    [Senate Hearing 109-284]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 109-284

                                                            Senate Hearings

                                     Before the Committee on Appropriations

    _______________________________________________________________________

    Departments of Labor,

    Health and Human Services,

    Education, and Related

    Agencies Appropriations

                                                          Fiscal Year 2006

                                             109th CONGRESS, FIRST SESSION

                                                                 H.R. 3010

            CORPORATION FOR PUBLIC BROADCASTING
            DEPARTMENT OF EDUCATION
            DEPARTMENT OF HEALTH AND HUMAN SERVICES
            DEPARTMENT OF LABOR
            NONDEPARTMENTAL WITNESSES

                                                            S. Hrg. 109-284

    DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
                  AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2006

    =======================================================================

                                    HEARINGS

                                    before a

                              SUBCOMMITTEE OF THE

                COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE

                           ONE HUNDRED NINTH CONGRESS

                                 FIRST SESSION

                                       on

                                   H.R. 3010

     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, 2006, AND FOR OTHER PURPOSES

                                   __________

                      Corporation for Public Broadcasting
                            Department of Education
                    Department of Health and Human Services
                              Department of Labor
                           Nondepartmental witnesses

                                   __________

             Printed for the use of the Committee on Appropriations

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                                   __________
                          COMMITTEE ON APPROPRIATIONS

                      THAD COCHRAN, Mississippi, Chairman
    TED STEVENS, Alaska                  ROBERT C. BYRD, West Virginia
    ARLEN SPECTER, Pennsylvania          DANIEL K. INOUYE, Hawaii
    PETE V. DOMENICI, New Mexico         PATRICK J. LEAHY, Vermont
    CHRISTOPHER S. BOND, Missouri        TOM HARKIN, Iowa
    MITCH McCONNELL, Kentucky            BARBARA A. MIKULSKI, Maryland
    CONRAD BURNS, Montana                HARRY REID, Nevada
    RICHARD C. SHELBY, Alabama           HERB KOHL, Wisconsin
    JUDD GREGG, New Hampshire            PATTY MURRAY, Washington
    ROBERT F. BENNETT, Utah              BYRON L. DORGAN, North Dakota
    LARRY CRAIG, Idaho                   DIANNE FEINSTEIN, California
    KAY BAILEY HUTCHISON, Texas          RICHARD J. DURBIN, Illinois
    MIKE DeWINE, Ohio                    TIM JOHNSON, South Dakota
    SAM BROWNBACK, Kansas                MARY L. LANDRIEU, Louisiana
    WAYNE ALLARD, Colorado
                        J. Keith Kennedy, Staff Director
                  Terrence E. Sauvain, Minority Staff Director
                                     ------
                                     ------

       Subcommittee on Departments of Labor, Health and Human Services,
                        Education, and Related Agencies

                     ARLEN SPECTER, Pennsylvania, Chairman
    THAD COCHRAN, Mississippi            TOM HARKIN, Iowa
    JUDD GREGG, New Hampshire            DANIEL K. INOUYE, Hawaii
    LARRY CRAIG, Idaho                   HARRY REID, Nevada
    KAY BAILEY HUTCHISON, Texas          HERB KOHL, Wisconsin
    TED STEVENS, Alaska                  PATTY MURRAY, Washington
    MIKE DeWINE, Ohio                    MARY L. LANDRIEU, Louisiana
    RICHARD C. SHELBY, Alabama           RICHARD J. DURBIN, Illinois
                                         ROBERT C. BYRD, West Virginia (Ex
                                             officio)
                               Professional Staff
                                Bettilou Taylor
                                  Jim Sourwine
                                  Mark Laisch
                             Sudip Shrikant Parikh
                                  Candice Ngo
                            Ellen Murray (Minority)
                             Erik Fatemi (Minority)
                          Adrienne Hallett (Minority)

                             Administrative Support
                                  Rachel Jones

                                C O N T E N T S

                                  ----------

                            Wednesday, March 2, 2005

                                                                       Page

    Department of Education: Office of the Secretary.................     1

                            Tuesday, March 15, 2005

    Department of Labor: Office of the Secretary.....................    73

                           Wednesday, March 16, 2005

    Department of Health and Human Services: Office of the Secretary.   145

                            Wednesday, April 6, 2005

    Department of Health and Human Services: National Institutes of
      Health.........................................................   177

                             Monday, July 11, 2005

    Corporation for Public Broadcasting..............................   317

        Material Submitted by Agencies not Appearing for Formal Hearings

    Social Security Administration...................................   365
    Railroad Retirement Board........................................   380

                           Nondepartmental Witnesses

    Department of Labor..............................................   385
    Department of Health and Human Services..........................   397
    National Institutes of Health....................................   497
    Department of Education..........................................   622
    Related Agencies...........................................672
    Miscellaneous..................................................??? deg.

    DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
                  AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2006

                                  ----------

                            WEDNESDAY, MARCH 2, 2005

                                           U.S. Senate,
               Subcommittee of the Committee on Appropriations,
                                                        Washington, DC.
        The subcommittee met at 9:30 a.m. in room SD-126, Dirksen
    Senate Office Building, Hon. Arlen Specter (chairman)
    presiding.
        Present: Senators Specter, Cochran, Harkin, and Kohl.

                            DEPARTMENT OF EDUCATION

                            Office of the Secretary

    STATEMENT OF HON. MARGARET SPELLINGS, SECRETARY
    ACCOMPANIED BY:
            C. TODD JONES, ASSOCIATE DEPUTY SECRETARY FOR BUDGET AND
                STRATEGIC ACCOUNTABILITY
            THOMAS SKELLY, DIRECTOR, BUDGET SERVICE

                   OPENING STATEMENT OF SENATOR ARLEN SPECTER

        Senator Specter. Good morning, ladies and gentlemen, the
    Appropriations Subcommittee on Labor, Health, Human Services,
    and Education will now proceed. We are joined by the
    distinguished Secretary of Education, Margaret Spellings, who
    has had an outstanding academic and professional career, served
    for 6 years with then-Governor George Bush of Texas, came to
    the White House 4 years ago and has recently been appointed and
    confirmed as Secretary of Education.
        As I had talked to the Secretary earlier, our Senate
    schedule is very, very crowded. We have on the floor at the
    moment the Bankruptcy bill, for which I have duties as chairman
    of the Judiciary Committee, and the majority leader has
    scheduled a meeting at 10 o'clock on pending asbestos
    legislation, which is a matter of real importance to the
    administration and to the Congress, so I'm going to have to
    excuse myself a few minutes before 10 to attend that meeting,
    but my distinguished ranking member, Senator Harkin, has agreed
    to take my place. He does that with great distinction. He and I
    have exchanged the gavel seamlessly for longer than either of
    us is prepared to admit. But we have a true partnership, and
    when he's here I know it will be in very good hands.
        I've already talked to Senator Harkin about waiving our
    opening statements so we can go right to your testimony, Madame
    Secretary, and use the time to the maximum advantage to hear
    from you.

                  SUMMARY STATEMENT OF HON. MARGARET SPELLINGS

        Secretary Spellings. Thank you very much, Mr. Chairman.
    Thank you; good morning, Mr. Chairman, Senator Harkin, I'm
    thrilled to be here. This is my first appearance before your
    committee and I know you'll be as kind and gentle on me as you
    are with other administration officials.
        I certainly appreciate the hard work that we have to do
    together, a lot of tough choices this year, and I pledge to
    work with you productively to get to a good result.
        First, I'd like to introduce my budget team: Tom Skelly,
    the Budget Service Director, and Todd Jones, Associate Deputy
    Secretary for Budget and Strategic Accountability. And let me
    take this opportunity to say a special thanks to Chairman
    Specter. I, and my entire Department, wish you a full and
    speedy recovery.
        Senator Specter. Thank you.

                   REDUCING THE DEFICIT AND IMPROVING RESULTS

        Secretary Spellings. I am here to testify on behalf of
    President Bush's 2006 discretionary budget request for the
    Department of Education. The President's budget accomplishes
    several goals; the first is fiscal discipline. In his February
    2 State of the Union Address, the President underscored the
    need to restrain spending in order to sustain our economic
    growth and prosperity. It is important that total discretionary
    and non-security spending be held to levels proposed in the
    2006 budget. Its savings and reforms will help us achieve the
    President's goal of cutting the budget deficit in half by 2009,
    and we urge Congress to support them.
        The fiscal year 2006 budget includes more than 150
    reductions, reforms, and terminations in non-defense
    discretionary programs, and of those, a third are under the
    Department of Education. We are committed to working with
    Congress to achieve these savings. Given the fiscal realities,
    we must target our resources towards flexibility and results,
    and let me tell you a little about those results.

                               HIGH SCHOOL REFORM

        First, the budget would expand the promise of the No Child
    Left Behind Act to our Nation's high schools. No Child Left
    Behind rests on the common sense principles of accountability
    for results, data-based decisionmaking, high expectations for
    all, and empowering change. These principles have proven good
    for our elementary and middle schools, and they are needed
    today in our high schools.
        Let me share a few facts that I know you probably have
    heard before: our 15-year-olds perform below average
    internationally in mathematics, literacy, and problem solving.
    Just 68 out of every 100 entering ninth-graders will receive
    their high school diploma on time. Just 27 will enter college
    and still be enrolled by their sophomore year, when nearly 80
    percent of the fastest-growing jobs require at least that level
    of preparation. Two-thirds of those who do graduate from high
    school are not adequately prepared for college, and more than
    half of all college students take remedial education courses
    when they go to post-secondary education.
        Last weekend, the bipartisan National Governors Association
    reported that high schools are failing to prepare too many of
    our students for work and higher education, and Bill Gates told
    them, ``Training the workforce of tomorrow with today's high
    schools is like trying to teach kids about today's computers on
    a 50-year-old mainframe.'' Even the New York Times, just
    yesterday, and the Washington Post editorial pages have weighed
    in. The Times said, ``American students are falling farther and
    farther behind their peers in Asia and Europe.'' It called for
    a far more rigorous curriculum across the board, and the Post
    called on States to ``stop blocking testing and standards and
    find ways to raise them.'' Call it what you will--a challenge,
    a problem, a crisis--it's imperative that we give our high
    schools the tools to succeed in the economy in which 80 percent
    of these jobs require more rigorous levels of education.

                      HIGH SCHOOL INTERVENTION INITIATIVE

        The President's $1.24 billion High School Intervention
    Initiative would help give students the academic skills needed
    to succeed in the 21st century. These reforms would be designed
    and directed, not by the Federal Government, but by States and
    school districts themselves. The budget would provide $250
    million to measure student achievement annually, and hold
    schools accountable for student performance. As we have learned
    from No Child Left Behind, what gets measured, gets done.

                           READING FIRST STATE GRANTS

        We've made a serious effort in improving basic literacy in
    the early grades. We spent more than $2.7 billion in Reading
    First grants to States and school districts, training more than
    90,000 teachers, and teaching 1.5 million students. Today,
    reading and math scores are up in all States across the Nation,
    and urban school districts are leading the way.

                RAISING READING AND MATH AND TEACHER INCENTIVES

        Some high school students struggle with reading and math,
    too. They would benefit from our Striving Readers program, $200
    million, a $175 million increase over 2005, and a new secondary
    education mathematics initiative of $120 million. A $500
    million Teacher Incentive Fund would reward our best educators,
    and attract more of them to serve in our most challenging
    schools.

                    PROVIDING FOR MORE CHALLENGING CURRICULA

        As you've heard, there is a near-unanimous call for more
    rigorous high school curricula. The President's budget would
    invest $45 million, an increase of $42.5 million, to encourage
    students to take more challenging course work. This includes a
    boost for the public-private State Scholars program, which
    strives for a college-ready curriculum in every high school,
    and new, enhanced Pell Grants for students completing such
    rigorous programs.
        The budget also provides a 73 percent increase to expand
    the availability of advanced placement in international
    baccalaureate programs in high-poverty schools.

                             CONTINUING PRIORITIES

        Second, the President's budget continues the solid progress
    begun under No Child Left Behind. Congress overwhelmingly
    passed this bipartisan law just 3 years ago, and today, across
    the country, test scores are rising, schools are improving, and
    the achievement gap is beginning to close. The budget would
    increase Title I Grants to Local Educational Agencies, the
    engine of No Child Left Behind, by $603 million. This
    represents a 52 percent increase since the law was signed. The
    budget also provides a $508 million increase for the Special
    Education Grants to States program, 75 percent higher than 5
    years ago.

                             COLLEGE AFFORDABILITY

        Finally, the President's budget makes college affordability
    a high priority. It would provide $19 billion over 10 years in
    mandatory funds for Pell Grants, resulting from student loan
    program reforms. This will retire the Pell Grant funding
    shortfall and help more than 5 million recipients attend
    college next year alone. The maximum individual Pell Grant
    would be increased by $100 for each of the next 5 years, to
    $4,550, and grants would be available year-round, so students
    can learn on their own time-table.

                     PRESIDENTIAL MATH AND SCIENCE SCHOLARS

        To encourage more students, especially poor and minority
    students, to enter the critical fields of math and science, our
    budget also includes a new Presidential Math/Science Scholars
    Program, which would award up to $5,000 each to low-income
    college students pursuing degrees in those demanding and in-
    demand fields.

                        COMMUNITY COLLEGE ACCESS GRANTS

        Finally, the budget establishes a new $125 million
    Community College Access Grants fund to support dual enrollment
    credit transfers for high school students taking college-level
    course work. With this budget's passage, student financial
    assistance will have risen from $48 billion to $78 billion
    during this administration.
        In conclusion, let me say that I appreciate and respect the
    priorities you make and the promises you keep as the people's
    representatives. What I have just outlined are the President's
    education priorities; the common thread in all of them is
    aligning needs with results.

                               PREPARED STATEMENT

        We will not agree on everything, it will not always be easy
    to find common ground in a Nation on wartime footing, and a
    tight fiscal climate, but I am here to listen to your
    priorities. The President has made tough choices, we know you
    will, too. And we want to work with you to make the very best
    choices for America's students.
        Thank you very much.
        [The statement follows:]

                 Prepared Statement of Hon. Margaret Spellings

        Mr. Chairman and Members of the Subcommittee: Thank you for this
    opportunity to testify on behalf of President Bush's 2006 discretionary
    request for the Department of Education. I believe we have a strong,
    focused budget proposal this year, one that reflects the need for both
    fiscal discipline and continuing support for State and local efforts to
    carry out No Child Left Behind. Moreover, our budget would
    significantly strengthen the impact of No Child Left Behind at the high
    school level, helping to ensure that every student not only graduates
    from high school, but graduates with the skills to succeed in either
    the workforce or in postsecondary education.
        President Bush is requesting $56.0 billion in discretionary
    appropriations for the Department of Education in fiscal year 2006, a
    decrease of $529.6 million, or less than 1 percent, from the 2005
    level. This request is consistent with the President's overall 2006
    budget, and reflects his determination to cut the Federal budget
    deficit in half over the next 5 years. Even with the proposed
    reduction, discretionary appropriations for education would be up
    nearly $14 billion, or 33 percent, since fiscal year 2001.

                   REDUCING THE DEFICIT AND IMPROVING RESULTS

        In his February 2 State of the Union Address, the President
    underscored the need to restrain spending in order to sustain our
    economic prosperity. As part of this restraint, it is important that
    total discretionary and non-discretionary spending be held to levels
    proposed in his fiscal year 2006 budget request. The savings and
    reforms proposed in this request are critical to achieving the
    President's goal of cutting the budget deficit in half by 2009, and we
    urge the Congress to support this goal.
        Overall, the President's 2006 discretionary request proposes more
    than 150 reductions, reforms, and terminations in non-defense programs.
    The Department of Education's budget proposal includes several major
    reductions and 48 terminations, 33 of which are small, narrow-purpose
    programs funded at less than $40 million in 2005. On behalf of the
    Department, I want the Members of this Subcommittee to know that we are
    determined to work with the Congress to achieve these savings.
        Let me add that our proposed reductions and terminations reflect
    the longstanding practice of this administration to streamline
    government, end unnecessary duplication, and redirect scarce taxpayer
    dollars only to those programs that work. Many of our proposed
    eliminations were requested by previous administrations as well, on the
    grounds that they were a low priority and lacked results. In other
    words, the reductions proposed in our 2006 request reflect not only the
    obvious need for fiscal discipline, but also our determination to spend
    taxpayer dollars as effectively as possible. As President Bush has
    said, ``A taxpayer dollar ought to be spent wisely, or not spent at
    all.''

                               HIGH SCHOOL REFORM

        As most of you know, our request for elementary and secondary
    education focuses on strengthening the impact of No Child Left Behind
    in our high schools through the $1.5 billion High School Initiative.
    Our key proposal in this area is $1.24 billion for High School
    Intervention, which would support a wide range of locally determined
    reforms aimed at ensuring that every student not only graduates from
    high school, but graduates with the skills to succeed in either college
    or the workforce. We also are asking for $250 million for High School
    Assessments to increase accountability for high school achievement and
    give principals and teachers new tools and data to guide instruction
    and meet the specific needs of each student.
        Together, these two components of the President's High School
    Initiative would give States and school district administrators more
    effective tools for improving high schools than they have under the
    existing array of uncoordinated, narrow-purpose programs that this
    initiative would replace.
        The need to direct more attention to our high schools is beyond
    question. Currently just 68 out of every 100 ninth-graders will
    graduate from high school on time. Moreover, a recent study by the
    Manhattan Institute showed that two-thirds of students leave high
    school without the skills to succeed in college. As a result, only 27
    of those original 100 ninth-graders make it to their sophomore year of
    college, and just 18 graduate from college. These figures are even more
    troubling when you consider that 80 percent of the fastest-growing jobs
    require at least some postsecondary education.
        In addition to High School Intervention and Assessments, we are
    seeking a $175 million expansion of the new Striving Readers program,
    which supports the development and implementation of research-based
    methods for improving the skills of teenage students who are reading
    below grade level. Similarly, a new, $120 million Secondary Education
    Mathematics Initiative would help raise mathematics achievement,
    especially for at-risk students, in our high schools. We also want to
    help strengthen high school curricula by providing a $22 million
    increase for the Advanced Placement program, as well as a total
    increase of $45 million for the State Scholars programs to encourage
    more students to complete a rigorous high school curriculum.
        And as you consider our High School Initiative, I hope you will
    keep in mind the startling costs of the alternative: American companies
    and universities currently spend as much as $16 billion annually on
    remedial education to teach employees and students the basic skills
    they should have mastered in high school.

