HEALTH RESOURCES AND SERVICES ADMINISTRATION STATEMENT OF ROBERT HARMON Dr. HARMON. Thank you, Mr. Chairman. This is my second week on the job and as I left Missouri, where I was the State Health Director, I received a number of plaques and so forth. I told my colleagues: These plaques are fine; what I would really like is a house in Bethesda. [Laughter.] I do bring the State and local perspective. I also was a local health officer in Arizona previously, and I will be working closely with Dr. Mason and Dr. Sullivan to improve the working relationship of the Federal Government with the States and the localities. The 1991 budget for HRSA continues the agency's preeminent role in providing health care and education to the underserved, the disadvantaged, and minorities. This budget of $1.6 billion will meet our commitments through community and migrant health centers, maternal and child health block grant, treatment programs for persons with black lung, Hansen's disease, AIDS, and other conditions, support for health professions students and institutions, and a wide variety of other activities dealing with organ transplantation, vaccine injury compensation, health care services for the homeless, and the initiative to reduce infant mortality. I would like to direct your attention briefly to several new or expanded activities that we will be undertaking. We are seeking $107 million for the new minority health initiative, which includes expanded and revitalized programs on loan repayments and scholarships for service in underserved areas, a program to provide a full range of health care and social services in our public housing units, community-based recruitment of minorities and disadvantaged into health professions careers, and institutional support and faculty development to sustain minority enrollment levels at health professions schools. We are proposing $25 million as an increase in the MCH block grant for the one-stop shopping approach to provide health care, financial assistance, social services, and other community support to pregnant women and to children. We are also expanding the infant mortality prevention project in community health centers, at $4 million. We will continue HRSA's strong involvement in fighting the AIDS epidemic through grants in areas with a high incidence of AIDS, pediatric service demonstration projects, education and training centers to instruct health care providers in better AIDS treatment, grants to community and migrant health centers for treatment of HIV-infected persons, and renovation grants for facilities to deliver better intermediate and long-term care. PREPARED STATEMENT We will focus our health professions support on programs designed to assist the minority and disadvantaged students as a top priority. In 1991 HRSA will address many opportunities and numerous challenges. I believe the budget we are presenting to you will enable us to take advantage and meet those challenges. Thank you. [The statement follows:] STATEMENT OF DR. ROBERT HARMON I am pleased to appear before you today to discuss the fiscal year 1991 budget request for the Health Resources and Services Administration (HRSA). HRSA's clients are: 0 0 mothers and children, the homeless, the poor and disadvantaged, minorities, the medically underserved, migrant workers, health professions students, persons with AIDS, chronic lung disease and Hansen's those in need of organ transplants, those who are too sick to leave their homes. HRSA programs span a wide range of activities. They: provide grants or support for personal health services to numerous special populations, aid in improving the education, supply, distribution, and quality of the Nation's health professionals; and provide technical assistance to enhance the utilization of the nation's health resources and facilities to support these efforts. In fiscal year 1991, we are requesting approximately $1.6 billion and 1,528 full-time-equivalent 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. Since 1982, when the HRSA was formed, its mission has continued to rapidly adapt to a changing environment. While our agency's essential focus has remained ensuring health services to persons who might not otherwise receive care, the agency has developed new and innovative approaches to providing that care. At the same time HRSA has accepted responsibility for new programs addressing current public health needs. Community Health Centers The FY 1991 request includes $438 million to continue support of approximately 550 grantees providing primary health care services to over 5 million medically underserved people. These underserved individuals include those without access to care because they lack insurance, live in communities without sufficient health resources, have health concerns not met by traditional medical care, or face other barriers to care. The request also includes funding to improve compensation packages for center physicians. Migrant Health Centers The FY 1991 request for Migrant Health Centers includes $48 million for the continued support of services to migrant and seasonal farmworkers and their families. Access to health care for this group is very difficult to achieve because of the lifestyle, language, culture, and economic status of most migrant and seasonal farmworkers. Services to approximately 500,000 individuals will be supported. The request also includes funds for improving the compensation for center physicians. Infant Mortality In 1991 we are expanding the Infant Mortality Prevention Initiative to $36 million, an increase of $4 million above the 1990 appropriation. This request will support an additional 22 community and migrant health centers to provide case managed services to 75,000 high-risk pregnant women. It also will expand overall perinatal