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110th Congress Report 1stSession H0USE, 0F REPRESENTA. TIVES n0_231 DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS BILL, 2008 REPORT OFTHE COMMITTEE ON APPROPRIATIONS TOGETHERWITH MINORITY AND ADDITIONAL VIEWS [TO ACCOMPANYH.R. 3043] JULY 13, 2007.—Committed to the Committee of the Whole House on the State of the Union and ordered to be printed HOUSE OF REPRESENTATIVES I j CMS Library C2-07-13 7500 Security Blvd. Baltimore, Maryjend 21244 DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS BILL, 2008 — July 13, 2007. Committedtothe Committee oftheWhole House onthe State of theUnion and orderedtobe printed Mr. Obey, from the Committee on Appropriations, submitted the following REPORT together with MINORITY AND ADDITIONAL VIEWS [To accompanyH.R. 3043] The Committee on Appropriations submits the following report in explanation ofthe accompanying bill making appropriations for the Departments of Labor, Health and Human Services (except the Food and Drug Administration, the Agency for Toxic Substances and Disease Registry and the Indian Health Service), and Edu- cation, Committee for Purchase from People Who Are Blind or Se- verely Disabled, Corporation for National and Community Service, Corporation for Public Broadcasting, Federal Mediation and Concil- iation Service, Federal Mine Safety and Health Review Commis- sion, Institute ofMuseum and Library Services, Medicare Payment Advisory Commission, National Council on Disability, National Labor Relations Board, National Mediation Board, Occupational Safety and Health Review Commission, Railroad Retirement Board, and the Social Security Administration for the fiscal year ending September 30, 2008, and for other purposes. INDEXTOBILLANDREPORT Pagenumber Bill Report SummaryofEstimates andAppropriations 3 General Summaryofthe Bill 3 Administration-Directed Spending 4 36-627 2 Pagenumber Bill Report CrosscuttingInitiatives 6 — Title I DepartmentofLabor: Employment andTrainingAdministration 2 34 Employee Benefits SecurityAdministration 12 45 PensionBenefit GuarantyCorporation 12 46 Employment StandardsAdministration 13 47 Occupational SafetyandHealthAdministration 19 51 Mine Safety andHealthAdministration 23 54 BureauofLabor Statistics 24 55 Office ofDisabilityEmploymentPolicy ' 25 56 DepartmentalManagement 25 56 , Veterans Employment andTraining 27 61 Office ofthe InspectorGeneral 28 61 General provisions 28 62 — Title II DepartmentofHealth andHuman Services: HealthResources and Services Administration 33 63 Centers forDisease Control andPrevention 38 96 National Institutes ofHealth 41 125 SubstanceAbuse andMental Health Services Administration 48 174 AgencyforHealthcare Research and Quality 50 183 Centers forMedicare andMedicaid Services 50 185 AdministrationforChildren and Families 54 189 Administration onAging 62 204 Office ofthe Secretary 62 208 Office ofthe InspectorGeneral 64 214 PublicHealth and Social Services EmergencyFund 65 215 General provisions 67 219 — Title III Department ofEducation: Educationforthe Disadvantaged 77 221 ImpactAid 78 228 School ImprovementPrograms 79 229 Indian Education 81 234 Innovation andImprovement 81 235 Safe Schools and Citizenship Education 83 244 English LanguageAcquisition 84 247 SpecialEducation 84 248 Rehabilitation Services andDisabilityResearch 85 250 Special Institutions forPersonsWith Disabilities 86 253 Career andTechnicalEducation andAdultEducation 86 254 StudentFinancialAssistance 89 257 StudentAidAdministration 89 259 HigherEducation 90 259 HowardUniversity 91 270 College HousingandAcademicFacilities Loans 91 270 HistoricallyBlack College andUniversity Capital Financing 91 270 Institute ofEducation Sciences 92 271 Departmental Management 92 274 Office for Civil Rights 92 275 Office ofthe Inspector General 93 275 Gene—ral provisions 93 275 Title IV Related agencies: Committee for Purchase From People Who Are Blind or Severely Disabled 97 276 CorporationforNational and Community Service 97 276 CorporationforPublic Broadcasting 103 279 Federal Mediation and Conciliation Service 104 280 Federal Mine Safety and HealthReview Commission 106 280 Institute ofMuseum and Library Services 106 280 Medicare PaymentAdvisory Commission 106 282 — 3 Pagenumber Bill Report National Commission on Libraries and Information Science 283 National Council on Disability 107 283 NationalLaborRelations Board 107 283 NationalMediation Board 108 284 Occupational Safety and Health Review Commission 108 284 RailroadRetirementBoard 108 284 Social