We question the administration's proposal to end Federal support for public health graduate education. Given the current Federal budget deficit, certain reductions in spending are justified, but to terminate programs that promote health and prevent disease only adds to that deficit. It is a commonly held belief that prevention saves both lives and money. PREPARED STATEMENT Thank you, Mr. Chairman, for the opportunity to testify. The deans of the 24 graduate schools of public health respectfully urge this committee to appropriate adequate fiscal year 1992 funds to support various title VII and title XVII authorities of primary concern to the U.S. academic public health community. Thank you. Senator BUMPERS. Thank you very much, Mr. Gemmell. [The statement follows:] STATEMENT OF MICHAEL K. GEMMELL Mr. Chairman, I am grateful for the opportunity to testify on contributions of academic public health towards promoting health, preventing disease, and cutting medical costs, and to present the association's position on the federal role in public health professional education assistance and prevention research. Every study and report, dating back to 1979, has warned of the shortages of public health professionals. Indeed, the heightened demand for graduate education in public health and contracted federal support, points to a deterioration in the quality of instruction or to cuts in enrollment at a time when more public health professionals are needed. Secretary Sullivan, in his March 1990 report on the status of U.S. health personnel, maintains that: Shortages of public and community health personnel currently Compounding the problem of shortages of public health Earlier, an HIIS advisory panel, the Graduate Medical Education National Advisory Commission (GMENAC), projected a shortage of some 1,500 less than the 3,550 public health and preventive medicine physicians needed in the 1990s. In 1988, the IIIIS Council on Graduate Medical Education observed: The field of preventive medicine includes public health, general According to the Institute of Medicine, the nation's public health system is in "disarray." In a study entitled, The Future of Public Health (1988), the 10M reported that public health activities in the U.S. have been taken for granted and that there is a need for well-trained public health professionals. The EPA's science advisory committce warns: "the corps of young people being trained in the environmental health sciences has been declining since the mid-1970s to a level where an insufficient supply will emerge to fill the needs of the Agency as its older tenured scientists reach retirement age or leave the Agency." It recommended that Congress could avoid a potential crisis by instituting a training grant program at the universities. State health officers are particularly alarmed about the low number of nurses trained at the graduate level in public health. The limited but vital federal support for public health training has been declining slowly since the early 1980s. Ever since 1958, the Congress has recognized that specialized "Seventh Report to the President and Congress on the Status of Health Personnel in the United States" (1990) by the U.S. Department of Health and Human Services (DHHS). training of public health professionals is a federal responsibility to be shared with universities with accredited schools of public health. The eleven schools of public health then and the 24 schools now are "essentially national schools", since students come from the 50 states, Puerto Rico and from the U.S. related territories. Graduates of these schools then and now (over 3,500 this year) serve primarily in public and non-profit sector. Over 80 percent of the graduates work in government agencies, universities or for non-profit health organizations. There is no other source of comprehensive training in organization, policy development and management of health services, prevention programs and promotion of health for whole population groups. These schools take on the characteristic of "service academies". In fact, the "West Point(s) of Health" was the term applied to the schools of public health in 1958 when President Eisenhower signed the Hill-Rhodes bill. In that bipartisan landmark legislation, the Congress recognized specialized training of professional public health leaders for public service as a federal responsibility to be shared with the schools. Indeed, it was noted that, had not the schools already existed as an essential federal resource, the health equivalent of a service academy would have had to be created. ASPI questions the Administration's proposal to end federal support for public health graduate education. Given the current federal budget deficit, certain reductions in spending are justified. But to terminate programs that promote health and prevent discasc (c.g., public health training), only adds to that deficit. It's a commonly held belief that prevention saves, both lives and moncy. Thank you, Mr. Chairman, for the opportunity to testify. The deans of the 24 graduate schools of public health (list attached) respectfully urge Congress to appropriate adequate FY92 funds to support various Title VII and Title XVIII authoritics of primary concern to the U.S. academic public health community: ATTACHMENT