STATEMENT OF DR. ROBERT G. HARMON Mr. Chairman and Members of the Committee: I am pleased to appear before you today to discuss the fiscal year (FY) 1992 budget request for the Health Resources and Services Administration (HRSA). HRSA's clients are the disadvantaged, the underserved, minorities, poor mothers and children, the homeless, migrant workers. We also serve health professions students, persons with AIDS and HIV infection, those in need of organ transplants, those who are too sick to leave their homes. combat infant mortality; provide health services to the underserved; support community, migrant, and homeless health centers and quality of the Nation's health professionals; help care for persons with HIV and AIDS Since HRSA's inception in 1982, its mission has continued to rapidly adapt to a changing environment. While our agency has continued to focus on assuring primary health care services to the underserved it has developed new and innovative approaches to providing that care. At the same time, HRSA has accepted responsibility for new programs to meet pressing public health needs. In FY 1992, we are requesting over $2 billion and 1,430 full-timeequivalent positions. Our partners in this effort are State and local health departments, universities, private non-profit organizations, and many other participants in our nation's public health system. Project Healthy Start The infant mortality rate in this country remains far too high, especially among minorities. Currently, 40,000 American babies die every year before their first birthday. To address this problem, our request includes a total of $171 million for high incidence areas to be devoted to aggressive outreach and counselling of pregnant women to be followed by intervention services - smoking cessation, drug and alcohol abuse treatment, nutritional assistance and quality prenatal care to achieve improved pregnancy outcomes. Through these services and utilizing the recent Medicaid expansions, our goal is to reduce, by 50 percent, the infant mortality rate in these areas over five years. Community Health Centers The FY 1992 request includes $478 million to continue support of approximately 530 community health centers providing primary health care services to over 5.5 million medically underserved people. These underserved individuals include those without access to care because they lack insurance, live in communities without sufficient health delivery capacity, have health concerns not met by traditional medical care, or face other barriers to care. In 1991, we are proposing increased funding levels over the FY 1990 appropriation be directed to ten areas with the highest rates of infant mortality. The request also includes funding for the case management initiative providing a comprehensive approach to perinatal care designed to reduce infant mortality. Migrant Health Centers The FY 1992 request for Migrant Health Centers includes $52 million to continue support of services to migrant and seasonal farmworkers and their families. Access to health care for this group is difficult because of lifestyle, language, culture, and economic barriers. Services will be provided to approximately 500,000 individuals. Minority Health Assistance The FY 1992 budget includes $88 million to continue the Minority Health Programs authorized in the "Disadvantaged Minority Health Improvement Act." These programs are designed to increase the number of minority health professionals and to reduce the health disparities between minorities and the non-minority population as outlined in the 1986 Report of the Secretary's Task Force on Black and Minority Health. These programs include: Exceptional Financial Need Program ($17 million), providing nonservice conditional scholarship aid to disadvantaged students. This level of funding also includes the Financial Assistance for Disadvantaged Health Professions Student program. This level of funding will provide scholarships to approximately 2,700 students. Health Careers Opportunity Program ($26 million), Excellence in Minority Health Program ($12 million), this effort. Minority Health Education programs ($28 million), nursing education opportunities for individuals from Maternal and Child Health The Maternal and Child Health Block Grant Program allocates funds to States to provide a wide range of health services to mothers, infants and children, particularly those with low income or limited availability of health services, including preventive and primary care and rehabilitative services which help alleviate infant mortality problems and provide better access to health care. The 1992 request of $554 million is the same as the 1991 current estimate. The request includes: $471 million for State Block grants; and $83 million for special projects of regional and national significance (SPRANS) in the categories of research, training, hemophilia, genetic diseases, and maternal and child health improvement. The FY 1992 request includes $9 million of SPRANS set-aside to be directed to the Targeted Infant Mortality Initiative. National Health Service Corps (NHSC) The NHSC program is designed to improve the capacity to provide health services in Health Professional Shortage Areas (HPSAs) and improve access to health care in these areas through the placement and support of health professionals. The NHSC, and the related recruitment effort, play a critical role in the attempt to reduce shortages of physicians and other primary care providers such as nurse practitioners and midwives and physicians assistants in the most difficult to staff areas throughout the country. The budget request of $42 million will continue the program at approximately