National Health Service Corps program. However, the budget also eliminates most of the funding for the health professions program.

HEALTH PROFESSIONS PROGRAMS

Last week I met with hospital administrators from North Dakota who face a significant nursing shortage. I am also told that we have a shortage of mental health care providers throughout the State. North Dakota health professions programs are heavily dependent on Federal funds because of the State's severe economic problems.

In light of these shortages how can we severely cut health programs in the 1991 budget?

Secretary SULLIVAN. Thank you, Senator Burdick. There are a number of things that we are doing to address this problem. While we have indeed reduced the funding overall for health professions programs, the funds that we have in our budget which I believe are around $76 million are focusing on training primary care health professionals as well as addressing the problem of nursing short

age.

The Nursing Commission submitted its report to my office in December 1988. I appointed a committee headed up by Dr. Marie Henry, who is the senior public health official in charge of nursing programs to address and implement a number of the recommendations included in the report.

Some of the recommendations pertained to increasing the professionalism of nursing, improving working conditions, reducing nonnursing responsibilities, seeing that nurses were represented at a high level in the hospital administrative structure, and addressing the problem of salaries for nurses.

We are working diligently to implement these recommendations of the Nursing Commission's report, and I am confident that we will see some positive results.

One other thing regarding rural health, our budget includes an increase in National Health Service Corps funding of $63.9 million for scholarships and loans to individuals who will be targeted for both rural areas and inner cities.

Senator BURDICK. Mr. Secretary, we will look at this next year when you come up and see what progress has been made.

Some officials in my home State have encouraged me to oppose Medicare expansion. They say they cannot afford to pay for more services given their current budget restraints.

Would you tell the committee what you think of the Oregon Medicaid initiative or similar proposals that give the States the flexibility to prioritize certain Medicaid services.

Secretary SULLIVAN. Senator Burdick, we are following the Oregon program with great interest to see how that works. This is an effort to tackle a very difficult problem, and that is given limited resources, how the dollars are best spent. We are watching Oregon to see if this is, first of all, accepted by their citizens; that is, to provide the limited dollars for more primary care, including immunizations as well as not providing funds for transplantation. That represents a very serious issue that involves a number of ethical and other considerations.

We cannot comment beyond that other than to say we are very much aware of it, and we are following it with great interest.

Senator BURDICK. I understand the administration's budget for the National Health Service Corps would cover assistance for 750 students. Do you know how many underserved areas currently have vacancies and if it is significantly more than 750, why the administration is not giving this program higher priority? 750 seems very, very small to me.

Secretary SULLIVAN. Senator Burdick, we agree that there are a number of health priorities that we are trying to address. While we may not have an optimal response to this, is we have turned this issue around, and we do have increased funding for this year.

With the budget we propose for fiscal 1991, we would be increasing the total field strength to around 2,200. We are encouraging the use of other health professionals such as nurse practitioners and physicians' assistants as part of the overall health care team. Nurse midwives can also provide very valuable services in a number of instances.

Senator BURDICK. Agricultural safety is a top concern in North Dakota and other rural States. Last year Congress included report language instructing the Office of Rural Health to focus on agricultural and safety health issues. Do you know if this effort is underway and if so, how is the effort being coordinated with the USDA? Secretary SULLIVAN. Yes, Senator Burdick. Through the Centers for Disease Control we are devoting $12.3 million for farm safety because that is an important part of maintaining the health for rural citizens.

LOW-INCOME HOME ENERGY ASSISTANCE

Senator BURDICK. I am very concerned about the administration's proposal to cut the low-income home energy assistance program, better known as LIHEAP by nearly 25 percent next year.

I receive a great many letters, mainly from senior citizens, about the importance of LIHEAP and the difference it has made in their lives. Where the winter temperatures can be 20 or 30° below zerothat is real temperature-not a wind chill, LIHEAP can literally mean the difference between life and death. I assure you that North Dakotans cannot afford any cuts in LIHEAP. It should be increased at least enough to cover inflation. Instead you are here suggesting that we cut it by nearly one-fourth. Why?

