3. 4. 5. 6. 7. 8. 9. There must be a documented non-availability of health care There must be an effective community based organization either existent or in development which demonstrates the capacity to meet the needs of the unserved, underserved, and/or minority populations. There is documented information that active recruitment efforts have been undertaken and have failed. There is documentation that the lack of placement at the site will have a significant negative impact on the delivery capacity of the total system of care, including consideration of loss of services and/or possible site closure if the position is not filled. There is a documented record of sound fiscal management of the applicant. There is general community support of the placement of NHSC There is documentation that the NHSC member will be located so that the member will provide services to the greatest number of unserved, underserved, and/or minority persons residing in such area. Sites which meet these criteria are most likely to be included on the HPOL and be assigned a NHSC physician. Question. Is the NHSC aware of some of the special problems facing frontier areas in rural New Mexico and other parts of the country? Can any special effort be made for facilities that are the only health facility in such a large geographic area? Answer. The program uses the criteria just described in selecting the sites for which it will recruit. If the areas to which you refer meet those criteria, it is likely that appropriately operated sites would be included on the HPOL. HEALTH CARE FOR THE HOMELESS Question. Your justification request indicates that the FY 1991 Budget request for health care for the homeless of $33.7 million will fund 92 projects for 9 months. funding for the first quarter of FY 1992. You have requested no Does the budget assume sufficient funding in FY 1992 to fund all 92 of these projects at the 1991 level or more? Answer. The President's FY 1992 budget request has not yet been developed. Question. What is the specific funding assumption for FY 1992 in this Budget? Answer. There is no funding assumption for fiscal year 1992 since the President's fiscal year 1992 request has not been developed. Question. Will 9 month grants be necessary as a result of this request? Will this disrupt operations of the health care for the homeless projects? Answer. In December 1989 awards were made for the period January 1 through September 30, 1990. On October 1, 1990, supplemental awards will be made for the period October 1 through December 31. At the end of December, new awards will be made for the period January 1 through September 30, 1991. SUBCOMMITTEE RECESS Senator HARKIN. Thank you very much. The subcommittee will stand in recess until 10 a.m., Tuesday, February 20, when we will meet in SD-138 to hear from the National Institutes of Health under the jurisdiction of the subcommittee. [Whereupon, at 12:36 p.m., Friday, February 9, the subcommittee was recessed, to reconvene at 10 a.m., Tuesday, February 20.] DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION AND RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 1991 TUESDAY, FEBRUARY 20, 1990 SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS, U.S. SENATE, Washington, DC. The subcommittee met, at 10 a.m., in room SD-138, Dirksen Senate Office Building, Hon. Tom Harkin (chairman) presiding. Present: Senators Harkin, Bumpers, and Specter. DEPARTMENT OF HEALTH AND HUMAN SERVICES NATIONAL INSTITUTES OF HEALTH STATEMENT OF WILLIAM F. RAUB, ACTING DIRECTOR ACCOMPANIED BY: KATHERINE L. BICK, DEPUTY DIRECTOR FOR EXTRAMURAL RESEARCH JOHN D. MAHONEY, ASSOCIATE DIRECTOR FOR ADMINISTRATION NORMAN D. MANSFIELD, ASSOCIATE DIRECTOR FOR RESEARCH SERVICES LEAMON M. LEE, DIRECTOR, DIVISION OF FINANCIAL MANAGEMENT ANTHONY S. FAUCI, ASSOCIATE DIRECTOR FOR AIDS RESEARCH DENNIS WILLIAMS, OFFICE OF THE SECRETARY, DEPARTMENT OF HEALTH AND HUMAN SERVICES BUDGET REQUEST Senator HARKIN. Good morning. The Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies will come to order. This morning and in our session this afternoon the committee will consider the fiscal year 1991 budget request to the National Institutes of Health of $7.93 billion, which is $354 million or 4.7 percent over last year's level. I have been told the biomedical inflation rate is projected to be approximately 5.8 percent. In other words, the administration's budget request for NIH does not keep up with inflation. And I am sure this committee will want to make every effort to at least ensure that the NIH funding keeps pace with inflation-I say that at least at a minimum. This budget proposal does, however, include a number of features that do deserve support. I was pleased to see that the total number of research project grants of 20,439 and new grants totaling 5,095 were both increased in fiscal year 1991 over the levels that existed last year. Every meeting I have, Dr. Raub, with the biomedical research community includes a discussion of the declining percentages of the approved grants that are funded. I understand that the 1989 level was 29.4 percent. It is estimated to decrease to 24.2 percent in 1990. I was pleased to see in the budget request, however, that the estimated percentage of approved grants that will be funded in the President's budget would increase to 25 percent. We would all like to see a higher percentage of approved grants being funded each year. It is, therefore, good news to see the percentage move up in fiscal year 1991. I should note, however, that there appears to be a number of underlying factors completely within the control of NIH that resulted in the decline in the number of approved grants that are funded. One such factor-and some of these I want to cover in the questions and answers and you might want to address them in your statement-is the approval rate for grant applications. In 1989 NIH approved 95 percent of the grant proposals that were submitted. These approved grants were indicated to be meritorious and worthy of funding. That is in 1989, 95 percent. In fiscal year 1982 only 85 percent of the grant proposals submitted were approved. I would like to know why is this happening. As NIH chooses to approve an ever-increasing percentage of grants, it only follows that a smaller percentage will be funded. Another factor that contributed to the decline in the percentage of funded approved grants is that NIH lengthened the time period for grant funding. In 1989 the average length of the grant was 4.2 years. In 1981 it was 3.3 years. Again, I would like to know why this is also happening. Again, I am not necessarily quarreling with either one of these trends, but I just need to understand them. And I think members of the committee need to understand why this is happening. Needless to say, we could overcome these trends with large increases of funds every year and that may be your response. And each year we do try to provide additional funding. I would point out that the NIH budget has doubled since 1980, happening during a time when discretionary spending has essentially been flat in other programs under this subcommittee's jurisdiction. Since I entered Congress in 1974, the NIH budget has increased from $1.9 billion to $7.9 billion. So I think this indicates that Congress and the American people do have confidence and respect for the outstanding and important work of the National Institutes of Health. Today we will hear about the biomedical research challenges and opportunities that we face from all of the different Institutes' cen ters. And Dr. Raub, I would, in just closing my remarks, like to say a few words to you personally. Since last August when you were |