                             CONTINUING PRIORITIES

        The 2006 budget continues to place a strong priority on our three
    largest programs, which together form the foundation of the
    Department's efforts to help ensure that students at all levels have
    the opportunity to obtain a high-quality education. We are asking for a
    $603 million increase for the Title I Grants to Local Educational
    Agencies program, which is the engine driving the President's No Child
    Left Behind reforms. If enacted, this request would result in a $4.6
    billion or 52 percent increase for Title I since the passage of the
    NCLB Act.
        The budget also provides a $508 million increase for the
    reauthorized Special Education Grants to States program, for a total
    increase of $4.8 billion, or 75 percent, over the past 5 years.
        The third major continuing priority for 2006 is the Pell Grant
    program. Our budget includes a comprehensive package of proposals to
    restore Pell Grants to sound financial footing and significantly
    increase the purchasing power of the Pell Grant. These proposals would
    provide a combination of discretionary and mandatory funding that would
    retire the $4.3 billion Pell Grant shortfall, while raising the Pell
    Grant maximum award from $4,050 to $4,550 over the next 5 years. In
    2006 alone, the request would provide a $1.3 billion increase for Pell
    Grants, for a total of $13.7 billion, to raise the maximum award to
    $4,150 and provide grants to an estimated 5.5 million low-income
    postsecondary students.

                              NO CHILD LEFT BEHIND

        Title I remains our key priority for successfully implementing No
    Child Left Behind, but our 2006 request includes a major new proposal
    to help meet the law's requirement that every classroom be led by a
    highly qualified teacher. The new Teacher Incentive Fund would provide
    $500 million to help stimulate closer alignment of teacher compensation
    systems with better teaching, higher student achievement, and stronger
    teaching in high-poverty schools.
        Data on teacher qualifications show that high-poverty schools
    continue to have greater difficulty than low-poverty schools in
    attracting and retaining highly qualified teachers. For example, a
    recent study of California schools by The Education Trust-West showed
    that high-poverty schools tend to have teachers with fewer years of
    experience who, by definition under current, seniority-based
    compensation systems, are paid lower salaries than more veteran
    teachers.
        The Teacher Incentive Fund would give States $450 million in
    formula grants to reward and retain effective teachers and offer
    incentives for highly qualified teachers to teach in high-poverty
    schools. A separate, $50 million competitive grant program would
    encourage the development and implementation of performance-based
    compensation systems to serve as models for districts seeking to more
    closely link teacher compensation to student achievement.
        In addition to Title I and the Teacher Incentive Fund, our 2006
    request maintains strong support for No Child Left Behind programs,
    including almost $3 billion for Improving Teacher Quality State Grants,
    $1.1 billion for Reading First and Early Reading First, and $412
    million for State Assessment Grants.

                   EXPANDING OPTIONS FOR STUDENT AND PARENTS

        Finally, our request includes funding to continue the expansion of
    educational options for students and families. No Child Left Behind is
    helping to ensure that students in low-performing schools have the
    opportunity to transfer to a better school, or to obtain tutoring or
    other supplemental educational services from the provider of their
    choice. And Federal dollars are now financing opportunity scholarships
    that permit low-income students here in the District of Columbia to
    attend better-performing private schools.
        The 2006 budget would build on these new options by providing $50
    million for a new Choice Incentive Fund that would support State and
    local efforts to give parents the opportunity to transfer their
    children to a higher-performing public, private, or charter school. The
    request also maintains significant support for the charter school
    movement, with $219 million for Charter Schools grants and $37 million
    for the Credit Enhancement for Charter School Facilities program.

                                   CONCLUSION

        I believe these highlights of our 2006 request show that we have a
    strong budget for education, one that makes hard but necessary
    decisions to put significant resources where they can do the most to
    help improve the quality of our education system at all levels. I want
    to conclude with just a few comments on recent charges that our
    Administration is underfunding education, or that our 2006 proposal is
    an ``anti-education'' budget.
        First, the numbers just don't add up for our critics. As I noted
    earlier, under our request, President Bush would increase discretionary
    spending for the Department by $14 billion, or 33 percent, since taking
    office in 2001. Key programs have done even better: Title I would be up
    $4.6 billion, or 52 percent; Special Education Grants to States would
    rise $4.8 billion, 75 percent; and Pell Grants would be up $4.5
    billion, or 51 percent. And by the way, all of these increases have
    come at a time of historically low inflation.
        Second, with total national spending on elementary and secondary
    education more than doubling over the past decade, from roughly $260
    billion to well over $500 billion, it's very hard to make the case that
    money is where we are falling short in education, especially when all
    that new money has produced so little in the way of improved student
    achievement.
        Third, like nearly all Federal education spending, No Child Left
    Behind is intended to leverage ``not replace'' the much larger share of
    education funding coming from State and local sources. Even the
    tremendous increases of the past 4 years have succeeded in lifting the
    Federal share of elementary and secondary spending by just 1 percentage
    point, from roughly 7 percent to about 8 percent. Our goal should be to
    help States and school districts spend smarter on education, not just
    more, and No Child Left Behind is accomplishing this goal.
        Fourth, fully 3 years after the passage of No Child Left Behind,
    and during its third school year of implementation, I have yet to see a
    methodologically sound study providing any documentation of the charge
    that the law is underfunded. Does the law entail additional costs? The
    answer is yes, and our budgets have reflected those costs, but I have
    yet to see any evidence that we have significantly increased financial
    burdens on States or school districts, much less passed on any
    ``unfunded mandate.''
        Finally, context matters, and the size of the Federal budget
    deficit matters. To keep our economy strong, and to create new jobs for
    future graduates, we need to reduce the deficit and encourage more
    private sector investment in our economy. The Department of Education
    is doing its part to help achieve this critical goal.
        Thank you, and I will be happy to take any questions you may have.

                       INTRODUCTION OF COMMITTEE CHAIRMAN

        Senator Specter. Thank you very much, Madame Secretary.
    We've been joined by the distinguished chairman of the full
    Committee, Senator Cochran. Would you care to make an opening
    statement?

                   OPENING STATEMENT OF SENATOR THAD COCHRAN

        Senator Cochran. Mr. Chairman, I'm happy to join you this
    morning to welcome the Secretary to our hearings. I'm
    encouraged by the progress that the administration has made in
    targeting funds to areas of special need where school districts
    don't have the resources to do the job they would like to do in
    helping educate our elementary and secondary students. I think
    the traditional programs that have helped in this regard, such
    as Title I, need to be supported and we hope we can build on
    the things we've learned in the past about some teacher
    training programs that have improved morale, like the National
    Writing Project. I hope that we can get the administration's
    support for continuing programs of that kind. But, overall I
    think you have a big task, no more important job in Government
    than helping to see that we do the right thing for education
    programs throughout the country. It's the bulwark of our
    freedom and our economic prospects for the future. Everyone has
    a right to enjoy a good, quality education, and I think that's
    the goal of this administration. Strong leadership has been
    provided in that regard, and I congratulate you for the work
    you've done in the past, and also the President, for his
    leadership.
        Secretary Spellings. Thank you, Senator.
        Senator Cochran. Thank you for being here and cooperating
    with our committee.
        Secretary Spellings. Thank you.

                PROPOSED REDUCTIONS TO FEDERAL EDUCATION BUDGET

        Senator Specter. Thank you very much, Mr. Chairman. Thank
    you for an abbreviated statement, Madame Secretary, which gives
    me time to initiate a round of questioning for which we
    customarily have 5 minutes; although with only a few of our
    members present, that will be elongated into a number of
    rounds.
        As I mentioned to you in our conversation earlier, I'm very
    much concerned about the fact that the budget has a reduction
    of .9--almost 1 percent--and that is in the face of the
    inevitable problem of inflation. And we are telling the
    American people about this budget in the context of tremendous
    expenses which are going in other directions--very necessary
    expenses beyond any doubt--in what's happening around the world
    as we defend freedom with the President's initiative, and he
    deserves a lot of credit for what is happening around the
    world, with his leadership. With elections in surprising
    places, and more elections forthcoming. But, when we return to
    our constituents, we have some very tough questions to answer
    about education.

                       FEDERAL SHARE OF EDUCATION FUNDING

        Education is a capital asset, and a capital investment.
    There's no more important expenditure that the government
    makes, and we all know the Federal share of that is relatively
    limited, somewhere in the 7 to 8 percent range. And,
    appropriately--as you have already noted--the initiatives are
    to come from local school boards, where they are close to the
    problem in the States, that is our system of federalism, and it
    is a good system.

                         PROPOSED PROGRAM ELIMINATIONS

        I would begin on my request to you, Madame Secretary, as we
    work through the process--and you've only been in office since
    January 20--but, this subcommittee is going to need to have the
    specifics on why you have eliminated 48 programs. Those
    programs have come into existence as a result of study by the
    Congress, which has the fundamental appropriations authority
    under the Constitution. The President has to sign the bills,
    but the Congress has the authority under appropriations, and
    these programs have been suggested by a variety of people--one
    of them is mentoring seventh grade students which has come out
    of Philadelphia, and has very, very strong support. And every
    one of these programs has a sponsor. And when we sit down on
    our legislative agenda, people are very concerned. So, a
    beginning point is to give us--with specificity--why those
    programs have been eliminated.
        [The information follows:]

                       Programs Proposed for Elimination

        The 2006 request continues the practice of the Bush
    Administration--also consistent with previous administrations over the
    past 25 years--of proposing to eliminate or consolidate funding for
    programs that have achieved their original purpose, that duplicate
    other programs, that may be carried out with flexible State formula
    grant funds, or that involve activities that are better or more
    appropriately supported through State, local, or private resources. In
    addition, the government-wide Program Assessment Rating Tool, or PART,
    helps focus funding on Department of Education programs that generate
    positive results for students and that meet strong accountability
    standards. For 2006, PART findings were used to redirect funds from
    ineffective programs to more effective activities, as well as to
    identify reforms to help address program weaknesses.
        The following table shows the programs proposed for elimination in
    the President's 2006 budget request. Termination of these 48 programs
    frees up almost $4.3 billion--based on 2005 levels--for reallocation to
    more effective, higher-priority activities. Following the table is a
    brief summary of each program and the rationale for its elimination.

                            [In millions of dollars]
    ------------------------------------------------------------------------
                         Program terminations                        Amount
    ------------------------------------------------------------------------
    Alcohol Abuse Reduction......................................       32.7
    Arts in Education............................................       35.6
    B.J. Stupak Olympic Scholarships.............................        1.0
    Byrd Honors Scholarships.....................................       40.7
    Civic Education..............................................       29.4
    Close Up Fellowships.........................................        1.5
    Community Technology Centers.................................        5.0
    Comprehensive School Reform..................................      205.3
    Demonstration Projects for Students with Disabilities........        6.9
    Educational Technology State Grants..........................      496.0
    Elementary and Secondary School Counseling...................       34.7
    Even Start...................................................      225.1
    Excellence in Economic Education.............................        1.5
    Exchanges with Historic Whaling and Trading Partners.........        8.6
    Federal Perkins Loans Cancellations..........................       66.1
    Foreign Language Assistance..................................       17.9
    Foundations for Learning.....................................        1.0
    Gaining Early Awareness and Readiness for Undergraduate            306.5
     Programs....................................................
    Interest Subsidy Grants......................................        1.5
    Javits Gifted and Talented Education.........................       11.0
    Leveraging Educational Assistance Partnerships...............       65.6
    Literacy Programs for Prisoners..............................        5.0
    Mental Health Integration in Schools.........................        5.0
    Migrant and Seasonal Farmworkers.............................        2.3
    National Writing Project.....................................       20.3
    Occupational and Employment Information......................        9.3
    Parental Information and Resource Centers....................       41.9
    Projects With Industry.......................................       21.6
    Ready to Teach...............................................       14.3
    Recreational Programs........................................        2.5
    Regional Educational Laboratories............................       66.1
    Safe and Drug-Free Schools and Communities State Grants......      437.4
    School Dropout Prevention....................................        4.9
    School Leadership............................................       14.9
    Smaller Learning Communities.................................       94.5
    Star Schools.................................................       20.8
    State Grants for Incarcerated Youth Offenders................       21.8
    Supported Employment State Grants............................       37.4
    Teacher Quality Enhancement..................................       68.3
    Tech-Prep Demonstration......................................        4.9
    Tech-Prep Education State Grants.............................      105.8
    Thurgood Marshall Legal Educational Opportunity Program......        3.0
    TRIO Talent Search...........................................      144.9
    TRIO Upward Bound............................................      312.6
    Underground Railroad Program.................................        2.2
    Vocational Education National Programs.......................       11.8
    Vocational Education State Grants............................    1,194.3
    Women's Educational Equity...................................        3.0
                                                                  ----------
          Total..................................................    4,264.4
    ------------------------------------------------------------------------

                      PROGRAM TERMINATIONS (DESCRIPTIONS)
                                                                    Millions
    Alcohol Abuse Reduction........................................... $32.7

        Supports programs to reduce alcohol abuse in secondary schools.
    These programs may be funded through other Safe and Drug-Free Schools
    and Communities National Programs and State Grants for Innovative
    Programs.

    Arts in Education.................................................  35.6

        Makes non-competitive awards to VSA arts and the John F. Kennedy
    Center for the Performing Arts as well as competitive awards for
    national demonstrations and Federal leadership activities to encourage
    the integration of the arts into the school curriculum. Eliminating
    funding for the program is consistent with Administration policy of
    terminating small categorical programs with limited impact in order to
    fund higher priorities. Arts education programs may be funded under
    other authorities.

    B.J. Stupak Olympic Scholarships..................................   1.0

        Provides financial assistance to athletes who are training at the
    United States Olympic Education Center or one of the United States
    Olympic Training centers and who are pursuing a postsecondary
    education. Athletes can receive grant, work-study, and loan assistance
    through the Department's postsecondary student aid programs. Rated
    Results Not Demonstrated by the PART due to lack of performance data
    and program design deficiencies, including its duplication of other
    Federal student aid programs.

    Byrd Honors Scholarships..........................................  40.7

        Promotes academic excellence and achievement by awarding merit-
    based scholarships to high school students, through formula grants to
    State educational agencies, who have demonstrated outstanding academic
    achievement and who show promise of continued academic excellence. This
    program duplicates existing Federal student financial assistance
    programs, as well as State, local and private efforts that provide
    merit-based resources for postsecondary education. Rated Results Not
    Demonstrated by the PART due to lack of performance data and program
    design deficiencies.

    Civic Education...................................................  29.4

        Provides a single non-competitive award to the Center for Civic
    Education to conduct We the People, a program to improve the quality of
    civics and government education. Also makes non-competitive and
    competitive awards for the Cooperative Education Exchange, a program to
    improve civic and economic education through exchange programs. Request
    is consistent with the Administration's policy of terminating small
    categorical programs that have limited impact, and for which there is
    little or no evidence of effectiveness, to fund higher priority
    programs.

    Close Up Fellowships..............................................   1.5

        Non-competitive award to Close Up Foundation supports fellowships
    to low-income students and teachers participating in Close Up visits to
    Washington, DC and other activities. Peer organizations provide
    scholarships to some of their participants without Federal assistance,
    and the organization's successful private fundraising eliminates the
    need for the program.

                                                                    Millions
    Community Technology Centers......................................  $5.0

        Supports centers that offer disadvantaged residents of economically
    distressed areas access to computers and training. Program has limited
    impact and funding for similar activities is available through other
    Federal agencies.

    Comprehensive School Reform....................................... 205.3

        This program largely duplicates activities that are readily carried
    out under the Title I Grants to LEAs program. In the 2000-01 school
    year, about 30,000 Title I schools (62 percent) were implementing
    research-based reform models and, beginning with 2002, the NCLB Act
    made statutory changes to further encourage schools to carry out the
    types of whole-school reforms supported by the Comprehensive School
    Reform program. For Comprehensive School Reform (continued): example,
    comprehensive reform is encouraged as part of school improvement
    efforts undertaken by Title I schools that do not make adequate yearly
    progress toward State standards for at least 2 consecutive years. Also,
    the Act lowered the poverty threshold for Title I schoolwide projects
    to 40 percent, thus expanding the number of Title I schools that are
    eligible to use Title I funds to carry out comprehensive school reform.

    Demonstration Projects to Ensure Quality Higher Education for
        Students with Disabilities....................................   6.9

        Funds technical assistance and professional development activities
    for faculty and administrators in institutions of higher education in
    order to improve the quality of education for students with
    disabilities. This program has achieved its primary goal of funding
    model demonstration projects. New projects can and do receive funding
    under FIPSE.

    Educational Technology State Grants............................... 496.0

        This program provides funding to States and school districts to
    support the integration of educational technology into classroom
    instruction, technology deployment, and a host of other activities
    designed to utilize technology to improve instruction and student
    learning. Schools today offer a greater level of technology
    infrastructure than just a few years ago, and there is no longer a
    significant need for a State formula grant program targeted
    specifically on (and limited to) the effective integration of
    technology into schools and classrooms. Districts seeking funds to
    integrate technology into teaching and learning can use other Federal
    program funds such as Improving Teacher Quality State Grants and Title
    I Grants to Local Educational Agencies.

    Elementary and Secondary School Counseling........................  34.7

        Elementary school and secondary school counseling may be funded
    through other larger and more flexible Federal programs, such as ESEA
    Title V--A State Grants for Innovative Programs.

    Even Start........................................................ 225.1

        This program aims to improve educational opportunities for children
    and their parents in low-income areas by integrating early childhood
    education, adult education, and parenting education into ``family
    literacy'' programs. However, three separate national evaluations of
    the program reached the same conclusion: children and adults
    participating in Even Start generally made gains in literacy skills,
    but these gains were not significantly greater than those of non-
    participants. Also, the Administration rated the program as Ineffective
    in the 2004 PART process. Other high priority programs such as Reading
    First and Early Reading First are better structured to implement proven
    research and to achieve the President's literacy goals.

    Excellence in Economic Education..................................   1.5

        Supports a grant to a single national non-profit educational
    organization to promote economic and financial literacy for K-12
    students. Elimination is consistent with Administration policy of
    terminating small categorical programs with limited impact in order to
    fund higher priorities.

                                                                    Millions
    Exchanges with Historic Whaling and Trading Partners..............  $8.6

        Supports culturally based educational activities, internships,
    apprenticeship programs and exchanges for Alaska Natives, Native
    Hawaiians, and children and families of Massachusetts. Elimination is
    consistent with Administration policy of terminating small categorical
    programs with limited impact in order to fund higher priorities.