Secretary SULLIVAN. Senator Burdick, this program was first implemented, during the oil shortage-during the years of the oil embargo-and that no longer exists. This was intended from the beginning to be a temporary program during that critical period.

Second, this is a program in which there are widely differing needs in different States and because of that, we feel that it is a program that should be focused more in the States-the demand is

so uneven.

This was never intended to be a permanent program of the Federal Government; it was enacted during the time of the oil embargo.

While the month of December was a cold month throughout the Nation and oil prices went up, the fact is now the oil prices as of a

few days ago were actually lower than on December 1. Those news stories that all of us saw in December no longer apply.

Senator BURDICK. I do not think you ever lived up there in the Northern States, have you?

Secretary SULLIVAN. No, but I have experienced 59° below zero with the wind chill, so I understand.

Senator BURDICK. Mr. Secretary, the administration again proposes to terminate the community services block grant program which received $389 million in the fiscal 1990 appropriation. As you know, these grants are made to States for community action agencies to run programs providing basic survival services to persons in need.

The plan, as you know, is to replace this nearly $390 million program with a single appropriation of $42 million in funds from the McKinney Homeless Assistance Program. Clearly we must fund programs to help the homeless, and I support this wholeheartedly. However, we must not pit one assistance program against another. We need all of them. We must not cut any of them. In seeking to cut out the funding for community service block grants the President is asking us to terminate the funding for the agencies that run 35 percent of the Head Start Programs for which he expresses such an affection.

I also found in your budget justification statement a suggestion that the assistance currently provided by community service block grants could be replaced by some other programs. One program which was mentioned was LIHEAP, the low-income home energy assistance program. Yet the same budget plans to cut one-fourth of LIHEAP's funds. Why does the administration repeatedly seek to terminate CSBG funds, knowing that the public wants this program and Congress wants it?

Secretary SULLIVAN. We believe that the purposes of the block grant program are being served in other areas of the budget, in LIHEAP, and the JOBS Program.

As I mentioned in my testimony, we are proposing full funding, at $1 billion, for the JOBS Program. This represents a significant funding increase and also the increase in our Head Start Program of $500 million that will help. Other Federal agencies, including the Small Business Administration, also help to address those needs as well.

Whereas we propose to eliminate these programs from the community services block grant, they are being served in other areas of our Department, as well as in other Departments. Some of our programs such as the JOBS, which I think was $463 million last year goes to $1 billion in our budget, and the Head Start Program goes from $1,386 million to $1,886 million.

Senator BURDICK. Thank you very much.

Senator HARKIN. Thank you. Senator Bumpers.

Senator BUMPERS. Thank you, Mr. Chairman.

Dr. Sullivan, welcome to-I guess your first appearance before this subcommittee.

Secretary SULLIVAN. Second.

Senator BUMPERS. I missed the first one.

Dr. Sullivan, who is Acting Director at NIH?

Secretary SULLIVAN. It is Dr. William Raub who is the Acting Director.

Senator BUMPERS. Are you on the committee to select the successor to Dr. Wyngaarden?

Secretary SULLIVAN. I am not on the search committee which I appointed, and will be making their recommendations to me.

Senator BUMPERS. Have you prescribed a litmus test that the new Director will have to pass, for example, on the abortion issue? Secretary SULLIVAN. No; Senator Bumpers, I did not. The search committee has a number of distinguished people from the private sector: Harold Amos, Ph.D., Harvard Medical School; Theodore Cooper, M.D., Upjohn Co.; James F. Dickson III, M.D., Boston University; James R. Gavin III, M.D., University of Oklahoma; Frederick C. Robbins, M.D., Case Western University; Richard S. Ross, M.D., Johns Hopkins University; Virginia V. Weldon, M.D., Monsanto Co., and others. I indicated to them that the primary criteria for the new director at NIH would be scientific excellence and administrative capabilities.