SecurityAdministration 110 285 TitleV—General Provisions: House ofRepresentatives ReportRequirements 289 Summary of Estimates and Appropriations The following table compares on a summary basis the appropriations including trust funds for fiscal year 2007, the budget request for fiscal year 2008 and the Committee recommendation for fiscal year 2008 in the accompanying bill. 2008 LABOR, HHS, EDUCATION APPROPRIATIONS BILL [In millionsofdollars] Fiscalyear 2008committeecompared to— com2p0a0ra7ble 2008budget com2m0i0t8tee com2p0a0ra7ble 2008budget DepartmentofLabor $14,691 $13,942 $14,891 +$200 +$949 -6 Advances 2,531 2,525 2,525 0 DepartmentofHealth and HumanServices 422,185 472,056 477,406 +55,221 +5,350 Advances 69,456 71,457 71,457 +2,001 0 DepartmentofEducation 60,310 59,099 62,971 +2,661 +3,872 Advances 15,034 15,034 17,004 +1,970 +1,970 RelatedAgencies 48,774 52,492 52,659 +3,885 +167 Advances 17,210 14,800 15,220 -1,990 +420 GrandTotal,currentyear 545,960 597,589 607,927 +61,967 +10,338 Advances 104,231 103,816 106,206 +1,975 +2,390 Currentyeartotal using302(b) scorekeeping 545,834 596,394 607,428 +61,594 +11,034 Mandatory 401,224 455,478 455,680 +54,456 +202 Discretionary 144,610 140,916 151,748 +7,138 +10,832 PROGRAM LEVEL DISCRETIONARY [In millionsofdollars] Fiscalyear— 2008committeecompared to— com2p0a0r7able 2008budget com2m0i0t8tee com2p0a0ra7ble 2008budget DepartmentofLabor $11,686 $10,964 $11,913 +$227 +$949 DepartmentofHealth and Human Services 64,054 63,195 68,344 +4,290 +5,149 DepartmentofEducation 57,473 56,225 62,068 +4,595 +5,843 RelatedAgencies 11,522 11,326 11,913 +391 +587 Subtotal Program Level $144,735 $141,710 $154,238 +$9,503 +$12,528 General Summary of the Bill Funding levels in the fiscal year 2008 appropriation bill for the Departments ofLabor, Health and Human Services, Education and Related Agencies reflect the Committee's efforts to understand the challenges that the nation faces over the next ten years and what the nation must do to address them. While reducing the Federal deficit is a worthy goal, th—e nation has a number of other deficits that are equally important deficits in worker development, safety 4 and protection; deficits in health access, affordability and quality; and deficits in educational access and opportunity. In this bill, the Committee makes crucial investments in priority programs that will help to begin the process oferasing these deficits over the next several years—. Bill total Total funding, including offsets, for the Departments of Labor, Health and Human Services, Education and Related Agencies Appropriations Ac—t, 2008 is $607,428,474,000. Discretionary programs. For Discretionary accounts for fiscal year 2008 the bill provides $151,748,000,000, including offsets. This is $7,137,515,000 and 4.9 percent above the fiscal year 2007 comparable level. — Mandatoryprograms. The bill provides $455,680,474,000 for entitlement programs in fiscal year 2008. This is $54,456,359,000 above the fiscal year 2007 comparable level. Funding requirements for entitlement programs are determined by the basic authorizing statutes. Mandatory programs include general fund support for the Medicare and Medicaid programs, Supplemental Security Income, Trade Adjustment Assistance and Black Lung payments. The following chart indicates the funding levels for the major mandatory programs in fiscal years 2007 and 2008. MANDATORY [Dollars inthousands] Program Fiscalyear2007 Fiscalyear2008 Change DepartmentofLabor: Federal UnemploymentBenefitsandAllowances $837,600 $888,700 +$51,100 Advancestothe Ulandothertrustfunds 465,000 437,000 -28,000 Special Benefits 227,000 203,000 -24,000 Special BenefitsforDisabledCoal Miners 229,373 208,221 -21,152 Energy Employees Occupational Illness Compensation Fund 102,307 104,745 +2,438 BlackLung DisabilityTrustFund 1,069,546 1,068,000 -1,546 DepartmentofHealth and Human Services: VaccineInjuryCompensationTrustFund 55,871 57,547 +1,676 Medicaidcurrent law benefits 155,467,869 194,109,000 +38,641,131 MedicaidStateand local administration 9,881,583 10,014,716 +133,133 CMSVaccinesforChildren 2,905,330 2,763,957 -141,373 MedicarePaymentsto HealthcareTrustFunds , 176,298,480 188,828,000 +12,529,520 WelfarePayments 39,000 39,000 0 ChildSupport Enforcement 4,424,678 3,910,713 -513,965 Social Services BlockGrant 1,700,000 1,700,000 0 PromotingSafeandStableFamilies 345,000 345,000 0 PaymentstoStatesforFosterCare andAdoption 4,912,000 5,082,000 +170,000 Medical BenefitsforCommissioned Officers 370,698 402,542 +31,844 DepartmentofEducation: