Table Of Content

7 S. Hrg. 103-696. Pt. 2 Senate Hearings Before the Committee on Appropriations Y 4, AP 6/2: S, HRG, 103-696/ PT.2 Oepartnents of Libon Health and Hu. . . Departments of Labor, Human Health and Services, and and Related Education, Agencies Appropriations Fiscal Year 1995 103d CONGRESS, SECOND SESSION H.R. 4606 PART 2 (Pages 1-820) DEPARTMENTOF EDUCATION DEPARTMENTOFHEALTHANDHUMANSERVICES DEPARTMENTOFLABOR S. Hrg. 103-696, Pt. 2 DEPARTMENTS OF HEALTH AND HUMAN LABOR, AND AND RELATED SERVICES, EDUCATION, AGENCIES APPROPRIATIONS FOR HSCAL YEAR 1995 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE ONE HUNDRED THIRD CONGRESS SECOND SESSION ON H.R. 4606 AN ACT MAKING APPROPRIATIONS FOR THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES, FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 1995, AND FOR OTHER PURPOSES Part 2 (Pages 1-820) Department of Education Department of Health and Human Services Department of Labor Printed for the use of the Committee on Appropriations U.S. GOVERNMENT PRINTING OFFICE 77-209cc WASHINGTON : 1994 ForsalebytheU.S.GovernmentPnntingOffice SuperintendentofDocuments,CongressionalSalesOffice,Washington,IX: 20402 ISBN 0-16-046339-4 COMMITTEE ON APPROPRIATIONS ROBERT C. BYRD, West Virginia, Chairman DANIEL K. INOUYE, Hawaii MARK O. HATFIELD, Oregon ERNEST F. HOLLINGS, South Carolina TED STEVENS, Alaska J. BENNETT JOHNSTON, Louisiana THAD COCHRAN, Mississippi PATRICK J. LEAHY, Vermont ROBERT W. KASTEN, Jr., Wisconsin JIM SASSER, Tennessee ALFONSE M. D'AMATO, New York DENNIS DeCONCINI, Arizona ARLEN SPECTER, Pennsylvania DALE BUMPERS, Arkansas PETE V. DOMENICI, New Mexico FRANK R. LAUTENBERG, New Jersey DON NICKLES, Oklahoma TOM HARKIN, Iowa PHIL GRAMM, Texas BARBARA A. MIKULSKI, Maryland CHRISTOPHER S. BOND, Missouri HARRY REID, Nevada SLADE GORTON, Washington J. ROBERT KERREY, Nebraska MITCH McCONNELL, Kentucky HERB KOHL, Wisconsin CONNIE MACK, Florida PATTY MURRAY, Washington CONRAD BURNS, Montana DLfVNNE FEINSTEIN, California James H. English, StaffDirector Mary S. Dewald, ChiefClerk J. Keith Kennedy, Minority StaffDirector Subcommittee on Departments of Labor, Health and Human Services, and Education, and Related Agencies TOM HARKIN, Iowa, Chairman ROBERT C. BYRD, WestVirginia ARLEN SPECTER, Pennsylvania ERNEST F. HOLLINGS, South CaroUna MARK O. HATFIELD, Oregon DANIEL K. INOUYE, Hawaii TED STEVENS, Alaska DALE BUMPERS, Arkansas THAD COCHRAN, Mississippi HARRY REID, Nevada SLADE GORTON, Washington HERB KOHL, Wisconsin CONNIE MACK, Florida PATTY MURRAY, Washington CHRISTOPHER S. BOND, Missouri Majority Professional Staff Ed Long, James J. SouRwiNE, Carol C. Mitchell, and Susan McGovern Minority Professional Staff Bettilou Taylor and Craig A. Higgins Administrative Support Gladys Clearwaters (II) CONTENTS Wednesday, March 16, 1994 Department ofHealth and Human Services: Page Office ofthe Secretary 1 Public HeaJth Service 23 Health Resources and Services Administration 30 Centers for Disease Control and Prevention 35 SubstanceAbuse and Mental Health ServicesAdministration 42 Health Care FinancingAdministration 47 Thursday, March 17, 1994 Department ofHealth and Human Services: National Institutes ofHealth 183 National Cancer Institute 231 National Heart, Lung, and Blood Institute 257 National Institute ofDental Research 265 National Institute ofDiabetes and Digestive and Kidney Diseases 271 National Institute ofNeurological Disorders and Stroke 279 National Institute ofAllergy and Infectious Diseases 289 National Institute ofGeneral Medical Sciences 299 National Institute ofChild Health and Human Development 309 National Eye Institute 315 National Institute ofEnvironmental Health Sciences 321 National Institute onAging 329 National Institute of Arthritis and Musculoskeletal and Skin Dis- G3.S6S OOi7 National institute ofDeafness and Other Communication Disorders .. 