capacity in community and migrant health centers to approximately 190,000 pregnant women per year. This will be accomplished through a proven case-managed, comprehensive approach that will focus on the coordination of appropriate services throughout the high risk mother's child bearing years. Minority Health Initiative The FY 1991 budget includes $107 million to launch a Minority Health Initiative. This initiative is made up of several programs designed to increase the number of minority health professionals and to reduce the health disparities between minority populations and nonminority populations as outlined in the 1986 Report of the Secretary's Task Force on Black and Minority Health. These programs are designed to increase the number of health practitioners serving minority/disadvantaged populations. Key components include: the revitalized NHSC loan repayment/scholarship program a new program, Health Services in underserved The Health Professions Institutional Development program ($12 million), providing funds for faculty development and general institutional support to maintain minority enrollment levels, and Community Based Recruitment ($5 million), to support Maternal and Child Health The Maternal and Child Health block grant allocates funds to States to provide a wide range of health services to mothers and children, including preventive and primary care and rehabilitative services which help alleviate infant mortality problems and provide better access to health care. Our 1991 request is for $579 million, an increase of $25 million above the 1990 current estimate. The request includes: 0 0 $471 million for State Block grants, $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, and $25 million for One-Stop shopping to improve the delivery of health care services for pregnant women and infants. National Health Service Corps The National Health Service Corps program is designed to improve the capacity to provide health services in Health Manpower Shortage Areas (HMSA) and improve access to health care in these areas through the placement and support of health professionals. This program, and the related recruitment effort play a critical role in the attempt to reduce physician shortages in the most difficult to staff areas throughout the country. The budget request of $42 million will continue the program at approximately the 1990 level. National Health Service Corps Recruitment The budget request for NHSC recruitment is $64 million to support scholarships and loan repayments to health professionals and health professions students in exchange for service in a HMSA. The request includes an increase of $55 million associated with the Minority Health Initiative to support scholarships and loan repayments for disadvantaged and minority students. Homeless The 1991 budget provides $34 million in new budget authority for a total program level of $46 million 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 335,000 homeless individuals in approximately 92 health care for the homeless programs. 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 fiscal year 1990 the cumulative Federal investment in Health Professions will total nearly $9 billion. This investment has increased the supply of health professionals. Also, beginning in the late 1970's and through the 1980's, it has addressed more targeted objectives such as primary care, disadvantaged assistance, and improvement in advanced and specialized nurse training. In recognition of these successes in programs the Administration proposes to shift the emphasis from health professions training to other targeted HRSA priorities such as reducing infant mortality, increasing the number of minority health professionals, providing health services to underserved populations, and supporting AIDS HIV programs. HRSA will continue to administer the health professions and nursing revolving loan funds which will make available approximately $86 million for loans to about 32,500 students. The budget also includes $185 million in loan guarantee authority for the HEAL program to begin a phase-down. In addition, the FY 1991 request continues funding for Exceptional Financial Need scholarships, Excellence in Minority Health, and the Disadvantaged Assistance programs which were included in President Bush's amended budget. National Practitioner Data Bank The President's FY 1991 Budget proposes to enhance the collection of user fees to cover the full cost of operations of the National Practitioner Data Bank. User fees collected in 1991 will fund the remaining cost of the first phase of the contract and to begin to implement Section V of P.L. 100-93, which will add other health professions to the databank. A primary objective for FY 1991 is to develop a system to monitor and assess compliance with the reporting requirements of the law and to report instances of noncompliance to the Secretary and to the Office of the Inspector General for field investigations. 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. Also, fewer organs are being shipped overseas and, as a result, more U.S. residents, nation-wide, are receiving transplants. The 1991 budget request includes $3 million to continue support of the Network as well as the Scientific Registry used to track the scientific and clinical status of organ recipients. In additions, the request includes funds to continue support of the agency's Organ Transplantation staff. 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. Funding to provide technical assistance for hospitals in fiscal trouble is also included. AIDS HRSA AIDS/HIV activities continue to be an important part of the battle to control this dreaded disease. In 1991, HRSA is asking for a total of $73 million for AIDS projects. The funds will be used as follows: |