Vocational Rehabilitation 2,837,160 2,837,160 0 RelatedAgencies: Federal Paymentstothe Railroad RetirementAccount 150 150 0 PaymentstoSocial SecurityTrust Funds 20,470 28,140 +7,670 Supplemental SecurityIncome 37,231,000 40,738,000 +3,507,000 Administration-Directed Spending — Directed spending. The Committee notes that Congress has made significant reforms in the way it reviews funding for the Fed- eral government; reforms which the Committee takes very seri- ously as it executes its constitutional authority. For example, the Committee has committed to reducing the number of earmarks in order to ensure that these projects are adequately vetted and eval- 5 uated. Nonetheless, earmarking or directed spending of Federal dollars does not begin with Congress. It begins with the Executive Branch. For example, the Administration's own fiscal year 2008 request for this bill includes a number ofrequests to earmark funds to certain organizations. These earmark requests include: $10,000,000 for Reach Out and Read; $10,000,000 for Teach for America; $8,900,000 for the Points of Light Foundation; $4,450,000 for America's Promise; $1,774,000 for the Mind-Body Institute; and, YMCA $1,429,000 for the ofAmerica. The Executive Branch also engages in another practice which steers or directs money to specific entities or purposes through a process of providing grants or contracts to support various activities and services. The practice of contracting has increased signifi- cantly in the past five years. For example, Department of Health and Human Services contract obligations have more than doubled from $4,970,200,000 in fiscal year 2001 to $13,199,400,000 in fiscal year 2006. The number of contract employees at HHS exceeds 32,000, about half the number of civil service employees. A significant share of these contracts was awarded on a non-competitive basis. In fiscal year 2006 alone, HHS awarded nearly 21,000 contracts worth $1,954,600,000 with less than full and open competi- tion. In contrast, this bill is expected to limit Congressionally-directed earmarks by Members of the House of Representatives to approximately one quarter ofthat amount. The Committee also notes recent audits and reports that have re- vealed egregious, potentially extralegal activities, which were aimed at steering funding to specific individuals and entities through non-competitive grants and contracts. For example, between September 2006 and March 2007, the De- partment of Education Office of Inspector General (OIG) completed one ofits most exhaustive investigations, which resulted in six sep- arate audits ofthe reading first program. These audits documented efforts by the Department of Education to steer billions in reading first funds for the purchase of certain reading textbooks and assessments in order to benefit favored publishers and individuals. In September 2006, the Department ofEducation OIG found that the Department's program officials strongarmed States and school districts until they selected the reading textbooks and assessments favored by Administration officials. (Office of Inspector General, U.S. Department of Education, Final Inspection Report, The Read- ing First Program's Grant Application Process (2006)). After further investigation of reading first, the OIG found that Department ofEducation administrators improperly promoted commercial reading programs in potential violation ofFederal law (Office ofInspec- tor General, U.S. Department of Education, Final Inspection Re- port, The Department's Administration of Selected Aspects of the Reading First Program (2007)). For example, the Madison School District in Wisconsin had substantial data demonstrating that its students were learning at the rate that reading first was aiming for. Nonetheless, the district lost its $2,000,000 reading first grant when the district would not purchase the unproven commercial reading program promoted by the Department of Education's contractors. Across the country, including in Illinois, Kentucky, Massa- chusetts, Maine and New Jersey, States and districts with pro- — 6 grams that were not on the Department's preferential list were either rejected for grants or pressured to change their methods even though some argued, as did Wisconsin, that their programs met the law's standard. This is the type of pressure that the OIG found to be in potential violation ofFederal law. Finally, the OIG found significant bias and conflicts of interest on the part of contractors and their subcontractors who were hired to provide unbiased