Question. It is my understanding that ESL classes for eligible legalized aliens are generally filled to capacity. Please provide a detailed state by State justification of the Administration's contention that costs for English language and citizenship instruction are much lower than expected.

Answer. It is the Department's evaluation that when the legalization program has been completed, States are expected to have spent less than $300 million on required educational classes, roughly 12 percent of past and proposed grants to States. About 1 million of the ELA's would need the 60 required hours of instruction. The average rates States charge for instruction is below $5 per hour. From this, we estimate States will spend approximately $300 for required educational classes.

Question. Public Law 101-238 authorizes two additional uses of SLIAG funds -- for outreach activities and to prevent employment discrimination. Does the Administration anticipate an increase in costs billed as a result of this change in the authorizing statute?

Answer. The amount of SLIAG funds that may be used for these activities ranges between $2.4 million to $3.5 million in total. The use of SLIAG funds for each of these purposes is limited to 1 percent of each State allotment for years subsequent to FY 1988 or $100,000, whichever is greater.

Question. Did the Administration consider these additional activities in calculating its FY91 SLIAG request?

Answer. The Administration request would give States enough funds to double FY 89 spending levels for fiscal years 1990, 1991, and 1992.

QUESTIONS SUBMITTED BY SENATOR FRANK

LAUTENBERG

SMOKING

Question. Do you support minimum age laws at the state level for the sale of tobacco products to minors?

Answer. Cigarette smoking is the leading cause of preventable death and yet the extent of its availability is appallingly great. For those 44 States that have banned the sale of tobacco products to minors, I commend them. I encourage all States and localities to enforce existing laws and to adopt stricter laws where necessary.

Question. Do you agree that the Federal government should encourage States without these laws to enact them?

Answer. In view of the lethal nature of tobacco and its easy accessibility to our youth, I encourage States to adopt and enforce strong laws against the sale and promotion of tobacco products to minors.

Question. Do you agree that 18 is a reasonable minimum age for States to enact?

I

Answer. The Federal government has historically deferred to the States to establish the age of majority and associated privileges. To a great extent, this limits Federal action. believe, morally, that it is simply wrong to promote a product which, when used exactly as intended, causes death. especially reprehensible to lure young prople into smoking and It is nicotine addiction or to facilitate their purchase of tobacco products. Therefore, I think it is important to continue to encourage States and localities to enforce existing laws and to adopt stricter laws where necessary.

Question. Do you agree that the Federal government could be more helpful in helping States enforce minimum age laws?

Answer.

I believe we must continue to encourage States to establish and vigorously enforce minors from the harmful effects of smoking. For my part, I policies to protect intend to use existing authorities and the influence of my office to continuously raise the issue of tobacco use and its adverse health effects. can assist in the dissuasion of cigarette smoking, for example, I also believe that the private sector by writing letters to tobacco retailers, requesting that they take aggressive action to prevent the illegal sale of tobacco to minors.

Question.

What is your position on vending machine sales of tobacco products?

Answer. Bearing in mind that tobacco, itself, is a lethal product, I applaud actions by the States, such as Utah, Idaho, Maine, Alaska and New Hampshire which have restricted cigarette vending machine sales to locations inaccessible to minors. The town of White Bear Lake, Minnesota, has even gone so far as to ban cigarette vending machines entirely. I commend these jurisdictions for their leadership and urge others to take similar action.

Question. Should we permit tobacco products to be sold in vending machines?

Answer. To permit tobacco to be sold in unsupervised vending machines, or to send tobacco products through the mail, or to pass-out tobacco products freely without regard to age is most questionable, and such policies should be reviewed. After all, alcoholic beverages are not sold through vending machines.

Question. Do you agree that restrictions on vending machines are necessary in order for minimum age laws to be adequately enforced?

Answer. The availability of tobacco products to our youth is too easy and I think that strong action should be taken to prevent it. I encourage States to adopt and enforce strong laws against selling and promoting tobacco to minors.