347 National Institute on Mental Health 363 National CenterforHuman Genome Research 369 National Library ofMedicine 379 John E. Fogarty International Center for Advanced Study in the Health Sciences 385 National Center for Research Resources 391 National Institute ofNursing Research 401 National Institute onAlcohol Abuse andAlcoholism " 407 National Institute on DrugAbuse 411 Tuesday, March 22, 1994 Department ofEducation: Secretary ofEducation 421 Office ofElementary and Secondary Education 521 Thursday, March 24, 1994 DepartmentofLabor: Office ofthe Secretary 555 Employment and TrainingAdministration 597 Occupational Safety and Health Administration 602 Mine Safety and Health Administration 606 Employment Standards Administration 611 Friday, May 13, 1994 DepartmentofLabor: Office ofInspector General 689 (HI) IV Page DepartmentofEducation: Office ofInspectorGeneral 711 DepartmentofHealth and Human Services: Office ofInspector General 731 Social Security Administration 741 DEPARTMENTS OF LABOR, HEALTH AND HUMAN AND AND SERVICES, EDUCATION, RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 1995 WEDNESDAY, MARCH 16, 1994 U.S. Senate, Subcommittee of the Committee on Appropriations, Washington, DC. The subcommittee met at 9:30 a.m., in room SD-192, Dirksen Senate Office Building, Hon. Tom Harkin (chairman) presiding. Present: Senators Harkin, Bumpers, Kohl, Specter, Hatfield, Ste- vens, Cochran, Gorton, Mack, and Bond. DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary statement of hon. donna shalala, secretary opening remarks of senator tom harkin Senator Harkin. Good morning. The subcommittee on Labor, Health and Human Services, and Education, and Related Agencies will come to order. I might just note before we even start that I am informed that starting at 10 a.m., we have three votes, so I will cut my statement short and perhaps we can get through with Madam Secretary before that 10 a.m., vote. Today is the first of three hearings with Cabinet secretaries within the jurisdiction ofthis subcommittee. It is a pleasure to welcome Health and Human Services Secretary Donna Shalala today. She has long been an advocate of children's and early intervention programs, areas where we share a strong mutual interest. Following Secretary Shalala's testimony this morning we will be hearing from a second panel from the Department, Dr. Phil Lee, Assistant Secretary of the Public Health Service, Dr. Sumaya, Ad- ministrator of HRSA, and Dr. David Satcher, Centers for Disease Control and Prevention. Secretary Shalala has presented an ambitious budget for next year. HHS's total budget request for fiscal 1995 is $211 billion. In discretionary spending, this budget calls for $32.9 billion, a $1.5 billion or a 4.7-percent increase over last year. Highlighting this budget is $21.3 billion in investment spending for a variety of President Clinton's children and health initiatives, (1) $700 million for Head Start increase, $310 million more for alcohol and drug treatment, $93 million more for Ryan White, and $424 in mandatory spending for immunization. This year's addition to the investment initiatives is the National Institutes of Health with a $517 million increase over the 1994 appropriated level. PREPARED STATEMENT I will dispense with the rest of my statement and ask that it be put in the record. [The statement follows:] StatementofSenatorTom Harkin Good morning, the Subcommittee on Labor, Health and Human Services, Edu- cation and RelatedAgencies will cometo order. Today is the first ofthree hearings with Cabinet secretaries within thejurisdic- tionofthis subcommittee to discuss the fiscal year 1995 budget. It's a pleasure to welcome Health and Human Services Secretary Donna Shalala to the ^bcommittee today. Secretary—Shalala has long been an advocate of children's and early intervention programs areas where we share a strong mutual interest. Following Secretary Shalala's testimony this morning, we'll be hearing from a second panel ofwitnesses from the Department. Testifying will be: Dr. Philip Lee, As- sistant Secretary, Public Health Service; Dr. Giro Sumaya, Administrator, Health Resources and Services Administration; Dr. David Satcher, Centers for Disease Con- trol and Prevention; Dr. Elaine Johnson, Acting Administrator, Substance Abuse and Mental Health Services Administration; and Bruce Vladeck, Administrator, Health Care FinancingAdministration. Secretary Shalala has presented an ambitious budget for next year. HHS's total budget request for fiscal year 1995 is $211 billion. For discretionary spending, this budget caUs for $32.9 billion, a $1.5 billion or 4.7 percent increase over last year. Highlighting this budget is $21.3 billion in investment spending for a variety of President Clinton's children and health