technical assistance to States and school districts, potentially in violation of Federal law (Office of Inspector General, U.S. Department of Education, Final Inspection Report, RMC Research Corporation's Administration of Reading First Pro- gram Contracts (2007)). Recently, ABC News reported that, after receiving millions of dollars in reading first contracts, one publisher w—ith political con- nections to the Administration sold his company once valued at $5,000,000—for $360,000,000. (ABC World News With Charles Gib- son (May 2007)). Some of these same publishers and individuals continue to reap financial gains under reading first because the Ad- ministration has failed to address ongoing conflicts ofinterest. The seriousness of the OIG's findings is underscored by reports that the OIG has made criminal referrals to the Justice Depart- ment as a result ofthese investigations. At the same time that the Department of Education was pro- moting certain reading products that lacked evidence oftheir valid- ity, reading programs such as Reading Recovery and Success for All with strong evidence of effectiveness, according to the Depart- ment's own what works clearinghouse, were virtually shut out of reading first. In fact, Department of Education data show that schools without Reading first fund—s were more likely t—o use Read- ing Recovery and Success for All proven approaches than were schools receiving reading first grants. The Committee finds, however, that efforts to steer funding to favored entities are not limited to the Department of Education. Re- cently, the Congressional Research Service documented an unusu- ally large number of sole source grants issued by the Employment and Training Administration within the Department of Labor, which resulted in 90 percent of discretionary funds for the High Growth Job Training Initiative being awarded on a non-competitive basis over a five-year period. Finally, the Committee notes that this bill contains more than $68,000,000,000 for discretionary grant programs under which all or a portion of the funds are allocated on a discretionary basis to grantees selected by the Administration. Altogether, the Adminis- tration steers or directs far greater spending to specific projects, individuals, and companies than is directed or earmarked by Con- gress. CROSSCUTTING INITIATIVES The following section of the report highlights nine initiatives within the bill that target various needs of the American people access to different types ofhealth care and public health prepared- ness, biomedical research to inform and improve that health care, education for kindergarteners through twelfth graders and post- secondary students, and training and protecting adult workers. A number of programs supported by the bill appear more than once 7 in the initiatives, appropriately so because some of the programs have broad, multi-layered missions. For example, community health centers are an important source of primary care for the uninsured. They also provide dental care in many communities, as well as pre-natal care to mothers considering how to manage their pregnancy. All these programs stand on their own, but also partici- pate in individual or multiple cross-cutting initiatives that serve those most in need. INCREASING ACCESS TO HEALTH CARE FOR THE UNINSURED The Committee includes a $622,875,000 increase over fiscal year 2007 and $645,302,000 over the request for critical safety net health programs in order to respond to the nation's healthcare crisis. Twenty years ago, fewer than 30 million Americans lacked health care insurance. Today, Census Bureau data show that there are approximately 46.6 million uninsured Americans. This means life-saving care is out of reach for almost 16 percent or one in six Americans. If current trends continue, the ranks of the uninsured will balloon to 56 million by 2013. To date, the Federal government has responded to the health insurance crisis by patching the frayed safety net ofhealth programs, chiefly through Medicaid and the State Children's Health Insur- ance Program (SCHIP). Nationally, 50 million Americans, including 24 million children, will be enrolled in Medicaid during fiscal year 2008. An average of 4.4 million children were enrolled in the SCHIP program at a par- ticular point in time last year. However, these programs do not generally cover adults without children or those with incomes above $20,420, which is 200 percent ofthe Federal poverty level for one person. In addition, 1.8 million eligible children