Question. Do you agree that limiting vending machine sales of tobacco products to places where minors are not permitted would be one effective way of limiting youth access to tobacco products?

Answer. I believe these actions make sense given that many cigarette vending machines are easily accessible to minors and allow circumvention of the laws that exist in 44 States banning the sale of tobacco products to minors.

Question. Do you support efforts at the state level

which require schools to be smoke-free?

Answer. We need to promote a tobacco-free environment everywhere. This is particularly true in places predominantly occupied by our children in day care and schools so that they are not exposed to smoke-enclosed rooms nor to role models who use tobacco.

Question. Do you think the Federal government has a role to play in encouraging States to enact and enforce laws requiring that schools be smoke-free?

Answer. I think we need to prevent those actions in our society that influence children and young adults into starting to use tobacco. Protecting our young population is the responsibility of both the public and private sectors. To this end, I believe, strategies that help to establish and enforce policies to protect our minors from the lethal perils of smoking need to be encouraged.

Question. Do you think teachers should be able to smoke in schools?

Answer. Developing and implementing a successful

nationwide anti-smoking strategy demands the participation and commitment of each of us. To get this message to our children, we must be consistent in our delivery of the message. We must de-glamorize tobacco use, minimize its social acceptability, underscore its lethal potential and lessen the exposure/visibility of role models who use tobacco.

AIDS HEALTH CARE

Question. What is the Department of Health and Human Services doing to address the high cost of AIDS care in cities like Newark and Jersey City?

The

Answer. With regard to HHS financing of direct health care for AIDS patients, the Federal Medicaid and Medicare programs are involved in paying for AIDS treatment where the patients qualify based on need. Nationally, about 40% of all AIDS patients have their care paid for through Medicaid. estimated $870 million in total Federal Medicaid payments in 1991, plus the approximately $870 million in State matching funds, are expected to account for nearly 25% of total national AIDS medical costs. Many private insurers and all State Medicaid programs now include coverage for some HIV treatment drugs, such as AZT.

New Jersey was also the first State to apply for and be granted a Medicaid Home and Community Based Waiver to allow reimbursement for home treatment services to beneficiaries with AIDS and AIDS-related complex. Under this waiver, which became effective March 1, 1987, New Jersey is allowed to provide case management, personal care, medical day care, narcotic and drug abuse treatment, private duty nursing care, and intensive foster care to these beneficiaries. Through this waiver, New Jersey expects to be able to treat qualifying AIDS patients more humanely and at less cost than would be the case under standard Medicaid coverage for institutional services.

For the longer term, two principal efforts of HHS to address the high cost of AIDS care in States such as New Jersey are through research and prevention. Ultimately, finding treatments and vaccines against AIDS, and supporting information and education activities to prevent the spread of AIDS by changing high risk behaviors, will be the best defense against the high cost of AIDS care. In total, the Public Health Service (PHS) expects to spend almost $1.7 billion on AIDS/HIV research and prevention activities in 1991, an increase of $109 million, or +7%, over expected 1990 spending, and $395 million over 1989. AIDS/HIV prevention/education and surveillance projects supported by the Centers for Disease Control (CDC) in the State of New Jersey totaled about $8.2 million in 1989. This included, as examples, an AIDS education project with the Boys' and Girls' Club of Newark, which was provided about $109,000; a study with the City of Newark on the prevalence of tuberculosis among deceased intravenous drug users who were HIV-positive compared to those without HIV infection was funded for about $213,000; an AIDS prevention project with Planned Parenthood of Essex County was provided about $175,000; and information/ education projects with the Newark school system was provided about $180,000.

SUBCOMMITTEE RECESS

Senator HARKIN. Thank you very much. The subcommittee will stand in recess until 1:15 p.m. At that time we will hear from the Family Support Administration, the Office of Human Development Services, the HHS Inspector General, the Health Care Financing Administration, and the Social Security Administration.

[Whereupon, at 12:30 p.m., Wednesday, February 7, the subcommittee was recessed, to reconvene at 1:15 p.m., the same day.]