    Federal Perkins Loans Cancellations...............................  66.1

        Reimburses institutional revolving funds for borrowers whose loan
    repayments are canceled in exchange for undertaking public service
    employment, such as teaching in Head Start programs, full-time law
    enforcement, or nursing. These reimbursements are no longer needed as
    the Administration is proposing to eliminate the Perkins Loan program,
    which duplicates other student loan programs and serves a limited
    number of institutions.

    Foreign Language Assistance.......................................  17.9

        Activities to promote improvement and expansion of foreign language
    instruction may be supported by larger, more flexible ESEA programs,
    such as Improving Teacher Quality State Grants and State Grants for
    Innovative Programs.

    Foundations for Learning..........................................   1.0

        Competitive grants provide services to children and their families
    to enhance young children's development so that they become ready for
    school. The request is consistent with the Administration's effort to
    increase resources for high-priority programs by eliminating small,
    narrow categorical programs that duplicate other programs, have limited
    impact, or for which there is little or no evidence of effect. The
    budget request includes funding for other, larger programs that support
    early childhood education and development.

    Gaining Early Awareness and Readiness for Undergraduate Programs.. 306.5

        Provides grants to States and partnerships to support early college
    preparation and awareness activities at the State and local levels to
    ensure low-income elementary and secondary school students are prepared
    for and pursue postsecondary education. GEAR UP received an Adequate
    PART rating because it employs a number of strategies that other
    studies have found to be effective, but no data are available to
    measure progress toward long-term program goals. The proposed new High
    School Intervention initiative would provide a more comprehensive
    approach to improving high school education and increasing student
    achievement, especially the achievement of those most at-risk of
    educational failure and dropping out.

    Interest Subsidy Grants...........................................   1.5

        Program finances interest subsidy costs of a portfolio of higher
    education facilities loans guaranteed under Federal agreements with
    participating institutions of higher education. Balances from prior
    year appropriations are sufficient to cover all remaining obligations.

    Javits Gifted and Talented Education..............................  11.0

        Primarily supports research and demonstration grants, but these
    grants are not structured to assess program effectiveness and identify
    successful intervention strategies that could have broad national
    impact. Only research programs that can be held accountable to rigorous
    standards warrant further investment.

    Leveraging Educational Assistance Partnerships....................  65.6

        Program has accomplished its objective of stimulating all States to
    establish need-based postsecondary student grant programs, and Federal
    incentives for such aid are no longer required. State grant levels have
    expanded greatly over the years, and most States significantly exceed
    the statutory matching requirements. State matching funds in academic
    year 1999-2000, for example, totaled nearly $1 billion or more than
    $950 million over the level generated by a dollar-for-dollar match.

    Literacy Programs for Prisoners...................................   5.0

        Provides competitive grants to State and local correctional
    agencies and correctional education agencies to support programs that
    reduce recidivism through the improvement of ``life skills.'' Request
    is consistent with the Administration's effort to eliminate small
    programs that have only indirect or limited effect.

                                                                    Millions
    Mental Health Integration in Schools..............................  $5.0

        Makes competitive grants to increase student access to mental
    health care by linking school systems with the mental health system.
    The request is consistent with the Administration's effort to increase
    resources for high-priority programs by eliminating small, narrow
    categorical programs that duplicate other programs, have limited
    impact, or for which there is little or no evidence of effect.

    Migrant and Seasonal Farmworkers..................................   2.3

        Supports rehabilitation services to migratory workers with
    disabilities, but such activities may be funded through the VR State
    Grants program.

    National Writing Project..........................................  20.3

        Supports a nationwide nonprofit educational organization that
    promotes K-16 teacher training programs in the effective teaching of
    writing. States may support such activities through flexible programs
    like Improving Teacher Quality State Grants. Rated Results Not
    Demonstrated by the PART review due to lack of reliable performance or
    evaluation data on the effectiveness of supported interventions.

    Occupational and Employment Information...........................   9.3

        This career guidance and counseling program has a narrow purpose
    and no demonstrated results. The PART review of this program rated it
    Results Not Demonstrated, largely due to a lack of data on program
    outcomes.

    Parental Information and Resource Centers.........................  41.9

        Parent education and family involvement activities are required and
    funded under other ESEA programs, such as Title I Grants to Local
    Educational Agencies, and are a specifically authorized use of funds
    under ESEA Title V-A State Grants for Innovative Programs. The PART
    review of this program rated it Results Not Demonstrated, partly
    because of its unclear statutory purposes.

    Projects With Industry............................................  21.6

        PWI projects help individuals with disabilities obtain employment
    in the competitive labor market. VR State Grants serves the same target
    populations and may provide the same services. Rated Adequate by the
    PART process but also determined to be duplicative of the much larger
    VR State Grants program. In addition, data reliability problems
    undermine accurate assessment of program performance.

    Ready to Teach....................................................  14.3

        This program supports competitive grants to nonprofit
    telecommunications entities to carry out programs to improve teaching
    in core curriculum areas, and to develop, produce, and distribute
    innovative educational and instructional video programming. State
    Grants for Innovative Programs and Improving Teacher Quality State
    grants provide ample resources for the types of activities supported by
    this program.

    Recreational Programs.............................................   2.5

        Supports projects that provide recreation and related activities
    for individuals with disabilities to aid in their employment, mobility,
    independence, socialization, and community integration. The program has
    limited impact, and such activities are more appropriately financed by
    State and local agencies and the private sector.

    Regional Educational Laboratories.................................  66.1

        Recent reauthorization did not make needed improvement in structure
    and function of the Regional Educational Laboratories, which have not
    consistently provided high quality research and development products or
    evidence-based training and technical assistance.

    Safe and Drug-Free Schools and Communities State Grants........... 437.4

        Provides formula grants to States to help create and maintain drug-
    free, safe, and orderly environments for learning in and around
    schools. The program has not demonstrated effectiveness and grant funds
    are spread too thinly to support quality interventions. The
    Administration proposes to redirect some of the program's funds to
    provide an increase for Safe and Drug-Free Schools National Programs,
    which is better structured to support quality interventions, and to
    permit grantees and independent evaluators to measure Safe and Drug-
    Free Schools and Communities State Grants progress, hold projects
    accountable, and determine which interventions are most effective. The
    Administration's Performance Assessment Rating Tool (PART) rated this
    program as Ineffective in 2004.

                                                                    Millions
    School Dropout Prevention.........................................  $4.9

        Significantly higher funding for dropout prevention and re-entry
    programs available through Title I Grants to LEAs, Title I Migrant
    State Grants, and State Grants for Innovative Programs makes this
    program unnecessary. Also, at the 2006 request level, States are
    required to reserve approximately $110 million from their Title I
    allocation for purposes of helping students stay in school and make the
    transition to public schools from local corrections facilities and
    community day programs.

    School Leadership.................................................  14.9

        Program supports recruiting, training, and retaining principals and
    assistant principals--activities that are specifically authorized under
    other, much larger programs such as Improving Teacher Quality State
    Grants and State Grants for Innovative Programs.

    Smaller Learning Communities......................................  94.5

        A separate program is not needed for the purpose of creating
    smaller learning communities. The number of fundable applications for
    grants under the 2004 competitions dropped significantly and the
    Department lapsed more than $26.4 million from the fiscal year 2003
    program appropriation. One likely reason for the low level of interest
    in the program is the lack of compelling evidence on the effectiveness
    of the smaller learning communities strategy in strengthening high
    school education and raising achievement. The creation or expansion of
    smaller learning communities in large high schools may be supported by
    Title I Grants to Local Educational Agencies or State Grants for
    Innovative Programs--the latter of which specifically authorizes the
    creation of smaller learning communities. Also, the President's
    proposed new High School Initiative will give educators greater
    flexibility to design and implement approaches for improving the
    achievement of high-school students.

    Star Schools......................................................  20.8

        Supports distance education projects to improve instruction in a
    variety of curricular areas. Programs such as State Grants for
    Innovative Programs and Improving Teacher Quality State grants provide
    ample resources for these activities.

    State Grants for Incarcerated Youth Offenders.....................  21.8

        Formula grants to State correctional agencies assist and encourage
    incarcerated youth to acquire functional literacy skills and life and
    job skills. Request is consistent with the Administration's effort to
    eliminate small programs that have only indirect or limited effect on
    improving student outcomes.

    Supported Employment State Grants.................................  37.4

        Program has accomplished its goal of developing collaborative
    programs with appropriate public and private nonprofit organizations to
    provide supported employment services for individuals with the most
    significant disabilities. Supported employment services are also
    provided by the VR State Grants program.

    Teacher Quality Enhancement.......................................  68.3

        Program provides funds to improve recruitment, preparation,
    licensure, and support for teachers by providing incentives,
    encouraging reforms, and leveraging local and State resources to ensure
    that current and future teachers have the necessary teaching skills and
    academic content knowledge to teach effectively. All of the activities
    allowable under the Teacher Quality Enhancement program can be carried
    out under other existing Federal programs. Rated Results Not
    Demonstrated by the PART process due to lack of performance data and
    program design deficiencies.

    Tech-Prep Demonstration...........................................   4.9

        This program to establish secondary technical education programs on
    community college campuses has narrow and limited impact. The
    Administration's proposed $1.2 billion High School Initiative will give
    educators greater flexibility to design and implement programs that
    best meet the needs of their students, including Tech-Prep programs.
    States could use funds to support vocational education, mentoring and
    counseling programs, partnerships between high schools and colleges, or
    other approaches.

                                                                    Millions
    Tech-Prep Education State Grants..................................$105.8

        A separate State grant program to support State efforts to develop
    structural links between secondary and postsecondary institutions that
    integrate academic and vocational education is unnecessary. The
    Administration's proposed $1.2 billion High School Initiative will give
    educators greater flexibility to design and implement programs that
    best meet the needs to their students. States could use funds to
    support vocational education, mentoring and counseling programs,
    partnerships between high schools and colleges, or other approaches.

    Thurgood Marshall Legal Educational Opportunity Program...........   3.0

        Program provides minority, low-income or disadvantaged college
    students with the information, preparation, and financial assistance
    needed to gain access to and complete law school study. Disadvantaged
    individuals can receive assistance through the Department's student
    financial assistance programs.

    TRIO Talent Search................................................ 144.9

        Provides grants to colleges to encourage disadvantaged youth to
    graduate from high school and enroll in a postsecondary education
    program. The proposed new High School Intervention initiative would
    provide a more comprehensive approach to improving high school
    education and increasing student achievement, especially the
    achievement of those most at-risk of educational failure and dropping
    out. Talent Search received a Results Not Demonstrated PART rating due
    to a lack of data on key performance measures and no evaluation
    findings.

    TRIO Upward Bound................................................. 312.6

        Provides grants to colleges to support intensive academic
    instruction for disadvantaged high school students and veterans to
    generate the skills and motivation needed to pursue and complete a
    postsecondary education. The proposed new High School Intervention
    initiative would provide a more comprehensive approach to improving
    high school education and increasing student achievement, especially
    the achievement of those most at-risk of educational failure and
    dropping out. Upward Bound received an Ineffective PART rating due to a
    lack of data on key performance measures and evaluation results that
    found the program has limited overall impact because services are not
    sufficiently well targeted to higher-risk students.

    Underground Railroad Program......................................   2.2

        Provides grants to non-profit educational organizations to
    establish facilities that house, display, and interpret artifacts
    relating to the history of the Underground Railroad, as well as to make
    the interpretive efforts available to institutions of higher education.
    The program has largely achieved its original purpose.

    Vocational Education National Programs............................  11.8

        The program's activities, which include research, assessment,
    evaluation, dissemination, and technical assistance, would be addressed
    as part of the Administration's proposed High School Initiative for
    ensuring that secondary students improve their academic achievement and
    graduation rates.

    Vocational Education State Grants................................1,194.3

        Funds would be redirected to support a new comprehensive strategy
    for improving the effectiveness of Federal investments at the high
    school level and for a community college access initiative. The High
    School Initiative will give educators greater flexibility (coupled with
    enhanced accountability) to design and implement programs that best
    meet the needs of their students. States could use funds to support
    vocational education, mentoring and counseling programs, partnerships
    between high schools and colleges, or other approaches.

    Women's Educational Equity........................................   3.0

        Activities promoting educational equity for girls and women may be
    supported through larger, more flexible programs like ESEA Title V-A
    State Grants for Innovative Programs.

                   PROPOSED REDUCTIONS TO EDUCATION PROGRAMS

        Then there's almost $1 billion in program reductions, so we
    need to know the specifics there, again. There are new
    initiatives which we will consider very, very carefully, $2.325
    billion, but those are some of the places where we're going to
    need to start.
        [The information follows:]

              Programs Proposed for Reduction in Fiscal Year 2006

                                  EDUCATION DEPARTMENT DISCRETIONARY BUDGET, DECREASES
                                                 [Dollars in thousands]
    ----------------------------------------------------------------------------------------------------------------
                                                                                             2006 request over 2005
                                                                     2005          2006           appropriation
                              Program                           appropriation    request   -------------------------
                                                                                               Amount      Percent
    ----------------------------------------------------------------------------------------------------------------
    ESEA:.....................................................
        Indian Education National Activities..................        $5,129        $4,000      -$1,129        -22.0
        Education for Native Hawaiians........................        34,224        32,624       -1,600         -4.7
        Impact Aid Construction...............................        48,544        45,544       -3,000         -6.2
        Alaska Native Education Equity........................        34,224        31,224       -3,000         -8.8
        Advanced Credentialing................................        16,864         8,000       -8,864        -52.6
        Physical Education Program............................        73,408        55,000      -18,408        -25.1
        State Grants for Innovative Programs..................       198,400       100,000      -98,400        -49.6
                                                               -----------------------------------------------------
          Total, ESEA.........................................       410,793       276,392     -134,401        -32.7
                                                               =====================================================
    IDEA:
        IDEA Technical Assistance & Dissemination.............        52,396        49,397       -2,999         -5.7
        IDEA Technology and Media Services....................        38,816        31,992       -6,824        -17.6
        IDEA State Personnel Development......................        50,653   ...........      -50,653       -100.0
                                                               -----------------------------------------------------
          Total, IDEA.........................................       141,865        81,389      -60,476        -42.6
                                                               =====================================================
    Postsecondary:
        National Technical Institute for the Deaf.............        55,344        54,472         -872         -1.6
        Strengthening Alaska Native & Native Hawaiian Serving         11,904         6,500       -5,404        -45.4
         Institutions.........................................
        TRIO Other............................................        13,335         3,625       -9,710        -72.8
                                                               -----------------------------------------------------
          Total, Postsecondary................................        80,583        64,597      -15,986        -19.8
                                                               =====================================================
    All Other ED Programs:
        Helen Keller National Center..........................        10,581         8,597       -1,984        -18.8
        Research & Innovation in Special Education............        83,104        72,566      -10,538        -12.7
        VR Assistive Technology...............................        29,760        15,000      -14,760        -49.6
        VR Demonstration and Training.........................        25,607         6,577      -19,030        -74.3
        Adult Basic & Literacy Education State Grants.........       569,672       200,000     -369,672        -64.9
                                                               -----------------------------------------------------
          Subtotal, Other ED Programs.........................       718,724       302,740     -415,984        -57.9
                                                               =====================================================
    S&E: Program Administration...............................       419,280       418,992         -288         -0.1
                                                               -----------------------------------------------------
          Subtotal, S&E.......................................       419,280       418,992         -288         -0.1
                                                               -----------------------------------------------------
          Total, All Other ED.................................     1,138,004       721,732     -416,272        -36.6
                                                               -----------------------------------------------------
          Total, Decreases....................................     1,771,245     1,144,110     -627,135        -35.4
    ----------------------------------------------------------------------------------------------------------------

                        PROGRAM REDUCTIONS (DESCRIPTION)

    No Child Left Behind (NCLB):                                    Millions
        Indian Education National Activities..........................  $4.0

        The request provides $4.0 million for National Activities, which
    funds research, evaluation, and data collection designed to fill gaps
    in our understanding of the educational status and needs of Indians and
    on identifying educational practices that are effective with Indian
    students. The program also provides technical assistance to school
    districts and other entities receiving Indian Education formula and
    discretionary grants.

                                                                    Millions
        Education for Native Hawaiians................................ $32.6

        The Education for Native Hawaiians program provides supplemental
    education services and activities for Native Hawaiians, many of whom
    perform below national norms on achievement tests of basic skills in
    reading, science, and math. Grants support a variety of authorized
    activities. Other Department elementary and secondary education
    programs, particularly the State formula grant programs, also support
    improved achievement for Native Hawaiians. The proposed $1.6 million
    reduction in funding reflects the elimination of two one-time grants
    included in the 2005 appropriation.

        Impact Aid Construction.......................................  45.5

        School districts also generally pay for most of their school
    construction costs using their own resources and rely on property taxes
    to finance these costs. Districts affected by Federal operations have
    limited access to those sources of funding. The $45.5 million proposed
    for Construction would provide both formula and competitive grants to
    school districts. Formula grants assist districts with large
    proportions of military dependent students and students residing on
    Indian lands. Competitive grants focus on helping LEAs make emergency
    renovations and modernization upgrades. The request is reduced by $3
    million in funding reflecting a one-time project in fiscal year 2005.

        Alaska Native Education Equity................................  31.2

        The Alaska Native Education Equity program provides educational
    services to meet the special needs of Native Alaskan children. By
    statute, a portion of funds must be awarded annually to specific
    entities. The remaining funds support competitive grants for teacher
    training, student enrichment, and other activities that address the
    special needs of Alaska Native students in order to enhance their
    academic performance. Other Department elementary and secondary
    education programs, particularly the State formula grant programs, also
    support improved achievement for Alaska Native students. The proposed
    $3 million reduction reflects the elimination of two one-time grants
    included in the 2005 appropriation.

        Advanced Credentialing........................................   8.0

        This program supports the development of advanced credentials based
    on the content expertise of master teachers. Funds also support related
    activities to encourage and support teachers seeking advanced
    credentials. The 2006 request would support the American Board for the
    Certification of Teacher Excellence's development of an Initial
    Certification and a Master Certification to give States and districts
    more options for improving teacher quality and, most importantly,
    raising student achievement. The reduced request reflects the
    Department's decision not to extend its 5-year grant to the National
    Board for Professional Teaching Standards beyond the additional year of
    funding directed in the fiscal year 2005 appropriation.