are not yet enrolled in either Medicaid or SCHIP. The Committee first addressed the problem of the uninsured by funding State planning grants during fiscal years 2000 to 2005. States used these grants to collect data about the characteristics of the uninsured within their State and to develop proposals to offer affordable health insurance coverage. Planning grants were the genesis of some of the comprehensive programs States like Massachusetts, Maine, Vermont, and Cali- fornia are now putting in place. These programs rely on a mix of State, Federal, participant, and provider/insurer contributions. Other States were not able, for fiscal or political reasons, to move beyond initial planning activities but are now ready to undertake more serious health system reform efforts. The Committee believes that now is the time to build on the ear- lier State planning grants program to help States make further advances in covering uninsured Americans. Due to the considerable differences in the share of the population that has access to employer-based health insurance, the share covered by government benefit programs, and the geographic distribution of health care providers, these new State grants will be able to target programs in a way that is specific to their p—articular needs. State health access grants. The Committee bill provides $75,000,000 for a State health access initiative to be administered by the Health Resources and Services Administration. Grants — 8 would be awarded competitively to States that demonstrate they have a program design ready to implement and that they have achieved the necessary State and local statutory or regulatory changes to permit their project to move forward. The types of activities that could be supported through the Federal grant include "three share" community coverage (State/Federal, employer and beneficiary), reinsurance plans, subsidized high risk insurance pools, health insurance premium assistance, creation of a state insurance "connector" authority to develop benefit packages for small employers, development of statewide or automated enrollment sys- tems for public assistance programs and innovative strategies to in- sure low-income childless adults. — State high risk insurance pools. The Committee provides funding for a second important health care access program $50,000,000 to support State high risk insurance pools. This program was not funded in fiscal year 2007. The Administration did not request funding for fiscal year 2008. The Committee feels it is important to provide a Federal con- tribution to this health care safety net program. 33 States cur- rently operate high-risk pools that act as the health insurers oflast resort for almost 200,000 individuals who have lost or are ineligible for group insurance coverage, and who are medically high-risk and unable to purchase individual health insurance in the commercial market. The program also produces the side benefit of reducing costs for insured people by providing coverage to individ—uals who would otherwise be uninsured and very costly to care for thus reducing the cost-shifting that results in higher premiums to those with coverage. High-risk pools are a successful public/private part- nership. All risk pool participants pay a monthly premium, capped at 125 to 200 percent ofthe average market premium. Insurers and health care providers support the program through assessments, and some States contribute to their pools. Federal funding allows States with high risk pools to reduce premiums charged to participants and to improve benefits. The Committee has also tried to deal with the problem ofthe uninsured by expanding existing safety net programs that provide health care to uninsured and disadvantaged populations: ACCESS TO HEALTH CARE FOR THE UNINSURED INITIATIVE [Dollars inthousands] Agency/Program FiscalYear2008 2008Committeecomparedto— Committee FiscalYear2007 2008Budget DepartmentofHealth and HumanServices 6,423,769 +602,875 +625,302 Health Resourcesand ServicesAdministration: StateHealthAccessGrants 75,000 +75,000 +75,000 State High RiskInsurancePools 50,000 +50,000 +50,000 CommunityHealthCenters 2,188,000 +199,961 +199,533 RyanWhiteAIDSPrograms 2,237,086 +99,291 +79,174 Maternal &Child Health BlockGrant 750,000 +57,000 +57,000 HealthyStart 120,000 +18,482 +19,497 FamilyPlanning 310,910 +27,764 +27,807 National HealthServiceCorps 131,500 +5,827 +15,541 CDCChildhood Immunization 516,273 +58,750 +91,150 MedicareSHIPPrograms 45,000 +10,800 +10,600 DepartmentofLabor 20,000 +20,000 +20,000