the 1991 level. It will support a field strength of 1,030. National Health Service Corps Recruitment The FY 1992 budget request of $54 million for NHSC recruitment includes an increase of $5 million above the FY 1991 level to support 495 new scholarships and 285 federal loan repayments to health professionals and health professions students and increase the supply of obligated health practitioners in exchange for service in a HPSA. This will also support 30 State loan repayment agreements. Homeless The FY 1992 budget request of $63 million, includes an increase of $12 million above the FY 1991 level for health care to the homeless. This request will support a broad range of primary care, alcohol and substance abuse, and mental health services to approximately 420,000 homeless individuals in approximately 130 centers. This is an increase from 350,000 individuals and 109 centers in FY 1991. Emphasis will be placed on providing preventive as well as curative services to a broad sector of the homeless including runaway adolescents, homeless pregnant women and children, and individuals with chronic substance abuse and mental health problems. Grants will be made to applicants demonstrating broad community participation and linkages with other community providers of critical support needs of the homeless and effective and efficient provision of care. Health Professions At the end of FY 1991 the cumulative Federal investment in Health Professions totaled nearly $9 billion and has increased the supply of health professionals. Beginning in the late 1970's and through the 1980's, more targeted objectives such as primary care, disadvantaged assistance, and improvement in advanced and specialized nurse training have been our priorities. In recognition of these successes, the Administration proposes to shift the emphasis from broad-based health professions training to other targeted HRSA priorities which target minorities and underserved populations such as reducing infant mortality, increasing the number of minority health professionals, providing health services to underserved populations, and supporting AIDS HIV programs. National Practitioner Data Bank The FY 1992 Budget request proposes to expand the collection of user fees to cover the full cost of operations of the National Practitioner Data Bank. User fees collected in 1992 will fund the operating costs of receipt, storage and dissemination of information on medical malpractice sanctions taken against physicians and dentists. The total cost of operating the Data Bank is expected to be approximately $5 million in FY 1992. Organ Transplantation We believe that the allocation of organs for transplantation is more fair and equitable since the establishment of the national Organ Procurement and Transplantation Network. For example, the number of organs procured but not transplanted has decreased markedly from 10 percent in 1985 to 5 percent in 1989. Also, fewer organs are being shipped overseas and, as a result, more U.S. residents, nation-wide, are receiving transplants. The 1992 budget request includes $3 million to continue support of the Network as well as the Scientific Registry, which is used to track the scientific and clinical status of organ recipients. In addition, the request includes funds to continue support of the agency's Organ Transplantation staff and funds for grants and contacts to improve organ donation, especially among minorities. Rural Health The budget request includes $4 million for the Office of Rural Health Policy to fund a total of seven Rural Health Policy/Research Centers. These centers will provide an information base and a policy research capability on a wide range of rural health concerns including access to care, financing systems, alternative delivery systems, and occupational health issues. The request provides funding for a national rural health information center and to staff the National Advisory Committee on Rural Health. AIDS This budget continues programs authorized by the Ryan White Comprehensive AIDS Resources Emergency Act of 1990. The funds will be used as follows: $88 million for HIV Emergency Relief Grants providing $88 million for HIV Care Grants providing grants to all In addition, HRSA is requesting categorical funding of the following programs: $17 million for Education and Training Centers to continue 16 projects providing training of health care personnel who care for AIDS patients; $20 million to fund approximately 43 projects for Pediatric AIDS Health Care Demonstration Grants which demonstrate strategies and innovative models of intervention in pediatric AIDS; and $4 million for AIDS Facilities Renovation providing grants for the renovation or construction of non-acute care intermediate and long term care facilities for patient with AIDS. Vaccine Injury Compensation Program The National Childhood Vaccine Injury Act of 1986 established a program to provide compensation for vaccine-related injury or death. The HRSA maintains the fiscal records of the claims trust fund, provides medical advice to the court, and pays claims. The FY 1992 budget request of such sums as necessary for the post 1988 claims is estimated at $87 million, and $2 million is requested for administrative costs. No funds are requested for payment of the pre-1988 claims. Due to the high influx of petitions received, and preliminary budget estimates which far exceed the original design of the program, the Administration is currently looking into policy options for handling the payment of pre-1988 claims. Conclusion In conclusion, I can assure the members of the committee that we at HRSA see the coming year as one with many opportunities and numerous |