        Physical Education Program....................................  55.0

        This program provides competitive grants to local educational
    agencies and community-based organizations to pay the Federal share of
    the costs of initiating, expanding, and improving physical education
    programs (including after-school programs) for students in kindergarten
    through 12th grade, in order to make progress toward meeting State
    standards for physical education. Funds may be used to provide
    equipment and other support enabling students to participate in
    physical education activities and for training and education for
    teachers and staff. The 2006 request includes funds to pay for
    continuation costs for physical education grants, as the first year of
    a 2-year phase out of the program in order to redirect resources to
    higher-priority activities.

        State Grants for Innovative Programs.......................... 100.0

        This program provides flexible funding to State and local
    educational agencies for a wide range of authorized activities serving
    all students. Examples include reducing class size, professional
    development, funding Title I supplemental educational services, and
    creating smaller learning communities. The reduced request reflects a
    decision to redirect funding to higher-priority activities that are
    better targeted to national needs and have stronger accountability
    mechanisms.

    Individuals with Disabilities Education Act (IDEA):

                                                                    Millions
        IDEA Technical Assistance and Dissemination................... $49.4

        This program provides technical assistance and disseminates
    materials based on knowledge gained through research and practice. The
    proposed reduction reflects a restructuring of funding for technical
    assistance. This request is in addition to the separate $5 million
    request for a Transition Initiative and $10 million to be set-aside
    under the Grants to States program under a newly authorized technical
    assistance authority to help States meet data collection requirements.
    These other sources of funding for technical assistance will free up
    funds under this program for activities to help States, local
    educational agencies, teachers, parents, and others to implement the
    Individuals with Disabilities Education Improvement Act of 2004.

        IDEA Technology and Media Services............................  32.0

        This program supports research, development, and other activities
    that promote the use of technologies in providing special education and
    early intervention services. Funds are also used for media-related
    activities, such as providing video description and captioning of films
    and television appropriate for use in classrooms for individuals with
    visual and hearing impairments and improving accessibility to textbooks
    for individuals with visual impairments. The proposed reduction
    reflects the elimination of funding for one-time projects funded in
    2005.

        IDEA State Personnel Development..............................     0

        No funds are requested for the State Personnel Grants program,
    newly authorized by the Individuals with Disabilities Education
    Improvement Act of 2004, because the entire fiscal year 2005
    appropriation remains available for obligation through September 30,
    2006. These funds will be used to support 41 continuation awards and 8
    new awards.

    Postsecondary:
        National Technical Institute for the Deaf.....................  54.5

        The request represents a decrease of $872,000 below the 2005
    appropriation reflecting completion of construction projects funded in
    2005.

        Strengthening Alaska Native & Native Hawaiian Serving
          Institutions................................................   6.5

        The request includes $6.5 million for Part A, Section 317,
    Strengthening Alaska Native & Native Hawaiian-serving Institutions to
    cover the continuation of 12 projects. No funds are requested for new
    awards. The Administration does not believe a new round of awards is
    appropriate until we have the opportunity to determine the extent of
    need and the most effective means of helping to strengthen these
    institutions. In fiscal year 2005, we are proposing to increase the
    average new award size to an estimated $500,000 and invite eligible
    applicants to propose projects with a specific focus on renovation and
    improvements to their classrooms, libraries, laboratories, and other
    instructional facilities.

    Federal TRIO Programs, Other......................................   3.6
        Staff Training................................................   2.5
        Dissemination Partnership Projects............................     0
        Evaluation....................................................     0
        Administration/Peer Review....................................   1.1

        The reduced request for TRIO activities, overall, for 2006 reflects
    the decision to shift high-school-related TRIO resources to the
    proposed High School Intervention initiative, which would provide a
    more flexible, comprehensive, and accountable approach to addressing
    the college preparation needs of high school students. The new
    initiative would help ensure that the types of services currently
    provided by programs like Upward Bound and Talent Search are part of a
    broader effort to provide students, especially those most at-risk, with
    the full range of services they need in order to succeed.
        The remaining Federal TRIO Programs would receive $369.4 million to
    maintain services for more than 420,000 low-income, first-generation
    (or disabled) individuals. Among these remaining programs, Staff
    Training, Dissemination Partnership Grants, Evaluation, and
    Administrative Expenses would be reduced by a total of $9.7 million due
    to the elimination of the Upward Bound and Talent Search programs,
    which typically comprise more than half of TRIO grants. New Staff
    Training funds, down $2.8 million from 2005, would fund 6 new awards,
    at an average funding level of $417,000, to provide nearly 2,000 TRIO
    professionals with the skills necessary to run effective projects.
    Funding for Dissemination Partnership Grants would be eliminated
    because sufficient best practices at the postsecondary level are
    already available. Evaluation funding would be temporarily reduced by
    $525,000 due to the completion of the current round of program studies.
    Funding for administrative expenses, covering peer review of new award
    applications and other expenses, including performance measurement and
    analysis, would decrease by $2 million.

    All Other ED Programs:                                          Millions
        Helen Keller National Center..................................  $8.6

        This program serves individuals who are deaf-blind, their families,
    and service providers through a national headquarters Center with a
    residential training and rehabilitation facility and a network of 10
    regional offices that provide referral, counseling, and technical
    assistance. The reduced request does not include the additional $2.0
    million earmarked for the Center in 2005, which is not expected to be
    fully expended in 2005. At the request level, the Center would provide
    direct services for approximately 95 adult clients, 12 high school
    students, and 10 senior citizens at its residential training and
    rehabilitation program and serve 2,000 individuals, 500 families, and
    1,100 agencies through its regional offices.

        Research & Innovation in Special Education....................  72.6

        This program supports research to address gaps in scientific
    knowledge in order to improve special education and early intervention
    services and results for infants, toddlers, and children with
    disabilities. The request would support investments in special
    education research to advance our understanding of early intervention
    and assessment for young children with disabilities, language and
    vocabulary development, assessment for accountability, secondary and
    postsecondary outcomes, and serious behavior disorders. The decrease is
    equivalent to the amount of funds earmarked by Congress in 2005 for
    one-time projects. This program, which received a Results Not
    Demonstrated rating following a PART analysis completed during the 2005
    budget process, was recently moved to IES as part of IDEA
    reauthorization. The new Center for Special Education Research within
    IES will develop priorities for future research, as well as a plan for
    carrying out research programs with measurable indicators of progress
    and results.

        Vocational Rehabilitation--Assistive Technology...............  15.0

        The request includes $15 million for the Alternative Financing
    Program (AFP), which provides grants to States to establish or expand
    loan programs that help individuals with disabilities purchase
    assistive technology devices and services. To date, the AFP has
    provided or facilitated loans totaling $15.5 million to 1,515
    individuals with disabilities. These loans are enabling individuals to
    acquire technology they might not otherwise be able to obtain that
    improves their quality of life and, in many cases, enables them to work
    or participate in other productive activities. No funding is requested
    for other programs authorized under the Assistive Technology Act, as
    recently revised, including the AT State grant program, the Protection
    and Advocacy (P&A) for Assistive Technology program, and National
    Activities. While States have received more than 10 years of support
    for activities under the antecedent program, the Department has been
    unable to identify and document any significant benefits. The
    Administration has proposed to discontinue funding for the AT State
    grant program and instead, as part of the New Freedom Initiative,
    support the AFP, which holds greater promise of providing tangible
    benefits to individuals with disabilities. Activities carried out under
    the AT P&A program can be carried out under the Protection and Advocacy
    of Individual Rights program.

        Vocational Rehabilitation--Demonstration and Training.........   6.6

        Demonstration and Training programs support projects that expand
    and improve the provision of rehabilitation and other services
    authorized under the Rehabilitation Act, including related research and
    evaluation activities. The request would provide a total of $6.6
    million for new activities, including $2.0 million that would be used
    to jointly fund the Transition Initiative under the Special Education
    account. The request would eliminate $8 million for one-time projects
    in fiscal year 2005.

        Adult Basic and Literacy Education State Grants............... 200.0

        The Administration requests $200 million for Adult Basic and
    Literacy Education State Grants, with the expectation that new
    authorizing legislation will be enacted in 2006. This request is
    consistent with the Administration's goal of decreasing funding for
    programs with limited impact or for which there is little or no
    evidence of effectiveness. A PART analysis of the program carried out
    as part of the fiscal year 2004 budget process produced a Results Not
    Demonstrated rating. The program was found to have a modest impact on
    adult literacy, skill attainment and job placement, but data quality
    problems and the lack of a national evaluation made it difficult to
    assess the program's effectiveness. The request for State Grants
    includes level funding for the English Language and Civics Education
    grants, which enable States experiencing high levels of immigration to
    respond to the specialized educational needs of the immigrant/limited
    English proficient population.

                                                                    Millions
    Salaries and Expenses: Program Administration.....................$419.0

        The 2006 request includes $419 million, a slight decrease of
    $300,000 from the 2005 level, for the Program Administration account,
    which funds administrative support for most programs and offices in the
    Department. The request includes $254.2 million for the 2,242 FTE, and
    $164.8 million for non-pay costs. The non-pay request includes $4.1
    million to continue implementation of the Performance Based Data
    Management Initiative, which will collect timely data on student
    achievement and educational outcomes. Other non-pay costs include rent,
    travel, data collection, evaluations, computer hardware and software
    support for the staff, and other administrative activities.

                      FOREIGN LANGUAGE ASSISTANCE PROGRAM

        Let me begin as to a question--in the minute and a half
    that I have remaining--with a letter which Senator Cochran and
    I sent to you earlier this month, which you have responded to,
    regarding the new grant competition under the Foreign Language
    Assistance Program. We're concerned that the competition does
    not reflect congressional intent in appropriating these funds;
    we intended that they would help schools offer foreign language
    instruction to their students. Will you comment on that,
    please?
        Secretary Spellings. Senator, I've just recently become
    familiar with that issue, and I am trying to get to the bottom
    of all the various local issues that undergird that, but I
    think one of the things that we at the Department are trying to
    do is to provide maximum latitude to States and local districts
    on funding, and yet hold them accountable for results, and I
    will be glad to look into that issue more--I know that you just
    received the letter, I think, late last night--so, I want to
    work with you on these issues, and I'll look forward to talking
    with the local folks in your communities who have raised their
    concerns.
        Senator Specter. As I had announced earlier, I have other
    commitments, which I'm going to have to leave for, and as I
    said earlier, Senator Harkin will take over on the hearing if
    there is no other Republican present. Let me now turn to
    Senator Harkin for questioning. Senator Harkin, you have the
    floor.

                    OPENING STATEMENT OF SENATOR TOM HARKIN

        Senator Harkin [presiding]. Madame Secretary, again, thank
    you very much for appearing before the subcommittee, I thank
    the chairman for being here, too, and in absentia, thank
    Senator Specter for his great leadership of this subcommittee.
    I was just thinking, it has been 15 years, really, that we've
    worked together as chairman and ranking member, back and forth
    on this subcommittee, and it has been a great partnership. I
    think this really is one subcommittee that has worked together
    in a true bipartisan fashion--through Republican and Democratic
    administrations--through all those years. I've really
    appreciated that working relationship that we've had,
    especially on this subcommittee.

                 PROPOSED REDUCTION IN TOTAL EDUCATION FUNDING

        I just wanted to make a couple of statements about the
    budget that has come up here. I think we have to take a look at
    where we're headed, and why we're shifting some of the monies
    around. I--first of all--think that we need to put some more
    into the budget for education. The President's budget cuts
    funding for education for the first time in 10 years--now I'd
    be glad to listen to any counters to that--and we look at No
    Child Left Behind, and we discussed this before, you can say,
    ``Well, it's funded.'' But I'm talking about what expectations
    were when we passed No Child Left Behind--which I supported at
    that time--and I think the expectation level was that we would
    be at a certain level of funding, and we're not there.
        Title I, if it were fully funded, would cover about 3
    million more children. As for special education, and kudos to
    this administration for moving ahead on funding--but the fact
    is, we still are only around 19 percent of what we had promised
    30 years ago. And, so I will continue to prod whether it's this
    administration or any other one, as I did the one before yours,
    to continue to try to get towards that 40 percent full funding
    level. So, we're still underfunded, I think, in special
    education. In Iowa--we had the Governor in yesterday talking to
    our bipartisan group, Senator Grassley and I and our
    congressional delegation--he said Iowa would stand to lose
    about $14.1 million for career and technical education, $2.4
    million for education technology, $3.4 million for safe and
    drug-free schools, $1 million for family literacy programs, and
    $1.1 million for comprehensive school reform. That's the money
    that Iowa gets now that we wouldn't get under this budget.
    Again, it comes at an especially bad time, some 11,000 schools
    across the country have been designated ``in need of
    improvement,'' meaning they failed to make adequate yearly
    progress for 2 years in a row, and now they face sanction.
    That's about twice as many schools as last year. The number
    will go up sharply next year when AYP requirements even get
    tougher, this thing keeps getting tougher, year after year.
        So with this new budget, it seems like we're again asking
    for more reforms without really getting the resources; we're
    asking local school districts to make dramatic academic gains
    at the same time that we're cutting their funding. So, I don't
    know how we can expect 11,000 schools that are in need of
    improvement to hire better teachers, to close the achievement
    gap at a time when funding is being cut.
        I looked at the $1.5 billion High School Initiative, and
    then I thought, well, you couple that with the $2.2 billion in
    cuts to other education programs--like voc ed and GEAR UP and
    TRIO and smaller learning communities and things like that--so
    it seems like we're eliminating $2.2 billion for high schools,
    and replacing it with $1.5 billion for the new High School
    Initiative, which still represents a cut to our high schools.
        The Perkins/Voc Ed Program is also one that bothers me
    greatly, because you say that this would go to other high
    school initiatives, but in Iowa, 30 percent of our Perkins
    money goes to community colleges--so it's not high school--it
    goes to community colleges. And this has been a great thing in
    Iowa for economic development and for getting skills to our
    high school students going to community colleges.
        So, anyway, these are just some of the questions that I
    have about the budget, and about the thrust of it. Have I seen
    worse? Yes. Have I seen better? Yes. So, this falls someplace
    in the middle, at least as I see it. But I'd like to just ask a
    few questions.

                       NO CHILD LEFT BEHIND REQUIREMENTS

        First of all, about No Child Left Behind, Madame Secretary,
    you've got to be aware--as we all are--that we're hearing from
    our constituents about No Child Left Behind. A lot of concerns
    about it, educators, parents, they believe the law is too
    rigid, it's narrowing the curriculum. I don't know if this is
    just anecdotal or not, but I keep hearing stories about
    schools--in order to meet the rigid requirements of hiring
    better trained teachers, and qualified teachers for curriculums
    to meet No Child Left Behind--the first person that gets fired
    is the art teacher, or the music teacher, or the P.E. teacher.
    They're the ones who are let go. So, curriculums are being
    narrowed.
        The goal of 100 percent proficiency for all sub-groups in
    all subject areas seems to me to be unrealistic for our
    schools. We see States like Virginia, talking about pulling out
    from the law, even if it means giving up hundreds of millions
    of dollars from the Federal Government. So I was kind of
    surprised to see that now we want to extend this into high
    schools. It seems to me we ought to make the system work for
    grade schools first, before we go to high schools.
        Now--I'm going to bring this to a close here--you talked
    about remedial education. We're spending all this money later
    on downstream for remedial. If you're doing this in high
    school, that's kind of remedial. If we get it early on in grade
    schools, we don't have to remediate it in high school. So, it
    would seem to me that this high school initiative--I'm not
    adamantly opposed to it--it just seems to me that this is not
    the right time to do it. It seems to me, we've got to put those
    resources more into No Child Left Behind in elementary schools.

                             HIGH SCHOOL INITIATIVE

        Last, I must say I wear another hat--I'm on the education
    authorizing committee--and you are trying to make this change
    by putting on two sentences on our Appropriations bill. I think
    that's the wrong approach. This is an authorizing measure. I
    would think that both Senator Enzi and Senator Kennedy--Chair
    and ranking member of the HELP Committee, and others of us on
    the authorizing committee--would want to have something to say
    about how we extend the No Child Left Behind Act into high
    school as an authorizing measure, rather than putting it on an
    appropriations bill.
        So, two questions, Madame Secretary. This High School
    Initiative--should we put that money back into the grade
    schools, put it into the elementary schools now, rather than
    trying to extend the law. Second, shouldn't this be done in an
    authorizing measure?
        Secretary Spellings. Thank you, Senator, you've put out
    some great points that I'm thrilled to be able to respond to.
        First, as I said in my opening statement, there is some
    urgency in high school, no doubt about it. We need to be able
    to walk and chew gum--as we would say in Texas--and that is
    attend to, and stay the course, on No Child Left Behind. That's
    why we've sustained these large growths in reading funds;
    that's why we have a $600 million increase in Title I. But we
    also need to make sure that we are getting kids out of high
    school, fully prepared to either be successful in the work
    place or in college. I think we can, and we must, do both.
        Let me speak to the philosophy of this budget, overall, and
    that is--and this was at play, certainly, in the design and
    development of No Child Left Behind--and it is that we need to
    be very clear with States about what our expectations are, and
    then give them a lot of latitude in results, with respect to
    resources. That's why these 45 programs have been proposed for
    elimination, because the President believes that they do not
    represent, necessarily, either a critical mass, or have not, in
    all cases, been an effective use of resources.
        So the vision here is to create a new high school program
    in Title I, be clear with States about what we expect, and if
    they're getting great results with vocational education, or
    TRIO, or GEAR UP, or technology or whatever, there certainly is
    no impediment to doing that. And I'm confident--having
    represented local school boards--that when those programs get
    results for kids, they will. But I think the same people who
    are talking to you about the need for flexibility in No Child
    Left Behind, talk to me about how we prescribed a lot of
    particular, specific programs--with particular grant
    application processes, deadlines and so forth--and we are too
    much in their way with respect to managing their dollars. The
    National Governors Association just this weekend, as I said,
    met. This was one of the things they have called for. That's
    why we believe that the assessment and the measurement and the
    accountability is so critical, but let's give them more
    flexibility with respect to managing resources.