initiatives. Heading up this package is a $700 million increase for Head Start, $310 million more for alcohol and drug treatment, $93 million more for Ryan White, and $424 million in mandatory spending for immunization. This year's addition to the investment initiatives is the National Institutes of Health, with a $517 million increase over its 1994 appropriated level. OUTLAYCRISIS Before you begin testifjdng Madame Secretary, let me briefly discuss the budg- etary pressures facing our subcommittee for the coming year. President Clinton, in his State ofthe Union Address, said that this will be one ofthe toughest budgets ever presented to Congress." The reason is simple. To paraphrase political consult- antJames Carville, "its thebudgetcaps, stupid.' The first chart highlights the source of this pressure. Last year's Reconciliation bill essentially froze discretionary outlays for five years. Underthese tight caps, discretionary spending for fiscal year 1998 will be the same as fiscal year 1993 levels, and $62 billion below CBO baseline. Our subcommittee is not immune from these pressures, and the main source of the problems are the President's investment initiatives. This subcommittee includes nearly all ofthe President's "putting people first" programs, and 40 percent ofthe President's entire investment package, far greater than any ofthe twelve other appropriations subcommittees. Nearly all the increases the administration proposes for this subcommittee are devoted to the President's investment initiatives. The next chart proves this point. Ofthe $4.7 billion increase in budget authority for this subcommittee, $4.23 billion is devoted to investments. For outlays, investment increases total $2.6 billion, $2 billion more than the $600 million net increase for the entire subcommittee. Again, using OMB's numbers, that means even ifwe get an allocation that matches the President's budgetrequest for our subcominittee, outlays for our bill's non-investment programs will have to be cut by $2 billion. That's an outlay crisis! Our budget's biggest prob—lems, Secretary Shalala, are created by your department. The reason is obvious to paraphrase Willie Sutton, HHS is where the outlays are! First, yourbudgetproposes freezing approximately 80 individual programs, many ofwhich are very popularwith members ofthis subcommittee, including Com- munity Health Centers, Breast and Cervical Cancer Screening, Lead Poisoning Pre- vention, and the National Health Service Corps. In addition, the HHS budget cuts the Low-Income Home Energy Assistance Pro- grams by $707 million, or nearly 50 percent, below the fiscal year 1994 level. Restor- ing this massive cut in LIHEAP will require approximately $650 million in outlays. Further squeezing outlays is an administration proposal to delay approximately $300 million in obligations in NIH, Head Start, and Child Care. The President's budget also proposes a pause in indirect cost payments to universities and other research institutions at fiscal year 1994 levels, accounting for savings in outlays of between $60 and $80 million. Combined, HHS's proposals alone create a $1 billion outlay problem. That creates an immense crisis for this subcommittee as we prepare our budget for next year. Again, I'm concerned that the budget squeeze will strangle a number ofour subcommittee's programs which may not be investments for the President but which are very important to many members ofCongress and theirconstituents. As a first step, we will need your assistance in ensuring for our subcommittee the highest allocation possible, so that we can preserve the President's investment initiatives while workingto protect the interests ofmembers ofthe Senate. Secretary Shalala, again I want to welcome you to the Subcommittee. I'm looking forward to hearing from you today, and to working closely with you throughout the appropriations process. At this time I want to yield to Senator Specter for any opening comments that he would like to make. Discretionary Outlays (Dollars in Billions) S620 S610 CBO March Baseline (Green) S600 Budget Resolution (Black) S590 Hard Freeze (Red) S570 — S560- - $530^ 1993 Est. 1994 1995 1996 1997 1998 Fiscal Year LABOR HHS EDUCATION INVESTMENT - - INCREASES OVER FY 1994 1 BA (Red) Outlays (Green) MILLIONS ( ) Labor Health & Human Education Services