I ASPH REQUESTS FY92 APPROPRIATIONS FOR THE ADDRESS YEAR 2000 HEALTHI Shortages of public and community health personnel currently exist in the following specialties: epidemiologists, biostatisticians, several environmental and occupational health specialties, public health nutritionists, public health nurses, and physicians trained in public and preventive mcdicinc. Compounding the problem of shortages of public health personnel is that a declining number of physicians, scientists, and engineers are obtaining education in public health. These professionals are needed to address a wide variety of problems identified in Objectives for the Nation (DITIS, 1990). Physician epidemiologists are in particularly short supply. Engineers, toxicologists, chemists, and other scientists are needed to find solutions to numerous environmental health problems. Few nutritionists enter public health training, especially those pursuing doctoral education. Many public health problems are more severe in minority populations, yet few minority professionals choose careers in public health. Trained public health personnel are needed to address current major health problems and issues. Title XVII authorizes the CDC prevention centers grant program. It is designed to establish and maintain centers for the purpose of funding research designed to yield tangible results in health promotion and disease prevention. Prevention centers focus on outreach to state and local health departments and medical agencies to maximize the contribution to prevention and to increase the implementation of research findings. The public health training provisions in Title VII of PIIS act (the "Health Professions Reauthorization Act of 1988") expire September 30, 1991. ASPII urges re-authorization of traineeships to support graduate students that choose to enter careers deemed by the S Secretary in short supply, special projects for curriculum development in areas that address the Year 2000 Ilealth Objectives for the Nation and preventive medicine residences (PMRs) to support physicians entering the public health field. Title XVII of the PIIS act authorizes the creation of 13 centers for research and demonstration on health promotion and disease prevention to complement programs of the Centers for Disease Control and other federal initiatives in health promotion and disease prevention. Only seven centers have been funded to date. The principal attribute of each center is its capability to carry out both research and demonstration projects in disease prevention and health promotion. Located in an academic health center, cach center has a multi-disciplinary faculty that has working relationships with nursing, psychology, social work, education, business, and medicine. Each also has close working relationships with state/local health agencies and/or communitybased public health organizations. Prevention centers authority expires on September 30, 1991. ASPII urges the re-authorization (FY92-94) of this important CDC program. STATEMENT OF DONALD R. COHODES, VICE PRESIDENT, FEDERAL PROGRAMS, BLUE CROSS & BLUE SHIELD ASSOCIATION Senator BUMPERS. Mr. Cohodes. Is that correct? Mr. COHODES. Mr. Chairman, it is Cohodes. Mr. Chairman, I am Donald Cohodes, the vice president of Federal programs for the Blue Cross & Blue Shield Association. I want to thank the committee for this opportunity to testify today on the funding needs of Medicare contractors. I am going to be brief. We submitted a statement for the record. The Medicare contractor budget is driven by four basic forces. The principal one is the volume of Medicare claims. Each year claims grow at double digit levels, and this year we anticipate a growth of about 11.5 percent. The second driving factor on the Medicare budget is inflation, and we anticipate, as does the Government, that we will be facing inflation of 4 to 5 percent. The third factor is simply the growth in the number of beneficiaries which each year is about 2 percent. And the fourth and final factor is the change in the complexity of the workload and items such as physician payment reform are illustrative of the changes that we face. Given these factors, one would conclude at least a reasonable person might conclude that the budget requirements for next year are somewhere on the order of 15 to 20 percent above the fiscal year 1991 level just to maintain current services. Thus, it is astonishing to view the administration's budget request. That request of $1,457,000,000 is actually a $37 million reduction off of this year's funding level. Such a funding level would create some significant and damaging reductions in services to beneficiaries and providers. Most particularly, there are two areas of the budget that have been targeted for enormous reductions. The first area is for inquiries, and these are written and telephone questions of Medicare contractors. We anticipate we are going to receive well in excess of 30 million inquiries next year, and we will be funded to handle a little over 8 million. The second major category is the hearing category. Each year we are required to hold fair hearings on appeals. Well, we anticipate that we will have 10 million hearings in terms of requests, but be able to handle only 3 million. The result of all that is that there |