                USE OF AUTHORIZING AND APPROPRIATIONS PROCESSES

        As to the issue of the authorizing versus appropriations
    matter, certainly that is something that I have spoken with
    Senator Enzi and Senator Kennedy about--as you are well aware--
    we have the Perkins reauthorization before us, the Higher
    Education Act before us; therefore many opportunities to tackle
    some of those policy matters, rightfully, on the authorizing
    side as well. So, thank you for that.
        Senator Harkin. So, we could do this in the authorizing
    committee, rather than doing it in appropriations?
        Secretary Spellings. Well, I think the whole issue of high
    school is something that people are recognizing--within this
    body and around the country--needs attending to. Certainly
    resources, obviously, are a part of that equation, but I think
    there are some things on the policy side with respect to high
    school, such as what the expectations are, what the timelines
    are, and various other things that are going to be at issue
    here as well. This High School Assessment Initiative--though
    we've called for $250 million immediately to begin to develop
    those--we recognize it is more complicated. States are going to
    use end-of-course exams, some States will use exit exams, some
    States will use Advanced Placement exams, or other standardized
    assessments as a proxy for their assessment qualifications.
    It's going to take time. We don't envision this being fully
    implemented until 2009, 2010 when the first entering class of
    No Child Left Behind kids would have made it through the
    pipeline, if you will. So, there are a lot of things that are
    at play from a policy point of view, in addition to the
    resources that are needed here, from this committee.
        Senator Harkin. I still think we're going to have to
    examine this under authorization, rather than just
    appropriations.
        Let me just ask one question more, and then I'll go over to
    Senator Kohl. When the President says you're going to spend the
    taxpayers' dollars, it ``ought to be spent wisely, or not spent
    at all.'' Of course, that raises the question: Whose wisdom?
    Ours or yours?

                             STUDENT LOAN PROGRAMS

        But, there is one thing I want to bring to your attention,
    and that has to do with the student loan program, about
    spending money. Quite frankly, I think a lot of your proposals
    make a lot of sense on the student loan program. You're
    proposing to use the savings to increase Pell Grants--that's
    good--so I applaud that, I think you're headed in the right
    direction. But, I just want to bring something else to your
    attention. Even if we adopt your recommended changes to the
    student loan programs, your own budget documents, and I refer
    here to page 371, specifically, of the budget appendix, show
    that the cost to taxpayers--of each $100 lent under the Federal
    Family Education Loans, the FFEL program--it costs $8.91 in
    taxpayer subsidies. That's your own budget. On the other hand,
    your documents show that each $100 lent under the Direct Loan
    Program makes a profit of $2.06 to the taxpayers. In other
    words, returning $2.06 to the Treasury. Well, that means a
    student with total subsidized loans of $17,000--which is about
    the average debt of a student finishing a 4-year college right
    now, we're just taking averages--under the FFEL Program, that
    costs the Government, taxpayers, $1,514, to be exact. The same
    loans to a student in the Direct Loan Program makes a profit of
    $360. So, Madame Secretary, given these facts--and the
    continuing need to find the monies for increasing Pell Grants,
    and other student aid for disadvantaged students--shouldn't we
    be doing everything we can to encourage colleges to join the
    Direct Loan Program?
        Secretary Spellings. Well, certainly, Senator, that's
    obviously an option before them. I think our proposal has
    attempted to look at the broad range of financial aid
    services--how we manage it--from Perkins loans at 5 percent
    interest rates, to a 3 point something or other average rate in
    Direct Lending and the FFEL Program, and to look at this in a
    more efficient, effective way--we've had a transformation, if
    you will, of the financial services industry, elimination of
    the middle man in some cases, different relationships between
    universities and students and the Federal department and banks,
    and others--and we believe that there are efficiencies and
    savings to be drawn by looking at those programs broadly. To
    the tune of about $30 billion over 10 years, I believe,
    eliminating that short fall once and for all, and applying
    those efficiencies, those savings toward student aid. I think
    we will, maybe, have discussions about how to turn the various
    dials across the spectrum of financial aid, and how the loan
    program balances with resources towards grants--our neediest
    students--that's why the President has put a high priority on
    Pell. But, there's lots of room to talk about it, as you know,
    we have a laundry list of various proposals which range from, I
    think, $6 billion at the high end, we've called for variable
    interest rates, and a whole laundry list of proposals for your
    consideration.
        Senator Harkin. Madame Secretary, I appreciate that, I
    just, again, I look at the table. I was quite amazed when you
    look at the cost--from the Direct Loans, $2.06 back to the
    Treasury, $8.91 in subsidies out after all of those things you
    just talked about, which is fine, and good, you still have this
    problem. You still have money not being wisely spent by the
    Government. We hear all these stories about these lending
    institutions flying their student, college directors down for
    vacations and cruises and all kinds of different things, and
    they wine them and dine them, but it seems to me with this kind
    of data that we now have, that your Department ought to be
    forthright in just saying to colleges, ``Look, we want to save
    the taxpayers' money. We want to spend the money wisely, get in
    the Direct Loan Program.''
        Secretary Spellings. We certainly, obviously, have
    supported the Direct Loan Program, and will continue to do
    that, and as institutions around the country see the merit of
    that we stand ready to assist them. But again, it's a place
    where we've sort of had a local control attitude about
    financing higher education, as we all have together.
        Senator Harkin. I don't mind local control, this is Federal
    tax dollars. The States, if they want to waste their money that
    way let them, but we have our obligation on the Federal level.
        Secretary Spellings. Right, I appreciate that.
        Senator Harkin. But, I'm glad to hear what you just said,
    that's very important. Thanks, Madame Secretary. Senator Kohl.
        Senator Kohl. Thank you very much, Senator Harkin,
    Secretary Spellings.

               PROPOSED ELIMINATION OF VOCATIONAL EDUCATION FUNDS

        The President's budget eliminates, as you know, funding for
    Perkins on the grounds that it is ineffective, and that the
    money would be better used in the K-12 system. I've talked to
    Brent Smith in Wisconsin who is Chair of the Wisconsin
    Technical College Board, and he raises an important issue that
    you ought to consider.
        The Chair says that he notes today that the average age of
    a Wisconsin technical college student is 29. These students
    have moved beyond the K-12 system, so any diversion of Perkins
    funding to K-12 would be of no help to them, obviously. And
    these older students face other obstacles besides a lack of
    academic preparation. Some are returning to school after years
    in the work force, some are pursuing highly technical degrees,
    while others are economically disadvantaged; either single
    parents, dealing with a disability, or learning English for the
    first time. That's why Wisconsin technical colleges use their
    Perkins money so well to help their students meet these unique
    challenges. They've been successful, as the vast majority
    graduate, and obtain high-skill, high-wage jobs.
        Brent Smith and the Wisconsin Technical College System
    would like to know, without Perkins, how does the Department
    expect that technical colleges will serve the current
    generation of adult Americans--most of whom are well beyond
    their K-12 years--and who need help right now?
        Secretary Spellings. Thank you, Senator, for that question.
    Let me first say that I am a former vocational education
    student myself, so I do have appreciation for what they do.
        Our budget--with respect to the split between the community
    college funding that they received from Perkins, and the high
    school level of funding--we have attempted to accommodate that
    to make them whole within either the Labor Department budget,
    or in this budget. So, by our math, the funding for vocational
    education for high schools, and for community colleges, is
    about the same. We've called for a community college expansion
    initiative of $250 million in the Labor Department budget, $125
    million for a Community College Access Grant to support more
    articulation between high schools and community colleges, and
    so forth. So, while it's a different kind of allocation of
    resources, we do believe those funding levels are approximately
    the same. As I said--I don't know if you were in the room a
    minute ago--we believe, the President's notion of how we fund
    high schools and community colleges is that we ought to be
    clear with folks about what we expect and then allow them to
    direct resources as they see fit, to a particular goal, with
    accountability attached. I'm very confident that--in places
    like Wisconsin where those vocational education programs are
    getting demonstrable results for students--that they will be
    supported by local school boards, and State officials. So long
    as we know what the data shows. But, I think what we've heard
    over and over again, even as recently as this last weekend,
    with the National Governors Association, is that for too many
    kids, high schools are not working. Particularly for those at
    the low end of the system, if you will.
        Senator Kohl. Are you saying that the Perkins money has not
    been cut?
        Secretary Spellings. I'm saying that we've put the Perkins
    money in a high school title----
        Senator Kohl. I know, but as I point out in my question, it
    doesn't help the person enrolled in the community college, the
    vocational college, to get advanced training, it doesn't help
    that person at all, who needs that training, who's out there
    today, to allocate more money to high schools. That person, as
    you know, is obviously way beyond high school.
        Secretary Spellings. Right.
        Senator Kohl. The Perkins money does serve a very
    important, useful purpose. It's used well to train these people
    who are beyond high school, to get back into the work force.
    So, I'm not sure if I understand your answer.

                         FUNDING FOR COMMUNITY COLLEGES

        Secretary Spellings. Let me clarify. And that's why the
    President has called for additional resources for community
    colleges--to serve the type of individual you just mentioned
    through a $250 million plus-up and a partnership grant between
    local employers, community colleges, and the private sector, as
    well as an additional $125 million for community colleges in
    this Community College Access grants program. So, while they
    might not be served through the Perkins program, we do believe
    we've provided resources to community colleges, to allow them
    to continue to serve the type of student that you've just
    spoken about.

                           VOCATIONAL EDUCATION FUNDS

        Senator Kohl. The Perkins program was $1.3 billion. Now,
    you've talked about $100 or $200 million. Now, to my way of
    figuring, that's not a tradeoff.
        Secretary Spellings. Under the current Perkins program, as
    you know, some of the resources are in the K-12 system, and
    some of the resources are in the postsecondary system, and we
    have attempted to take the level of resources, approximately,
    from Perkins, that support high school, and put it in a high
    school initiative. Likewise, those resources that are serving
    postsecondary students have been applied to other community
    college programs to support those type of individuals.
        Senator Kohl. I appreciate what you're saying, I think if
    Brent Smith--who is Chair of the Wisconsin Technical College
    System--were here, he would be looking at you as quizzically as
    I am, trying to figure out what it is you're saying that will
    really help him as the Chair of the Wisconsin Technical College
    Board, what's going to help him in trying to do his job. I
    think there is clearly a net minus of money that we're talking
    about here, of significant proportions. I recognize money is
    scarce, and we can't do everything we want. But, I think what
    you're telling me is they won't get the kind of money that they
    have gotten heretofore. He is saying, as Chair, that they will
    really, really miss that money, because it is being used very
    well to help people that are post-high school, educate
    themselves to get into the work force. That's clearly what he
    would be saying.

                                  PELL GRANTS

        Secretary Spellings. I appreciate that point of view. I do
    want to mention a couple of other things that are on point for
    the students you are talking about, and that is the enhancement
    of Pell--more than half of the students that are in community
    colleges are Pell recipients--and we've also called for
    allowing that financial aid to be used year round, and for
    short-term training for individuals like those you've spoken
    of, to get the necessary skills to re-enter the work force.

                     PELL GRANT ELIGIBILITY AND TAX TABLES

        Senator Kohl. All right, well, let me talk about Pell for a
    minute. Last month most of our delegation from Wisconsin wrote
    the President about an issue involving Pell Grants.
        Specifically, the Department of Education is making
    immediate changes to the tax tables that determine eligibility
    for Pell Grants, as you know. As many as 5,500 Wisconsin
    students--who today get Pell Grants--could completely lose
    them, and thousands more will see their Pell Grants reduced.
    While I agree we need to use accurate tax information to
    determine eligibility, we need to remember that this will
    affect students who are in school today, and are counting on
    Pell Grants to remain in school. It would be unfair to change
    the rules, I think, in the middle of the game, and I think at
    the very least, we should all agree not to take money away from
    students who are, today, relying on the Pell Grants that they
    are getting. So, will you be able to work with us to see to it
    that Wisconsin--as well as Pell Grant recipients from other
    States, will not entirely lose their Pell Grant money, in the
    middle of their college education?
        Secretary Spellings. Let me react to that issue, on the tax
    tables. This Congress required the Department of Education to
    update these State tax tables that have not been done since, I
    believe, the late 1980s, or so, so it's been quite a while, and
    that's why the impact was more severe than it normally would
    have been, had we updated them more recently than that.
        My understanding is that the average award for those
    students is about $400 a year, and many of the folks that would
    be affected are first-time recipients, so they haven't received
    the aid yet. So, we do obviously struggle with this issue; we
    need to have the most accurate information available to fund
    these programs. But the way we've chosen to approach it in this
    budget is to increase the Pell award, to align this rigorous
    course of study to the Pell scholars, to allow for short-term
    training, to allow for year-round aid and so forth. But, I
    think we've righted the ship on the updated tax table once and
    for all, and we need to do it more consistently, and keep it
    current as we go forward, so that it will minimize the
    unfortunate effect that it had this time.
        Senator Kohl. I do appreciate that, but we apparently have
    a difference of opinion--and we could probably straighten it
    out if we looked more carefully at the facts--according to my
    information, as many as 5,500 in Wisconsin who are getting Pell
    Grants today could lose them--totally, or in part--as a result
    of this change. Now, you've said that's not so.
        Secretary Spellings. I'm not saying it's not so, I'm saying
    that my understanding is that the average award is quite small,
    and some number--I'm not sure that those people will have lost
    aid--I'll just have to look at Wisconsin's particular
    situation.
        Senator Kohl. Yes.
        Secretary Spellings. I'd be delighted to do that.
        Senator Kohl. Would you do that?
        Secretary Spellings. Sure.
        Senator Kohl. I would greatly appreciate it.
        Secretary Spellings. Sure.
        Senator Kohl. I thank you so much. Thank you, Senator
    Harkin.
        [The information follows:]
        Impact on Wisconsin Pell Grant Recipients of Revised Tax Tables
        Under the revised tax tables, 1,486 students--or 2 percent--of the
    72,252 Wisconsin students projected to receive Pell Grants under the
    previous tables would not receive grants in academic year 2005-2006.
    Projected Pell Grant awards in Wisconsin would be reduced by $4.1
    million under the revised tax tables. Based on national trends, the
    average amount lost per student is $131; awards to the neediest
    students, who qualify for the maximum Pell Grant, would be unaffected
    by the revised tables.

                  PROGRAM REDUCTIONS AND DEPARTMENTAL STAFFING

        Senator Harkin. Thanks, Senator Kohl. I just have three or
    four more questions, Madame Secretary.
        The budget proposes to eliminate 48 education programs, and
    create 12 new ones, for a cut of 36 programs. Well, that's a
    lot of programs that your Department will no longer have to
    administer. And yet, the reduction in work is not reflected in
    the number of employees at the Department of Education.
        For example, under the President's budget, the Office of
    Vocational and Adult Education would practically disappear.
    Seven of the 10 existing programs would be eliminated, for a
    funding cut of almost 90 percent. From $2 billion to $216
    million. And yet, the number of full-time employees for this
    office would drop by just 3 percent. From 121 to 117. I guess,
    my question is, why do you need practically the same number of
    employees to do a tiny fraction of the work? Why isn't that
    also reflected in the budget?
        Secretary Spellings. Well, Senator, that's something
    certainly that we would take a look at. I do think that we
    would envision having folks with that kind of capability
    provide technical assistance on the high school side, so while
    it's not a one-to-one correlation, we certainly would look at
    the staffing levels that are appropriate to support the new
    world order.
        I do want to mention one thing, and that is, of the 48
    programs that we've called for elimination of, about 15 of them
    are $5 million or less. And I think we would agree that it's
    hard to have a program with a national scope for a small amount
    of money. The remainder of them are about $40 million or less,
    so they are typically fairly small programs of a few million
    dollars, and 15 of the programs are $5 million or less.

                    SUMMARY STATEMENT OF HON. THOMAS SKELLY

        Mr. Skelly. Senator, I would just add, on the vocational
    education programs, many of those get funding that becomes
    available only in July. The 2005 Appropriations bill that you
    already passed this year, would provide funding beginning in
    July, and indeed in October 2005. We still need the staff in
    that office to obligate that money and make sure that it's well
    spent, under the existing law.
        The reason we had such a small reduction in employees in
    the 2006 budget, was that most of the work will still go on
    under the 2005 appropriation. We'll only see the savings from
    elimination of funding for those programs in 2007 and 2008.
        Senator Harkin. You're saying you have to last for 1 full
    year that we have the program, when it's a 90 percent cut and
    we're going to keep on 117 people to administer that, it
    doesn't sound right.
        Mr. Skelly. Again, it's going to take time to phase out all
    of the work. Part of the work of these employees is not just
    obligating the money each year, it's looking at what happens
    with the grants that were awarded in prior years, it's closing
    out those grants; there will be some work involved if Congress
    were to accept the proposal to eliminate the programs and just
    working all of that out. So, eventually there will be a drop in
    the staff, as these programs are eliminated. It just won't
    happen starting October 1, 2005 when this fiscal year begins.
    There will be a lot of work, still, for a good part of fiscal
    year 2006.
        Senator Harkin. Well, that's a pretty good answer. But it
    seems to me that there's going to be a period of time where
    you're going to have a lot of employees, looking back and
    assessing a program that's no longer in existence. If it's no
    longer in existence, why assess it? Why have employees looking
    back, assessing how a program worked, if you no longer have the
    darn thing?
        Secretary Spellings. Senator, that's certainly something
    that we would work with you on about what the right levels of
    staffing that are needed to support----
        Senator Harkin. Again, that's why we look at the budgets
    and we say, ``Well, you can do all this, we've got to see some
    drop in employees, also. Unless this is not a serious
    proposal.'' If it's a serious proposal, it ought to be done
    also with a cut in the employees also.

                         ELIMINATION OF SMALL PROGRAMS

        Now, can I just respond--just a second--to what you said
    about, a lot of these small programs are $5 million, or less.
    I've often said the genius of our American educational system
    is that we have local control, where you have well springs of
    ideas and innovation and that type of thing, you don't have a
    top-down structure where everybody marches to the same tune,
    that's sort of been the genius of our American educational
    system--so that experimentation has gone on. But, there has
    been some experimentation from the Federal side, too. And some
    of these small programs are just that; they are to test things
    out. A Senator, a Congressman, or a group gets together and
    says, ``This may be a good approach, let's try it out and see
    what happens.'' Then you see if it works, TRIO program being
    one, of course that's more than $5 million, obviously, it's a
    big program, but TRIO program is cut by almost a half. Yet,
    Trio program goes back--if I'm not mistaken--maybe 1969, 1968,
    something like that. I first became familiar with that as a
    Congressman in a rural area of Iowa back in the 1970's. I'd
    never heard of the TRIO program before. And, so through all
    these years, I think that it has proven its worth, but it
    started out as a small kind of a program to test some theories.
    That you could take kids from families where neither parent had
    ever gone to college, expose them to college situations, do
    some summer school training with them, and they would be more
    apt to pursue a higher education, and that has been proven,
    we've got data to prove that, going back to 1970. So, when
    you're cutting some of these small programs--a lot of them I
    don't even know myself, I mean, they're in there, but--it gets
    back to this wisdom thing, whose wisdom? Sometimes we put those
    in there to test things out, it's like the Writing Project that
    Senator Cochran has been pushing for years. I think that it is
    a legitimate function for us to try to test these things out
    and see how they work, and see if they do, and so when some of
    these are cut, you cut them and you do away with them before
    we've even seen whether they'll work or not--maybe some will,
    maybe some won't--it is a testing ground.
        Secretary Spellings. A fair point, and I think our question
    is, then, what's the demarcation between--when have you stopped
    testing a program, and when have you had a particular kind of
    model that's set forth for local communities--and I think, as I
    said again, the President's notion here is, let's be clear
    about what we expect, let's support measuring that achievement,
    and using that data to support improvements in the system, but
    then let's give local school districts the opportunity to
    double their TRIO Program, or whatever.