I further indicated to them that I had discussed this matter with the President and his chief of staff, and they support me in that position. I also made a public address on that issue in November of last year to the Association of American Medical Colleges where I related to them the fact that it was unfortunate that a low level individual in the White House personnel office, without my knowledge or concurrence, had made such an inquiry concerning abortion to an individual whose name had been submitted.

Senator BUMPERS. A person I would like to have seen head up NIH.

Secretary SULLIVAN. We had not submitted any names to the White House at that time.

Senator BUMPERS. You are sure that a litmus test on particular issues will not be given any applicants for the NIH Director's job? Secretary SULLIVAN. I cannot guarantee that, Senator Bumpers. Clearly this happened in an instance I had no knowledge or control over. I can guarantee you that this is not the primary criterion for that individual, and the statement that I gave to the Association of American Medical Colleges was reviewed by the White House, so I was speaking with their concurrence.

Senator BUMPERS. I accept that, and I thank you.

Senator HARKIN. Senator, are you through on this line of questioning?

Senator BUMPERS. No; go ahead if you like.

Senator HARKIN. I was going to get into that later on, but as long as you are on it, we might as well finish it.

You repeatedly say, Dr. Sullivan, that it is not the primary criterion. Is it even a criterion?

Secretary SULLIVAN. My position on that, Mr. Chairman, is those issues are not appropriate for the consideration of the Director of our premier biomedical research enterprise. Those decisions are more appropriately made at a policy level beyond that of the Director of NIH and, therefore, that question of abortion and other similar questions are not governing questions.

On any range of issues, we want to be sure that whoever is chosen, is someone who indeed can be an effective spokesman for our biomedical research. We would look at that individual's compatibility with our overall programs. On the issue of abortion is not criterion for the selection.

Senator HARKIN. Other matters you said relating to it, would that include fetal tissue research?

Secretary SULLIVAN. No; what I am referring to is we have a whole range of things that we are constantly dealing with such as how do we allocate the resources in our budget. There are always tensions and differences of perspective. What we need to have is someone who understands first of all not only the demands and needs of our biomedical research enterprise, but also how to work in a system where there are many competing demands.

Senator HARKIN. But the attitude of a prospective individual to be head of NIH, the attitude of that person toward fetal tissue research, you say is also not a criterion?

Secretary SULLIVAN. That is correct.

Senator HARKIN. Thank you, Dr. Sullivan.

Senator BUMPERS. Thank you, Mr. Chairman.

Dr. Sullivan, Stalin demanded philosophical and ideological tests of scientists and when the war started, he killed off all his best scientists.

Of course, I am not suggesting a parallel case here, but I am offended that candidates for a job which is probably the premier biomedical job in the country would be asked to pass a test on abortion.

I am not an ideolog on this issue, but I hope you will do everything you can to make certain that an abortion litmus test is not the test for this job. I may be dead wrong, but I frankly think that was one of the things that caused Dr. Wyngaarden to leave, and I thought he was doing a superb job.

On more mundane matters, have you seen the article in the New York Times Sunday magazine on the impact of drinking on the fetus-I believe the research was done at Emory University?

FETAL ALCOHOL SYNDROME

Secretary SULLIVAN. I did not see that particular article, Senator Bumpers, but I am very familiar with the problem of fetal alcohol syndrome and the resulting problems.

Senator BUMPERS. Of course we have all seen these horror segments on the news about crack babies, and it is a horrible thing. Of course the recent film from Romania of dozens of babies who have AIDS was heartbreaking.

Of course, we should be concerned about crack babies, but this article indicates that 2.7 percent of all the babies born in this country have learning disabilities as a result of fetal alcohol syndrome. I am just wondering if your Department, CDC, or any other agency, is trying to disseminate information on preventing fetal alcohol syndrome?

Here is a place where we are more likely to have great success with a limited amount of money. I would appreciate an update on

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