals is principally dependent on the rate at which funding resources are available. The findings discussed above have been submitted to NIH as part of a supplemental grant to the MGH Alzheimer's Center to investigate the extension of the diagnostic protocols to blood and nasal swabs. Under the proposed supplemental grant, we expect to progress further in developing a diagnosis for Alzheimer's, as well as the develop a test around an easily obtainable biological sample. Despite your efforts to increase funding for Alzheimer's research in fiscal 1991, it appears that only a very modest amount has trickled down for further development using our technology. There is still a need for more funds to be made available for this purpose. I would be happy to discuss this in further detail if you wish. Sincerely, ALVIN V. BLOCK, President. Senator HARKIN. Thank you. Again, welcome back to the subcommittee. You have been here before. I understand there are no specific requests here for money, but how soon do you expect that we could have accurate diagnostic tests for Alzheimer's, for example? Mr. BLOCK. With adequate funding, 3 to 5 years, possibly sooner. Senator HARKIN. I appreciate that. This is an area we ought to move ahead in. Thanks for all your good work at ESA. Mr. BLOCK. Thank you. Senator HARKIN. Thank you very much, Mr. Block. SUBCOMMITTEE RECESS Senator HARKIN. Thank you all for being here. I would like to thank all the witnesses who have appeared before us with regard to the proposed fiscal year 1992 budget request. Today's testimony completes our hearings of public witnesses, the subcommittee will now stand in recess until 2 p.m., when we will hear testimony from Hon. Lamar Alexander, Secretary of Education. [Whereupon, at 1:38 p.m., Thursday, April 25, the subcommittee was recessed, to reconvene at 2 p.m., the same day.] Material Submitted Subsequent to Conclusion of Hearings [CLERK'S NOTE.-Additional material was received by the subcommittee subsequent to conclusion of the hearings. The statements will be inserted in the record at this point.] (841) STATEMENT OF THE AMERICAN ASSOCIATION OF COLLEGES OF OSTEOPATHIC MEDICINE The American Association of Colleges of Osteopathic Colleges (AACOM) is pleased to present its views on FY 1992 funding for federal programs that support the education of health professionals, particularly the federal loan and loan guarantee programs under the Higher Education Act and the Public Health Service Act that are widely used by health professions students, especially the 6,615 students at the fifteen osteopathic medical colleges. In years past, AACOM testified before this Subcommittee about the partnerships formed between the osteopathic medical colleges and the federal government in pursuit of mutual goals such as primary care and family medicine, geriatrics, and improved rural health care. These remain major goals of the colleges of osteopathic medicine, as well as the federal government. However, continued success in each area depends upon the ability of the colleges of osteopathic medicine to recruit and retain students who share these goals. Many of these students will need federal loan support. Osteopathic medical students have higher borrowing needs on average than other health professions students. They depend to a greater extent on federally guaranteed and subsidized loan programs for these funds and their ability to begin and complete their education depends in large measure on the Subcommittee's continued support for the various federal student loan programs. This dependence is substantial. Ninety-six percent (96%) of the seniors graduating from osteopathic medical schools did so with debts averaging $71,500. This compares to about $45,000 for the 79% of allopathic medical students who graduated irdebted. It is important to understand the major factors that cause this dependence on higher borrowing. The first is that many osteopathic medical students come from families with lower incomes. Forty-eight percent come from families with annual incomes under $40,000. Their families cannot help them significantly, so they must seek financial aid. Second, osteopathic physicians in large proportion practice primary care in smaller communities. Thus they do not generate the kind of income that permits substantial giving to their colleges to help build large endowments. This means that tuition revenue is important and is about 50% of total revenue at many osteopathic medical schools. For allopathic medical schools tuition averages only about 8% of total revenue because of other income from endowments, state support and faculty practice income. Third, the majority of the osteopathic medical colleges (9 of 15) are private and do not have the cross subsidies, such as state appropriations, that are available to many other health professions schools. Nor do osteopathic medical colleges, because of their emphasis on primary and preventive health care, generate the kind of practice income that is typical of many other medical schools which do not emphasize primary care. Despite the high rate of borrowing by these students, osteopathic medical graduates have the lowest rate of defaults among the various health professionals in the Health Education Assistance Loan (HEAL) program. AACOM is proud of the record they have achieved to date. However, recent changes in federal law eliminating the tax deductibility of interest on student loans and limiting deferral of loan payment during residency have put more pressure on osteopathic medical graduates' ability to repay their loans. They must now begin repayment during residency training, a time of low earnings for all young physicians. AACOM is concerned that more defaults may occur as a result of these changes and is working hard with the authorizing committees to try to change these provisions. The HEAL program is one of the most important loan programs used by osteopathic medical students and is relied upon by 56% of these students. In 1980 only 2.2% of our students used the HEAL program; however, they have moved to this program because of the increasing cost of osteopathic medical education and the limits on borrowing under the Department of Education loans. Students may borrow $20,000 annually under HEAL and many students use the maximum amount every year. Full funding of HEAL is of critical importance to them, as is unimpeded and unrestricted borrowing under this program. The current $260 million credit ceiling that the FY 1991 appropriations law places on HEAL borrowing will cause major problems for all health professions students within the next two months because there will be no funds left. AACOM urges an immediate lifting of the ceiling so as not to limit access to this essential program. AACOM shares this Subcommittee's concern over the problem of defaults in HEAL, and is committed to devising solutions to stem the current default situation. But the education of current and future osteopathic medical students should not be threatened as Congress, health professions educators and the financial community work on solutions to these widely recognized problems. - What is particularly troubling is that some of the lowest cost HEAL loans may not be able to grow due to this limit. Two