                                 TRIO PROGRAMS

        Senator Harkin. Madame Secretary, local communities are not
    going to double TRIO Programs, because--I don't know, how many
    students are in TRIO now, 300,000 or 400,000, something like
    that, nationwide--so you go around the Nation, and there's just
    a few here, and a few there and a few here, and these are the
    poorest kids, usually from the poorest families, and you get
    two or three in a local district and, they have no power, they
    have no say-so. So, the local jurisdiction, the local school
    district--being pressed hard as they are right now for money,
    trying to raise funds for schools, being burdened with higher
    property taxes all the time--this is not going to be a thing
    that they're going to want to do, because it's so few. When we
    look at it from a national view--we say there's 300,000 or
    400,000 students out there that need this kind of assistance,
    that we've had the data to show that these kids are more
    successful in going on to higher education. So, I really don't
    think it's right to say that local jurisdictions will pick this
    up, it would just be so small they won't. That's why we started
    the program, that's why we've kept it up for 35 years.
        Secretary Spellings. But we have, obviously, a lot of kids
    who are in those sorts of positions and giving resources to
    school districts to design programs as they see fit--TRIO, GEAR
    UP, vocational education, technology-based programs, and so
    forth--those that are getting results for them and their kids
    is a better way to run the railroad, in the President's view.

                    PUBLICIZING THE NO CHILD LEFT BEHIND ACT

        Senator Harkin. Well, I guess I disagree with him on that.
        Let me ask you on just, a couple, three other things. This
    has to do with this Armstrong Williams case. Department of
    Education funds were used to pay political commentator
    Armstrong Williams to tout the No Child Left Behind Act. Mr.
    Williams did so without disclosing that he was being paid with
    taxpayer's dollars. I was glad to see the President made it
    clear that such an arrangement was unacceptable. So, what have
    you done since becoming Secretary to make sure this does not
    happen again, Madame Secretary? Have you made any attempt to
    recoup the funds paid to Mr. Williams from Ketchum, the PR
    company that hired him as a subcontractor?
        Secretary Spellings. The first part is, we have
    commissioned an Inspector General's investigation, which is
    underway. I expect that report very shortly, he's working hard
    to get to the bottom of all the facts--what we got, what we
    paid for, what we didn't get, what the expectations were, and
    so forth--and so I'm awaiting that information before I
    determine a course of action, obviously. Likewise, the
    Government Accountability Office is conducting two
    investigations, one of which was on an initial analysis that
    apparently the Department did on media outlets and so forth,
    and that's been responded to. Then there's another one that's
    ongoing, and our General Counsel in the Department is
    cooperating fully with that, but, we're still in the fact-
    finding mode. The President has been clear about this, and I
    have. I don't think it's acceptable for folks who represent
    themselves as journalists to be paid for punditry and it won't
    happen again.
        Senator Harkin. The President made it very clear, and I
    applaud him for that, I just wondered where you are, and you
    told me you were waiting for the IG's investigation to come in.

                 OUTREACH AND COMMUNICATION ON FEDERAL PROGRAMS

        Madame Secretary, I understand that your Department has a
    number of contracts with public relations and other similar
    firms. How much do you plan to spend on these types of
    contracts in fiscal year 2006? I don't find this anywhere in
    the budget.
        I understand you might not have that information with you,
    and if you could submit an answer for the record, I'd
    appreciate that.
        Secretary Spellings. I'd be glad to do that. I will say
    that many of the programs--in fact, some of the ones we've
    talked about today, or this morning--do call for communications
    efforts and outreach to parents, the higher ed community, and
    so on. So, I do think it's important that we not throw the baby
    out with the bath water, particularly with a new law like this
    where there are options for parents, there are needs for
    teachers to be educated, and other educators about what the law
    provides, and so forth. So, the short answer to your question
    is, I don't know how much money we'll spend on communications.
    I certainly will find out what we're looking at.
        Senator Harkin. Someplace buried in there, there's some
    budget allocation in your Department for that, and we just
    don't have it and we'd like to take a look at that.
        Secretary Spellings. We'll look into it.
        [The information follows:]

     Contracts With Public Relations Firms, Advertising Agencies, and the
                           Media in Fiscal Year 2006

        It is premature to identify at this time what will be the
    Department of Education's acquisition needs several months in the
    future, when fiscal year 2006 appropriations will be available for
    obligation. In considering future contracts, be assured that the
    Department will very carefully take into account the recommendations of
    the Inspector General and other reviews of the Department's past
    contracts to ensure compliance with all applicable laws.

                   GRANTS FOR ENHANCED ASSESSMENT INSTRUMENTS

        Senator Harkin. When we spoke some time ago, I told you--
    and at a previous hearing, I think on the Authorizing side,
    Madame Secretary--I said I was going to be like a laser beam on
    kids with disabilities, and so I'm back to that now with this
    next question.
        It's about the Grants for Enhanced Assessment Instruments
    program, which is intended to help States improve the quality
    of their tests. About $12 million will be available for this
    program in this fiscal year, 2005. In the Senate report, we
    urged the Department, when awarding grants, to give special
    attention to the needs of students with disabilities, and
    students with limited English proficiency. As you know, Madame
    Secretary, many schools have a difficult time--and we spoke
    about this--assessing the performance of these two groups.
    Often these students may have learned what they are supposed to
    have learned, but they can't demonstrate it because they aren't
    given the appropriate assessment.
        So, our report language asked the Department to put a high
    priority on grant applications that aim to improve the quality
    of the State tests for these two groups of students.
    Unfortunately, the Department seems to be ignoring this
    language. In your budget justification, it says that $12
    million will focus on the use of technology in designing State
    tests. There's nothing about students with disabilities, or
    students with limited English proficiency. So, I would
    appreciate it if you could take our Senate request into account
    when you award these grants. Perhaps there's a way to combine
    the Department's priorities with the Senate's priorities.
    Again, this is money wisely spent, there's wisdom, perhaps, on
    both sides here.
        For example, technology might be a good way to provide a
    special accommodation for students with disability. So, if
    you're going to do the technology, make it applicable to
    students with disabilities, so I hope you take another look at
    our report language, and at least update me on how you're going
    to do that for next year.
        Secretary Spellings. I absolutely will, and let me mention
    a couple of things. You and I did speak about this, and I
    convened--on the policy side--a group of experts to help us
    develop technical assistance, and listen to the educators and
    the advocacy community about where we are with special ed in
    the implementation of this law. I said--and I know you agree--
    that without No Child Left Behind I don't think we would be
    having this conversation, and I'm glad we are.
        Senator Harkin. I applaud that, and that's one of the
    reasons I supported that, because I said, ``Finally, we're
    going to get the kids with disabilities, and we're not going to
    leave them behind, either.'' So, that's why I'm focusing on
    this.
        Secretary Spellings. Schools are starting to attend to
    them. But, we've got a long way to go with respect to technical
    assistance on assessment and on curriculum, and I've asked the
    organization that you recommended to me to participate on this
    panel of experts, and this is certainly an area of interest
    that they have identified. I do pledge to take this into
    consideration as we award these grants, I think that's the kind
    of application we're going to see from States. And I do think
    there's a harmony between the technology application and the
    needs of these kids.
        Senator Harkin. But, when you put out those requests,
    again, how they're worded gives the States some idea of what
    they should put in their grant requests, and if there's nothing
    in there about better assessment for kids with disabilities,
    ``and please when you put in your grant request, we will look
    favorably upon that kind of thing,'' you know that, of course.
        Secretary Spellings. Right. But as I travel around the
    country, talking to educators, this is a hot issue. This is
    something they're struggling with, and this is the kind of
    application I expect to get, frankly.
        Senator Harkin. I'm glad you said that, I just hope that
    that word goes out there to the community out there, too.
        [The information follows:]

                        Grants for Enhanced Assessments

        The Department will give competitive priority to applications for
    fiscal year 2005 and fiscal year 2006 funds under the Enhanced
    Assessment Instruments Grants program that propose projects addressing
    the use of accommodations or alternate assessments to improve the
    quality of assessments for limited English proficient students and
    students with disabilities. The notice inviting applications for fiscal
    year 2005 funds under the program, tentatively scheduled for
    publication in late spring of 2005, will announce the priority.

                          U.S. CONSTITUTION INITIATIVE

        Senator Harkin. One last question, I'm asking this question
    on behalf of Senator Byrd, who could not be here. The fiscal
    year 2005 Consolidated Appropriations Act last December,
    included language proposed by Senator Byrd that designates
    September 17 of each year as Constitution Day. The language
    also required that Federal employees be provided with training
    and educational materials concerning the U.S. Constitution--
    both at the time of their orientation as new employees, and on
    September 17 of each year.
        In addition, the new law requires that all educational
    institutions receiving Federal funds hold an educational
    program on the Constitution on September 17. The law does not
    prescribe the exact content of the program, and it does not
    mandate any particular curriculum. There's no congressional
    intent to dictate to any educational institutions--public or
    private--exactly what must be said or done in the program
    provided by the institutions on this subject. The law simply
    requires that educational institutions hold a program on the
    Constitution, on Constitution Day, September 17.
        I've been told by Senator Byrd that the Office of Personnel
    Management is working with the Department of Education on a
    Constitution initiative, which OPM plans to announce in several
    months to fulfill the requirements of this new law. Madame
    Secretary, can you confirm for Senator Byrd that the Department
    of Education will forward to this subcommittee, by April 1,
    2005, its plan and/or guidelines for implementing the law's
    requirement that certain educational institutions hold a
    program on the Constitution on September 17.
        Secretary Spellings. I certainly will look into that,
    Senator, I'm not completely familiar with all the particulars
    that you mentioned, but I will certainly look into it and get
    back to you and Senator Byrd.
        Senator Harkin. I appreciate that. If you could get back to
    us, and see if you could do that by April 1, we're already into
    March. I didn't know if that date was in the law or not.
        Secretary Spellings. The 17th is a Saturday, I was just
    informed, so this year, September 17, Constitution Day is a
    Saturday, and that particular day kids will not be in school.
    So I think they're trying to work through issues like that, and
    run that to ground.
        Senator Harkin. That's one of the things that's supposed to
    be worked out in the guidelines. Obviously sometimes it will
    fall on a Saturday or Sunday, so you'll do it on a Friday or
    Monday, or something like that, I suppose.
        Secretary Spellings. Right, right.
        Senator Harkin. I think Senator Byrd just wants to know
    what your plans are for this.
        Secretary Spellings. Right, absolutely, and I will get back
    to him on that. We do have a working group working on this
    matter; obviously OPM is on the case also, so I'll report back.

                                CLOSING REMARKS

        Senator Harkin. Madame Secretary, that's all the questions
    I have, I don't have any other questions from any other
    Senators, if there's anything else that you'd like to leave
    with us here, I'd be glad to make sure we have it in the
    record, if there's anything else.
        Secretary Spellings. I've submitted a statement for the
    record, Senator. Thank you very much for your hospitality, and
    I appreciate it.
        Senator Harkin. Thank you, Madame Secretary, for being here
    and being forthright with your answers to the questions, and I
    look forward to this further submission to the record of those
    things that we asked about.
        Secretary Spellings. Will do, absolutely.

                     STATEMENT OF SENATOR MARY L. LANDRIEU

        Senator Harkin. We have received the prepared statement of
    Senator Mary L. Landrieu which will be placed in the record.
        [The statement follows:]

                 Prepared Statement of Senator Mary L. Landrieu

        Thank you very much, Secretary Spellings for giving us your time
    today. We appreciate your visit to Capitol Hill to help explain some of
    the budget decisions that were made by the Administration. Also, let me
    offer you my congratulations and best wishes as you begin your new
    position as Secretary of the Department of Education.
        There is no greater investment we can make in our future than in
    the education of our children. President John F. Kennedy once said,
    ``Our progress as a nation can be no swifter than our progress in
    education. The human mind is our fundamental resource.'' He was right;
    if we are to succeed, we must make education the forefront of our
    agenda. We must work to raise academic achievement in our public
    schools by putting the priority on performance instead of process,
    delivering results instead of developing rules, and on actively
    encouraging bold reform instead of passively tolerating failure.
        The passage of No Child Left Behind (NCLB) Act in 2001 reaffirmed
    Congress' commitment to be a more equal partner, instead of a major
    impediment, to real education reforms. However, the Administration's
    budget for fiscal year 2006 has not lived up to this promise and as a
    result they continue to leave children behind. This year, the Bush
    budget will create a budget shortfall of almost $9 billion for Title I
    funding under NCLB. As you know, Madam Secretary, Title I funding makes
    it possible for all children, regardless of economic background, to
    have access to a high quality education. In Louisiana, this shortfall
    will translate to over $212 million in funding not getting to local
    educational agencies in Louisiana and leaving behind 66,656 Title I
    students in the state.
        Investing in our children is critical to the well-being of our
    country. While investments in education without accountability are a
    waste of tax-payer dollars, accountability without strategic
    investments in education is a waste of time. If the promise of No Child
    Left Behind is to be truly fulfilled, we must not only continue the
    reforms begun under NCLB, we must fully invest in them. Requiring
    states to meet new, higher standards is a move in the right direction,
    but we must provide states with the resources they need to meet these
    new standards. Every year since the passage of NCLB, the budget
    shortfall for education spending offered by this Administration has
    increased. Making sweeping reforms, while robbing states of the
    resources they need to implement the reforms, is the way that states
    become left behind in education. The promise to ``Leave No Child
    Behind'' is an empty one unless we are willing to make the critical
    investments necessary to support our nation's children.
        What is almost more disturbing than the Administration's lack of
    interest in fulfilling the promise it made to American students 4 years
    ago, is the fact that the Administration continues to make new empty
    promises. This year, the President has proposed a new high school
    initiative as part of the education budget. He has proposed that $1.24
    billion be spent on the High School Intervention program. I have no
    objection to the idea behind this program, and wholeheartedly agree
    with the President that we must work to improve the education standards
    in our high schools. I do, however, take issue with fact that this new
    promise is being made when the old promises have yet to be fulfilled.
        Empty promises are not only being made in elementary and secondary
    schools, Madam Secretary. The President's budget includes $33 million
    for Enhanced Pell Grants. This increase in Pell Grant funding is
    exciting, as we should be increasing opportunities for all students to
    attend a college or university. However, as the adage goes, you cannot
    steal from Peter to pay Paul. While there is an increase in Pell Grant
    funding, there have been significant reductions made to college
    preparatory programs, such as TRIO. In Louisiana, there are currently
    fifty-nine TRIO programs, and over 17,700 students are currently
    participating in them. The merits of TRIO have been widely proven.
    Students who participate in the Upward Bound TRIO program are four
    times more likely to earn an undergraduate degree than students from
    similar backgrounds that do not participate in TRIO. In a state like
    Louisiana, where poverty continues to serve as a barrier to higher
    education, it is of the utmost importance that we provide all possible
    services to our students to encourage their pursuit of a college
    degree. Yet again, while the President highlights his commitment to
    higher education by increasing the Pell Grant funding, he fails to
    mention that that increase is coming at the expense of other higher
    education programs.
        There's a story that I remember hearing when I was a little girl
    about a church in the suburbs of New Orleans. The church was small and
    its membership was not particularly high. There was a leaky roof on the
    church, and for anyone who has been to south Louisiana, you know that
    during hurricane season, the last thing you want is a leaky roof. The
    church had started raising money to fix the roof, when the preacher got
    the idea that in order to attract new members, they should buy a new
    organ. The organ they had was old and, according to the preacher,
    didn't do justice to the Sunday hymns. The preacher rallied the
    congregation around the new organ, and everyone forgot about the leaky
    roof. A year later, the congregation had raised enough money, and one
    Sunday afternoon, they all moved the organ in. Now it does not take a
    meteorologist to tell you, it rains almost everyday during the summer
    in Louisiana, and sure enough, it rained in that little town, and the
    church roof leaked, and when the congregation arrived Sunday morning,
    the new organ was wet and broken.
        Madam Secretary, I would suggest that perhaps under your
    leadership, the Department of Education can finish out what it started
    before the rain comes and what improvements we've made get lost. Under
    NCLB we have identified the schools in need of improvements, now let's
    get about the business of improving them. We have identified the
    teachers who are under qualified, let's get about the business of
    getting them qualified. We have promised parents choices, let's get
    about the business of providing them.
        Thank you, Madam Secretary.

                         ADDITIONAL COMMITTEE QUESTIONS

        Senator Harkin. There will be some additional questions
    which will be submitted for your response in the record.
        [The following questions were not asked at the hearing, but
    were submitted to the Department for response subsequent to the
    hearing.]
                  Questions Submitted by Senator Arlen Specter

                              NEW BUDGET RESOURCES

        Question. The Administration's fiscal year 2006 budget proposes to
    extend No Child Left Behind to the high school level, by requiring
    States to test high school students in two additional grades. Studies
    have documented shortcomings in the preparedness of all high school
    graduates for work or college. However, funds proposed in the budget to
    support the high school reform initiative are generated through the
    elimination of GEAR UP, certain TRIO activities, and the vocational and
    technical education program. The Administration's goal of reforming
    high schools is important and laudable. However, eliminating popular
    and effective programs will make it more difficult to generate support
    for the Administration's reform proposal. Isn't the goal of helping
    States and local school districts prepare high school students for the
    21st Century workforce and college worthy of new resources, even within
    a tight budget?
        Answer. As I mentioned in my opening statement, the first goal of
    the President's 2006 request is fiscal discipline in terms of total
    discretionary and non-security spending. Doing our share in achieving
    that goal means we do not have new resources, overall, in our 2006
    budget, and that means we had to make some tough decisions. And we
    tried to make those decisions not on the basis of popularity or
    politics, but based on the results produced by the investment of
    taxpayer dollars.
        When we looked at the challenge of reforming our high schools and
    doing a better job of preparing our students for college and the
    workforce, we saw little evidence of a meaningful contribution by
    several current programs. Since we believe our High School Initiative
    holds greater promise of bringing about real change in the performance
    of our high schools, it made sense to re-direct funding from other,
    less-effective activities to the new program. Also, there is
    considerable flexibility in our High School Intervention proposal, and
    districts and schools that believe that college preparation and
    vocational activities are the most appropriate way to meet the needs of
    their high school students would be free to use funding under the new
    program to pursue such strategies.