programs --the HEAL "NOW Loan" Program offered to all osteopathic medical students through the Kirksville (MO) College of Osteopathic Medicine, and the Knight Tuition Plans/Key Bank of Maine "HEAL DEAL" program for M.D., D.O. and D.D.S. students have just negotiated improved terms that could have positive benefits in terms of future debt management. The credit ceiling may prevent these programs from proceeding. AACOM urges the Subcommittee to lift the credit ceiling as soon as possible. It penalizes disciplines, such as osteopathic medicine, that have very good repayment and default profiles. AACOM is strongly opposed to the Administration's proposal to phase out the HEAL program and to prevent new borrowers from entering it. This would have a devastating impact on our students, particularly at the private colleges of osteopathic medicine. AACOM does not understand this policy which seems to run counter to the aims of the Administration to encourage primary care training. AACOM urges this Subcommittee to reiterate its commitment to maintaining a strong HEAL program and to reject the Administration's proposal. AACOM supports the recapitalization of the Health Professions Student Loan Program (HPSL) at the authorized level of $15 million. AACOM does not consider HPSL an adequate substitute for the HEAL program, as has been suggested by the Administration. Osteopathic medical students need to have access to both programs if they are to put together an affordable financial package. Last year Congress reauthorized the National Health Service Corps (NHSC) and significantly increased funding for the scholarship and loan repayment programs. This program is critical to assuring that the most underserved areas of the country have primary medical care services available. AACOM encourages the Subcommittee to provide $60,000,000 for the scholarship and loan repayment programs. This will allow NHSC to continue to respond to critical health problems, such as high rates of infant mortality, so prevalent in underserved areas. Several programs help meet the financial needs of disadvantaged and underrepresented minority students in health professions schools. The Disadvantaged Health Improvement Act of 1990 established a number of beneficial programs designed to encourage the participation of minority and disadvantaged students in the health professions. For example, the Scholarships for Disadvantaged Students (SDS) program, the Minority Faculty Loan Repayment Program and the Grants to Communities-Health Professions Scholarship Program are all excellent initiatives. These programs can benefit students at osteopathic medical colleges which have achieved a 100% increase in first year enrollment of underrepresented minorities over the last four years. AACOM urges that the SDS program receive $18 million in appropriations; the Minority Faculty Loan Repayment should be funded at $2 million; and AACOM recommends funding of $2.5 million for the Grants to Communities program. In addition to the programs under the Department of Health and Human Services, our students make extensive use of Department of Education loans and loan guarantees under the authority of the Higher Education AXCOM urges the Subcommittee's continued support for Stafford Student Loans, Supplemental Loans for Students (SLS) and the Perkins Program. These programs round out the base of financial #3#.#tance so necessary to osteopathic students. For example, 85% of students were recipients of Stafford Loans during the 1988-89 academic year. Fifty-five percent (55%) use SLS. AACOM asks the Subcommittee to recommend funding at the authorized levels. AXCOM understands the limits that the new budget law places on Congress. Within these constraints, AACOM urges the Subcommittee to maintain the availability of federal student assistance. This is a critical issue for osteopathic medical students this year. AACOM deeply appreciates the Subcommittee's continuing commitment to health professions education. STATEMENT OF THE DIVISION OF REHABILITATION PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION I very much appreciate this opportunity to provide a written statement to the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies. As a rehabilitation educator at the School of Industrial and Labor Relations at Cornell University, and the current president of the Division of Rehabilitation Psychology (22) of the American Psychological Association (APA). I would like to address the issue of funding for the National Institute on Disability and Rehabilitation Research in the Department of Education. The Division of Rehabilitation Psychology was established in 1956 as an organization of psychologists concerned with the psychological and social consequences of disability and with ways to prevent and resolve problems stemming from disability. The Division currently has over one thousand members, and is part of the American Psychological Association, which is an International association of over 108,000 members and affiliates around the world, working to advance psychology as a science, a profession, and a means to promote human welfare. The National Institute on Disability and Rehabilitation Research (NIDPR) has played an important role in addressing the need for research on psychosocial issues in rehabilitation. The report of the Task Force on Medical Rehabilitation Research (1990) emphasizes the fact that in the United Stated today, disability has become a major problem because of an unbalanced approach to medical research and practice. As a society, we spare no expense on research and technology to save lives, but are reluctant to provide the necessary resources to address the physical, emotional, and socioeconomic problems that accompany the survival of persons with disabilities. NIDRR plays an important role in addressing this Imbalance, particularly through its commitment to funding applied research. With the creation of the new Center for Medical Rehabilitation Research within the National Institutes of Health (NIH) meeting the need for medically oriented, clinical rehabilitation research, NIDRR can continue to give priority to research that addresses the psychosocial and vocational needs of persons with disabilities, and the identification of the types of systems and services that will best meet those needs. While NIDRR has a record of supporting research on the psychosocial aspects of disability and rehabilitation, we believe that full Implementation of the Americans with Disabilities Act will require an even better understanding of the attitudinal and environmental barriers that Impede the full Integration of persons with disabilities in our society, particularly in employment settings. NIDRR currently does have a role to play in assisting in the Implementation of the ADA, through the administration of funds allocated for Technical Assistance Centers and the development of Information for persons with rights and responsibilities under the Act. However, we believe that NIDRR could make an even larger contribution in assuring the Implementation of the ADA if it was given additional resources for research and technical assistance. If the ADA IS to be effectively implemented without undue costly litigation, it is |