                            HIGH SCHOOL ASSESSMENTS

        Question. The budget proposes $250 million to pay for the costs of
    additional assessments proposed in the Administration's High School
    Reform initiative. According to GAO's report, Title I: Characteristics
    of Tests Will Influence Expenses; Information Sharing May Help States
    Realize Efficiencies (GAO-03-361, May 8, 2003) showed that costs for
    developing and administering tests could vary greatly. What is the
    basis for the request of $250 million to pay for these additional
    assessments?
        Answer. While test development and administration costs can vary
    widely, ESEA as reauthorized by NCLB already requires States to assess
    students in reading and mathematics at least once in the high school
    grades. The President's proposal would require testing high school
    students in those subjects in only two additional grades.
        Under ESEA Section 1111(b)(3)(D) Congress authorized a total of
    $2.34 billion over 6 years to assist States in developing the
    additional assessments required under NCLB. The additional requirement
    entailed implementation of assessments in reading and mathematics in
    each grade from 3rd grade to 8th grade (instead of once in each grade
    span of 3rd through 5th grade and 6th through 8th grade) plus
    implementation of science assessments once in each grade span of 3rd
    through 5th grade and 6th through 8th grade and once in high school.
    The NCLB requirements add up to 11 more assessments than were required
    prior to enactment of the Act.
        The High School Assessments proposal, which calls for assessing
    students in reading and mathematics at least three times during high
    school, would require States to implement two new high school
    assessments in two subjects, for a total of four new assessments. The
    proposed funding level of $250 million a year over several years will
    provide ample resources to implement the additional assessments. If,
    for instance, the Congress provides 4 years of funding for the high
    school assessments, that would equate to $250 million per assessment
    (that is, $1 billion divided by four assessments). This is slightly
    higher than the amount States received for the MCLB-required tests
    ($2.34 billion divided by 11 assessments).

                              COST OF ASSESSMENTS

        Question. How much of the estimated cost of the new assessment
    requirements would this request meet?
        Answer. While test development and administration costs can vary
    widely, the President anticipates that $250 million a year from fiscal
    year 2006 through fiscal year 2009 will cover a significant portion if
    not all the costs of developing the new assessments.

            ACCOUNTABILITY UNDER HIGH SCHOOL INTERVENTION INITIATIVE

        Question. The America Diploma Project recommended that States
    should not rely exclusively on large-scale assessments, because they
    ``cannot measure everything that high school graduates need to know and
    be able to do.'' How was this recommendation for States considered in
    the request for assessments specifically or more generally in the
    Administration's High School Reform initiative?
        Answer. While the American Diploma Project (ADP) did state that
    ``graduation exams cannot measure everything that matters'', it
    recommended that States ``measure what matters and make it count.''
    Consistent with the ADP recommendation, accountability under the High
    School Intervention proposal would be based on a range of student
    outcomes that include assessment scores as only one element of high
    school accountability. Other elements could include graduation rates,
    course completion, and enrollment in postsecondary education. The High
    School Intervention proposal would require States to establish clear,
    measurable goals and show significant improvements in student outcomes.
    The role of the expanded assessments would be to produce uniform,
    objective data for measuring student achievement and holding schools
    accountable for academic improvement of all high school students.

                               ADVANCED PLACEMENT

        Question. The fiscal year 2006 budget includes $51.5 million for
    the Advanced Placement program, an increase of $21.7 million over the
    fiscal year 2005 level. This program helps States and school districts
    expose students, especially low-income and minority students, to more
    challenging coursework. Studies have found that a key predictor of
    success in college is exposure to high school coursework of academic
    intensity and quality, which is why I supported an increase of $6.2
    million or 11.6 percent for this program in fiscal year 2005. What is
    the biggest challenge school districts must overcome to expose all of
    their students to challenging courses that prepare students for work or
    college, in particular those districts that educate large numbers of
    low-income students and how will these funds and others in the fiscal
    year 2006 request help address those challenges?
        Answer. School districts, especially those that educate large
    numbers of low-income students, face several challenges in creating a
    pipeline that prepares students for Advanced Placement (AP) and
    International Baccalaureate (IB) coursework and exams. First, districts
    need to realign their curriculum so that students are taking
    challenging coursework in elementary and middle school that prepares
    them for AP and IB-level courses in high school. Second, districts need
    to identify and recruit under-represented students, such as low-income
    and minority students, to enroll in the challenging courses. Third,
    districts need to provide professional development for teachers, to
    help them gain the content knowledge and pedagogical skills to instruct
    students in AP and IB courses. Finally, districts often need to find
    and implement creative solutions to increase capacity for AP and IB
    coursework in schools with low-income students, such as on-line
    coursework and partnerships with institutions of higher education. The
    funds in the fiscal year 2006 request would allow the Department to
    award grants to State educational agencies (SEA), local educational
    agencies (LEA), and national nonprofit educational entities to deal
    with each of these issues.

                    IMPACT OF THE ADVANCED PLACEMENT PROGRAM

        Question. This year, the Department must submit a report on the
    impact of the Advanced Placement program. Do you have anything to share
    at this moment about the impact of the program?
        Answer. The Department will submit a report to Congress on the
    impact of its Advanced Placement program later this spring. The report
    will show that, nationwide, the number of students participating in AP
    and IB is increasing. From 2000 to 2004, the percentage of all high
    school students who took an AP exam rose from 15.9 percent to 20.9
    percent. Also, the percentage of all high school students who scored 3
    or above on an AP exam rose from 10.2 percent to 13.2 percent.
        As overall participation has risen, participation by minority and
    low-income students has increased as well, but the access gap continues
    to persist. For example, students attending smaller schools and higher-
    poverty schools have less access to AP and IB. Also, black, Native
    American, and economically disadvantaged students participate in AP
    courses and exams at a lower rate than the national average.

                 READING BY THIRD GRADE--READING FIRST PROGRAM

        Question. President Bush committed to providing $5 billion over a
    5-year period for the Reading First program, which helps students read
    at least on grade level by the end of third grade. If Congress approves
    the $1.042 billion included in the fiscal year 2006 budget request,
    this 5-year funding goal will be achieved. Is progress being made
    toward achieving the President's goal of all students reading on grade
    level by the end of third grade?
        Answer. Reading First is the largest and most focused early reading
    initiative this country has ever undertaken. Although it is in its
    early stages of implementation, its impact is being felt across the
    country. Reading First provides an opportunity for every State to
    implement reading programs based on scientifically based reading
    research. Effective early reading instruction can prevent the
    difficulties that too many of our students, especially disadvantaged
    students, now face. Through Reading First, States have an arsenal of
    proven instructional methods, professional development, and proven
    interventions to increase the proportion of students who read on grade
    level by the end of the third grade.
        While State-level performance data will not be available until the
    summer of 2005, there are already very encouraging signs from around
    the country. For example, less than a quarter of students in first
    grade at Lowell Elementary School in Mesa, Arizona met the school's
    benchmark on a national reading assessment in 2003. The students,
    tested again in 2004 while in second grade, fared considerably better,
    with almost half meeting the benchmark. School officials, teachers, and
    parents credit the Reading First program as being an instrumental force
    behind this improvement. Schools around the country report similar
    outcomes as students in some of our Nation's neediest schools receive
    the intensive instruction necessary to help close the achievement gap
    in reading.

                     CORE COMPONENTS OF READING INSTRUCTION

        Question. How have these funds been used to implement
    scientifically-based reading instruction?
        Answer. In order to receive a Reading First subgrant, a local
    educational agency (LEA) must demonstrate that its core reading
    curriculum reflects the five essential components of reading
    instruction, as identified by the April 2000 Report of the National
    Reading Panel. These components are phonemic awareness, phonics,
    vocabulary development, fluency, and comprehension. Reading First also
    provides professional development to more than 90,000 K-3 teachers,
    ensuring that all teachers, including special education teachers, have
    the skills they need to teach reading and monitor student progress
    effectively in Reading First classrooms. In addition, the progress of
    students in Reading First classrooms is closely monitored through valid
    and reliable assessment instruments so that immediate intervention can
    prevent students from falling behind.

                               ARTS IN EDUCATION

        Question. The budget proposes to eliminate the Arts in Education
    program, which was funded at $35.6 million in fiscal year 2005. In a
    recent study by the Council for Basic Education, a nonprofit
    organization that advocates for liberal arts subjects, 25 percent of
    principals reported decreases in the time their schools devote to the
    arts and 33 percent expect decreases in the next 2 years. These changes
    have impacted poor minority students the hardest as 36 percent of
    principals in schools with large percentages of minority students
    reported reduced instructional time for the arts, while 42 percent
    anticipate future decreases. According to the report Champions of
    Change, students who participate in the arts outperform those who don't
    on virtually every measure. In addition, researchers have found that
    ``sustained learning'' in music and theater correlate to greater
    success in math and reading, and students from lower socioeconomic
    backgrounds see the greatest benefits. Isn't it important to maintain a
    Federal commitment to fund arts education, given different student
    learning styles and interests and the proven benefits of instruction in
    the arts?
        Answer. The arts play a significant role in education both for
    their intrinsic value and because of the ways that they can enhance
    general academic achievement and improve students' social and emotional
    development. No Child Left Behind includes arts as a core academic
    subject and holds arts teachers to the same high standards as it does
    those who teach English, math, science, and history.
        There are a variety of opportunities for districts and schools to
    include the arts in instruction. Districts seeking to implement arts
    education activities can use the funds they receive through the
    Improving Teacher Quality State Grants program to carry out
    professional development activities that improve the knowledge of
    teacher and principals in core academic subjects, including the arts.
    Additionally, districts may use their funds under the State Grants for
    Innovative programs to support programs in the arts. Lastly, the arts
    can also be an important part of learning and enrichment in programs
    supported by the 21st Century Community Centers program funds by
    involving cultural partners in the community, such as arts centers,
    symphonies, and theaters. The Administration's 2006 budget request
    would continue strong support for all of those programs.

                             EDUCATIONAL TECHNOLOGY

        Question. According to the Education Commission of the States
    Report to the Nation on the Implementation of No Child Left Behind,
    ``Many states do not have in place the technology infrastructure needed
    to collect, disaggregate and report data at the school, district and
    state levels. NCLB doesn't require the development of statewide data
    systems but, without them, states will have difficulty meeting a number
    of the law's requirements.'' Further, the Department's National
    Education Technology Plan identified Improving Teacher Training as a
    recommendation and also stated that, ``Teachers have more resources
    available through technology than ever before, but some have not
    received sufficient training in the effective use of technology to
    enhance learning.'' Given these recent findings and recommendations,
    why does the budget propose eliminating the Education Technology State
    Grant program, the only remaining Federal source of funds dedicated to
    addressing these issues?

                             EDUCATIONAL TECHNOLOGY

        Answer. The fiscal year 2006 budget request supports the
    Administration's policy of eliminating categorical programs that have a
    narrow or limited effect in order to increase support for high-priority
    programs. Educational technology needs can be addressed by using other
    sources of Federal funds. For example, districts may use their funds
    under the Improving Teacher Quality State Grants program to implement
    professional development programs that train teachers and principals to
    integrate technology into curricula and instruction in order to improve
    teaching, learning, and technology literacy.
        While developing and operating statewide student data systems are
    allowable activities with Education Technology State Grant funds, there
    is little evidence that States use these funds for that purpose. This
    elimination of the program should not affect States' activities in this
    area. In order to address the States' need to develop effective
    longitudinal data systems, the Department has requested continued
    funding for the Statewide Data Systems program. Continuation of this
    program will allow States and local educational agencies to use
    assessment and other data to identify struggling students and track
    their progress while complying with the requirements of No Child Left
    Behind.
        Question. In Pennsylvania, $22 million of the $23 million spent
    specifically on educational technology is generated by the Education
    Technology State Grant Program and an independent evaluation conducted
    by Metiri Group and Penn State University found that many of
    Pennsylvania LEAs are experiencing significant improvements in teacher
    skill level and student performance because of the funds available
    through this program. How will Pennsylvania continue to make the kind
    of progress identified by the evaluation without these resources,
    especially given the reduction in or elimination of other sources of
    Federal funds that may be transferred for use under this program?
        Answer. The Administration recognizes that Pennsylvania, like many
    States across the country, is facing a difficult budget situation.
    However, the flexibility provisions in No Child Left Behind allow
    districts to make use of their Federal assistance by permitting them to
    more efficiently allocate resources to address their particular needs.
    Pennsylvania districts will thus continue to be able to use Federal
    assistance for technology purposes.

                 LEVERAGING EDUCATIONAL ASSISTANCE PARTNERSHIPS

        Question. The Leveraging Educational Assistance Partnerships
    program has generated significant State need-based aid through matching
    funds that totals nearly $1 billion. Why does the fiscal year 2006
    budget propose to eliminate the $65.6 million in funding for the
    Leveraging Educational Assistance Partnerships program despite the fact
    that it is the only Federal program designed to expand the amount of
    need-based student aid provided by States?
        Answer. We believe the best way to foster college access and
    completion is to concentrate resources on Pell Grants, the largest and
    most need-based Federal grant program. There is no reason to continue
    to use scarce resources on LEAP, since Federal assistance is no longer
    needed to encourage States to provide need-based grant and work-study
    assistance.

           STATE PROGRAMS OF UNDER-GRADUATE NEED-BASED STUDENT GRANTS

        Question. While it is true that funds exceed the matching
    requirement, don't you believe there should be a Federal role in
    supporting continued and expanded State need-based aid programs that
    help all students access and complete college?
        Answer. When the program was first authorized as the State Student
    Incentive Grant program in 1972, 28 States had undergraduate need-based
    grant programs. Now all but two States have need-based student grant
    programs. The continued existence of the LEAP program has not
    encouraged the two remaining States to institute State grant programs.

                           STUDENT AID ADMINISTRATION

        Question. What are the specific administrative challenges
    associated with the current funding structure and how would a single
    discretionary appropriation address those challenges?
        Answer. Funding identical student aid administrative activities
    from multiple sources creates substantial additional complexity with no
    additional value for managers or oversight organizations such as
    Congress, GAO, or Department auditors. A single funding source would
    result in a process that is both significantly simpler and
    substantially more transparent.

                 ADJUNCT TEACHERS AND HIGHLY QUALIFIED TEACHERS

        Question. The budget proposes $40 million for a new program, the
    Adjunct Teacher Corps. This program would provide grants to place non-
    certified teaching professionals in the classroom and allow them to
    teach on a full or part-time basis. How does this new program, which
    proposes allowing unlicensed or uncertified teachers, fit with
    Congress' and the Administration's emphasis on highly qualified
    teachers in every classroom as envisioned under the No Child Left
    Behind Act?
        Answer. The $40 million request in the 2006 budget for a proposed
    Adjunct Teacher Corps initiative would provide competitive grants to
    partnerships of school districts and appropriate public or private
    institutions to create opportunities for professionals to teach
    secondary-school courses in the core academic subjects, particularly in
    mathematics and science.
        Grants would be used to: (1) identify, as adjunct teachers, well-
    qualified individuals outside of the K-12 educational system, including
    outstanding individuals at the height of their careers in business,
    government, foundations, and colleges, and (2) facilitate arrangements
    for them to function in this capacity, for example, by teaching one or
    more courses at a school site on a part-time basis, teaching full-time
    in secondary schools while on leave from their jobs, or teaching
    courses that would be available online or through other distance
    learning arrangements. In some cases, this initiative would provide
    opportunities for individuals to substitute teach in hard-to-fill
    positions.
        The intent of the Adjunct Teacher Corps initiative is not to bring
    more highly qualified teachers into the classroom on a permanent basis,
    but rather to integrate their knowledge and experience into classroom
    learning. Although potential participants would typically not be
    certified or licensed to teach in secondary schools, they often have a
    wealth of knowledge, skills, and professional experiences and would be
    able to provide real-world applications for some of the abstract
    concepts taught in classrooms. Adjunct teachers who are not employees
    of a school district would not be covered by the NCLB ``highly
    qualified teacher'' requirement. On a temporary basis, these teachers
    would give school districts opportunities to strengthen instruction in
    secondary schools in the core academic subjects, especially mathematics
    and science.

                         EVEN START AND FAMILY LITERACY

        Question. The budget request proposes to eliminate the $225 million
    Even Start program. This program successfully supports family literacy
    programs, which are comprised of adult education, parent education,
    parent-child activities and early childhood education activities. This
    concept has shown positive results and was strengthened by the
    reauthorization of the program under No Child Left Behind. The
    Administration has pointed to national evaluations conducted of the
    program as it existed prior to the reauthorization as evidence that it
    is ineffective. Madam Secretary, why are you proposing to eliminate
    this program based on evaluations that do not reflect the outcomes
    being achieved currently?
        Answer. Although the No Child Left Behind Act of 2001 strengthened
    some components of Even Start, these changes did not alter the
    structure or design of the program. Although some local projects may be
    successful, the overall effectiveness of Even Start remains very
    questionable. The 2000 Literacy Involves Families Together (LIFT) Act,
    which authorized Even Start prior to the No Child Left Behind Act,
    included language encouraging local projects to hire more qualified
    staff, to use instructional programs that are based on scientifically
    based research, and to increase the focus on evaluation. However, the
    changes made through LIFT and later NCLB did not alter the basic
    elements of the program, and a new evaluation would most likely yield
    the same results as the first three.
        While the premise underlying the Even Start program is attractive,
    the extent to which family literacy programs can enhance parent
    literacy and parenting skills is still unknown. The Administration
    believes that we should redirect the resources now available for Even
    Start to programs such as Reading First and Early Reading First that
    are based on a sound, scientifically based approach and are better
    focused on achieving their goals of improving the literacy skills of
    young learners.

                                ADULT EDUCATION

        Question. Currently, nearly half of the adults in Pennsylvania have
    limited literacy skills. Among individuals who are receiving welfare,
    are incarcerated, or the long term unemployed, 70 percent have limited
    skills. Based on the overall reduction proposed in the fiscal year 2006
    budget, Pennsylvania programs would lose $14 million, or 75 percent, of
    Federal funds for adult education and literacy programs. The fiscal
    year 2006 performance plan for the Department of Education sets
    performance targets for the percentage of adults with a high school
    completion goal who earn a diploma or its equivalent at 46 percent in
    fiscal year 2005 and 47 percent in fiscal year 2006. How does the
    Department intend to help States make progress toward the Department's
    performance goals with 65 percent less funding overall?
        Answer. As with K-12 education, adult education is funded primarily
    through State and local resources, and Federal funds are meant to
    supplement, not supplant, local efforts to provide educational services
    to high school dropouts, immigrants, and low-literacy adults. According
    to data collected by the Department, the Federal Government contributed
    approximately 26 percent of total adult education program funding in
    2003. The budget request also recognizes the importance of addressing
    the English-language needs of our Nation's immigrant population and
    therefore includes level funding for the English Literacy and Civics
    Education (EL/Civics) component of the program, which will support
    States in addressing the educational needs of their limited English
    proficient (LEP) populations. Pennsylvania is expected to receive
    approximately $1.4 million for EL/Civics grants in 2006.
        The Department will continue to provide States and local providers
    with technical assistance, research and implementation support, and
    curricular guidance for adult education programs. Through these
    activities, the Department will enhance the effectiveness of local
    adult education programs and thus help them to successfully attain the
    performance goals set by the Department.

                     MATH AND SCIENCE PARTNERSHIPS PROGRAM

        Question. The fiscal year 2006 budget proposes to reduce funding to
    States for math and science partnerships in order to provide a set-
    aside of $120 million for direct grants to school districts for math
    programs for secondary students. States are currently using their funds
    to run competitions that in some cases give a priority to applicants
    that seek to improve math achievement of middle and high school
    students. If States are designing their competitions with a priority to
    address mathematics achievement of secondary students, why should
    Congress reduce funds for States that best know how to address the
    educational needs of their school systems?
        Answer. For fiscal year 2006, the Administration is requesting $269
    million for the Mathematics and Science Partnerships program, a $90.4
    million increase over the 2005 appropriation. Of the total amount, $120
    million would be used for direct grants to LEAs to accelerate the
    mathematics achievement of secondary-school students and $149 million
    would be awarded to States by formula. The amount provided through
    formula grants would be a reduction of $29.6 million from the 2005
    level.
        American students' poor performance on national and international
    mathematics assessments, such as the National Assessment of Educational
    Progress and the 2003 Program for International Student Assessment,
    provides a compelling rationale for an intensive, targeted initiative
    to strengthen the mathematics skills of our middle- and high-school
    students, especially low-achieving students. The direct competitive
    grants requested in the budget would focus on ensuring that States and
    school districts provide professional development that is strongly
    grounded in research and that helps mathematics teachers become highly
    qualified. The Administration believes that it is critical to target
    funds directly to high-quality secondary-school mathematics projects,
    thus justifying the decrease in formula grants, which would not, as the
    program is structured, generate the type of intensive focus in
    secondary-school mathematics achievement that is clearly needed. The
    remaining funds for the formula grants would allow partnerships to
    conduct other important activities to improve student achievement,
    including activities that focus on science and elementary-school
    mathematics.
        Question. Why would a direct grant program out of Washington, D.C.
    be more effective at improving mathematics achievement than a State-
    based approach that is consistent with the authorization for this
    program?
        Answer. The competitive grants would support projects that have
    significant potential to accelerate the mathematics learning of all
    secondary students, but especially low-achieving students. This
    initiative would focus on ensuring that States and LEAs implement
    professional development projects for mathematics teachers that are
    strongly grounded in research and that help teachers to improve their
    instruction in mathematics.
        The Administration believes that it is critical to fund efforts
    specifically to accelerate mathematics learning at the secondary level
    by helping secondary students master challenging curricula and by
    increasing the learning of students who have fallen behind in
    mathematics. Research indicates that many students who drop out of
    school lack basic skills in mathematics, and our Nation needs to
    support these students so that they can catch up to their peers and
    stay in school.

                                CIVIC EDUCATION

        Question. Funding for the Education for Democracy Act--supporting
    both domestic and international civic education programs--was
    eliminated in your budget and that program has successfully helped
    American students understand and appreciate our fundamental values and
    principles. This funding also supports a school violence prevention
    program that has had results in rural and urban settings throughout the
    country. The international exchange program has been very successful in
    helping emerging democracies establish an education for democracy
    program in their schools, so students would begin to understand basic
    concepts such as the rule of law, the protection of minority rights,
    and respect for diverse religions and races. The democracy curriculum
    created from the international exchange program is the only curriculum
    used in schools throughout Bosnia by all three ethnic groups, the
    Serbs, the Bosnians, and the Croats. This unique international program
    is having similar success in more than 60 countries including Russia,
    Indonesia, and nine countries in the Middle East. Madam Secretary, can
    you comment on why a program that is consistent with the
    Administration's desire to advance the ideals of democracy was
    eliminated from your budget this year?
        Answer. The request for this program is consistent with the
    Administration's intent to increase resources for higher priority
    programs by eliminating small categorical programs that have limited
    impact, and for which there is little or no reliable evidence of
    effectiveness. Less than 5 percent of funds (approximately $1.5 million
    in fiscal year 2005) available through the Civic Education program
    support activities specifically related to school violence prevention.
    The Administration believes that a more effective approach to
    addressing school violence is to invest in Safe Schools/Healthy
    Students grants--which would receive $88.5 million under the 2006
    request--to create safe, disciplined, and drug-free learning
    environments.
        Likewise, only a tiny fraction of funds designated for the
    Cooperative Education Exchange support summer workshops and other
    activities related to democracy in Bosnia. But, since the Dayton
    Accords of 1995, the U.S. Department of State and U.S. Agency for
    International Development have played a key role in promoting democracy
    in Bosnia and Herzegovina, providing hundreds of millions in support
    and critical expertise in everything from revitalizing the
    infrastructure to promoting democratic reforms of education and the
    media. Further, through the cooperative efforts of American and
    European Union governments, in 2003 a common curriculum was adopted by
    all education ministers in Bosnia and Herzegovina. It may have once
    been true that the Civic Education Project Citizen curriculum was ``the
    only curriculum used in schools throughout Bosnia by all three ethnic
    groups;'' however, it is our understanding that the adoption of a
    common curriculum in 2003 marked the end of rigid ethnic and religious
    separation in schools, and that Serbs, Bosnians, and Croat students now
    routinely pursue shared courses of study in mixed schools and
    classrooms.
        While the Civic Education program supports some worthwhile
    activities, there are no reliable measures of the overall effectiveness
    of interventions supported using program funds. Studies and evaluations
    conducted by the Center for Civic Education provide limited information
    on program performance, but none are sufficiently rigorous to yield
    reliable information on the overall effectiveness or impact(s) of the
    various interventions supported through this program. Additionally,
    because one statutorily designated entity receives approximately 75
    percent of all Civic Education funds during any single fiscal year, the
    program's contribution to the Department's overall mission is marginal.
        The Administration does not believe additional funding is necessary
    for the implementation of activities currently supported through this
    program. The Center for Civic Education is an established non-profit
    organization with a broad network of program participants, alumni,
    volunteers, and financial supporters at the local, State, and national
    levels. The Center also has a long history of success raising
    additional support through such vehicles as selling program-related
    curricular materials, trainings, and workshops, partnering with non-
    profit groups on core activities, lobbying, and seeking support from
    foundations.

                       SPECIAL EDUCATION TEACHER SHORTAGE

        Question. The shortage of certified special education teachers is
    reaching very high levels and the issue needs to be addressed in order
    to ensure that all students are challenged in school and receive the
    same high level of education. Several statistics illustrate the point:
    half of new special education teachers leave the classroom within 3
    years; 98 percent of school districts report shortages of special
    education teachers; in 2002 our nation produced only 213 doctorates in
    special education; and one out of three faculty openings in special
    education go unfilled--diminishing the capacity of universities to
    train special education teachers. What does the fiscal year 2006 budget
    propose to address this critical shortage?
        Answer. Recent studies suggest that the on-going special education
    teacher shortage is affected by a number of factors, including special
    education teacher turnover rates, changes in the number of children
    with disabilities served under IDEA and Section 504, teacher training
    program enrollments and graduation rates, and the extent to which
    teacher training programs actually prepare teachers for the challenges
    they will face in the classroom. The fiscal year 2006 budget addresses
    the problem through multiple IDEA programs, including Grants to States,
    for which $11.1 billion is requested, and Personnel Preparation, for
    which $90.6 million is requested. SEAs and LEAs have the authority
    under IDEA to use Grants to States funds for a wide variety of
    personnel-related activities, including supporting personnel training
    and professional development and implementing plans to meet personnel
    shortages. Approximately 90 percent of Personnel Preparation program
    funds support grants to IHEs for the purpose of improving program
    curricula and making training and professional development
    scholarships. Such awards are targeted to improve both the quality and
    quantity of training for special education teachers and related
    services personnel. Individuals receiving scholarship assistance
    through projects funded under program are required to fulfill a 2-year
    service obligation or repay all or part of the costs of such
    assistance. This program also currently funds several projects that
    promote teacher retention through mentoring activities. Repayment
    obligations and mentoring programs are designed to aid in the retention
    of beginning special educators, a group that studies have shown to be
    particularly prone to attrition.
        It is worth mentioning that, for many years, one of the primary
    goals of Federal programs that support special education training has
    been to alleviate shortages by increasing the supply of special
    education teachers. However, except in certain isolated areas such as
    awards to train leadership personnel and personnel serving children
    with low-incidence disabilities, there is little evidence that these
    investments have resulted in measurable increases to the overall supply
    of special education teachers and related services personnel. For this
    reason, the fiscal year 2006 budget addresses the special education
    teacher shortage primarily by concentrating scholarship grant support
    in those areas where States and other investors have limited capacity
    and incentive to invest (e.g., supporting programs that prepare
    teachers of children with low-incidence disabilities and leadership
    personnel).

                       HIGHLY QUALIFIED SPECIAL EDUCATORS

        Question. What is your plan to ensure that all students benefit
    from having a highly qualified teacher in their classroom?
        Answer. The No Child Left Behind Act of 2001 (NCLB) emphasizes
    teacher quality as one of the primary factors contributing to improved
    student achievement. Consistent with this emphasis, and to better equip
    States for the critical task of ensuring that all teachers of core
    academic subjects are highly qualified, the Department has dedicated
    significant resources to such activities as providing on-going
    technical assistance and developing guidance that clearly articulates
    how the highly qualified teacher provisions affect all teachers and
    related personnel, including special educators. As part of an extensive
    outreach effort on the highly qualified teacher provisions, the
    Department recently sent a cadre of experts called the Teacher
    Assistance Corps to each State to clarify the highly qualified
    requirements, provide technical assistance, and capture promising
    implementation strategies. Many of these practices are available now
    through the www.teacherquality.us Web site, and more will be added as
    the Department continues to visit States as part of its highly
    qualified teacher monitoring. Any State that requests additional
    technical assistance on the highly qualified teacher requirements as
    they apply to special education teachers will receive such help.
    Through the Teacher-to-Teacher initiative, the Department also supports
    teacher roundtables, regional workshops, a national Research-to-
    Practice Summit, and electronic teacher video training modules. The
    Teacher-to-Teacher Web site, at www.paec.org/teacher2teacher, offers
    on-demand professional development in the latest research-based
    practices.
        Because the recently reauthorized IDEA incorporates the ESEA
    definition and standards relating to highly qualified teachers with
    only slight modifications, the Department plans to continue its current
    focus on working with SEAs and LEAs towards the goal of ensuring that
    all students benefit from having a highly qualified teacher in their
    classroom. In addition to such on-going activities, consistent with
    this focus on highly qualified teachers, in announcing recent
    competitions for new Personnel Preparation competitive awards the
    Secretary emphasizes that the Department is interested in funding
    training programs that prepare highly qualified special educators. By
    emphasizing these requirements in new awards to grantees training
    special education personnel, the Department expects to gain critical
    insights into the most effective and efficient ways of ensuring that
    program curricula and professional development requirements are aligned
    with and support the highly qualified teacher requirements.

                        STATE SCHOLARS CAPACITY BUILDING

        Question. The budget proposes $12 million in fiscal year 2006 for
    State Scholars Capacity building. Congress has not provided funds
    specifically for this purpose previously, but the Department has
    supported State Scholars Partnerships through funding available under
    Vocational Education National Programs. With the additional funds
    requested in fiscal year 2006, subgrants would be made to support State
    Scholars Partnerships in 26 States. Research has demonstrated that
    students who complete a rigorous course of study during high school are
    better prepared to be successful in college and the workforce.
    Specifically, what are the findings from any evaluation that has been
    conducted on State Scholar projects?
        Answer. Since 1992, the Scholars Initiative has been piloted in
    local communities within several U.S. states, including Arkansas,
    Oklahoma, Tennessee, and Texas. We are seeing some good early results
    in the States and communities that have launched Scholars initiatives.
    Enrollment in Algebra I and Geometry at Little Rock high schools, for
    example, rose 6 and 8 percent, respectively, in the district's first
    year of participation in Arkansas Scholars. However, only one State,
    Texas, has implemented the State Scholars Initiative statewide for a
    long enough period for us to begin to examine long-term outcomes. The
    percentage of Texas high school students who completed the Scholars'
    recommended course of study rose from 15 percent in 1999 to 63 percent
    in 2003 (Texas Education Agency, Academic Excellence Indicator System.
    2003). We find this highly encouraging, although we cannot attribute
    these outcomes solely to Texas State Scholars initiative. While
    students and parents found the recommendations of the Texas Business
    and Education Coalition to be compelling, and students then increased
    their enrollment in challenging academic courses, State policy-makers
    also began to recognize the importance of providing all students with a
    rigorous academic education. Accordingly, they phased out lower-level
    graduation requirements in favor of graduation requirements that
    aligned with the Scholars academic core.

        PUBLIC SCHOOL CHOICE REQUIREMENT OF THE NO CHILD LEFT BEHIND ACT

        Question. Reports by The Government Accountability Office,
    Education Commission of the States and others have documented the
    challenges school districts face in meeting the public school choice
    requirement of No Child Left Behind. In response to a December 2004
    report on the implementation of the No Child Left Behind Act, the
    Department identified Parental Information and Resource Centers and
    grants funded under the Fund for the Improvement of Education as
    sources of outreach and information to parents on a national level
    about the school choice option. The response stated further that, ``We
    know that our efforts have led to parents learning about, and taking
    advantage of, their opportunity to transfer students. Much remains to
    be done, however.'' What is the Department doing currently and
    proposing in the fiscal year 2006 budget to help States and school
    districts effectively implement this provision of the law?

                   PARENTAL INFORMATION AND RESOURCE CENTERS

        Answer. On the budget side, the need to support local efforts to
    implement the public school choice requirements of No Child Left Behind
    has been a key rationale for the consistently large increases President
    Bush has requested for Title I Grants to Local Educational Agencies.
    With Title I funding up $4 billion, or 45 percent, over the past 5
    years, we believe school districts have sufficient resources to carry
    out public school choice. And of course we are asking for $600 million
    more in 2006.
        The bigger challenge has been providing effective technical
    assistance and guidance to States and school districts. We have
    published detailed guidance on the public school choice provisions and
    distributed that guidance widely to key groups, including through
    presentations and workshops on public school choice at the National
    Title I Directors Conference, as well as conferences of the Black
    Alliance for Educational Options, National Alliance of Black School
    Educators, and National Association of Federal Program Administrators.
    We plan to continue these efforts at many other conferences during the
    coming year.
        In addition, we have published several ``Innovations in Education''
    guides related to public school choice, including ``Creating Strong
    District School Choice Programs,'' ``Creating Successful Magnet School
    Programs,'' and ``Successful Charter Schools.'' The Department has
    disseminated and presented on these guides widely, and our web site
    contains information on No Child Left Behind choice options in a
    variety of formats.
        We are currently developing an Interactive Toolkit on Choice that
    will include tools, templates, and models used by school districts that
    are successfully implementing public school choice. We also are
    planning a two-day Train-the-Trainers Conference on Public School
    Choice intended to expand the number of experts available nationwide to
    provide technical assistance to districts on public school choice.
        NCLB choice options continue to be a key focus of State and local
    monitoring visits, where we pay special attention to outreach efforts
    by districts to make parents aware of public school choice. Finally,
    determining and disseminating the best practices for informing parents
    about choice options will be a key goal for our new technical
    assistance centers.

                   PARENTAL INFORMATION AND RESOURCE CENTERS

        Question. Why does the Department propose to terminate funding for
    the Parental Information and Resource Centers program, just months
    after identifying them as a resource that has helped parents take
    advantage of their right to transfer their child to a higher performing
    public school?
        Answer. While the Parental Information and Resource Centers (PIRCs)
    make a limited contribution to informing parents about choice options
    under the No Child Left Behind Act, the overall structure of the
    centers limits their effectiveness. For example, one problem with the
    PIRCs that has been highlighted by the Administration's Performance
    Assessment Rating Tool is the multiple purposes served by the program,
    which prevent the kind of focused, tailored delivery of services that
    can have a meaningful impact in achieving program goals.
        We believe the parental involvement and outreach goals of No Child
    Left Behind are more effectively met through the existing requirements
    under Part A of Title I for the some 15,000 participating Title I
    districts and schools, which include not only parental involvement
    activities but school improvement-related reporting and outreach
    specifically intended to help parents take advantage of NCLB choice
    options. The Department continues to work with States and districts to
    improve the effectiveness of these Part A-funded activities, through
    both ongoing technical assistance and on-site monitoring visits. The
    PIRCs activities largely duplicate such efforts, as well as those of
    the comprehensive technical assistance centers currently under
    competition, at a time when we must make tough decisions about the best
    way to invest scarce resources in the most effective manner possible.

                                  PELL GRANTS

        Question. The Administration proposed to add $5.6 billion to the
    Pell Grants program in fiscal year 2006, $867 million of which is
    discretionary and the remaining $4.7 billion is mandatory spending
    proposed in the reauthorization of the Higher Education Act. The
    Administration has proposed a very important investment. What will be
    the impact of the proposal on the typical students receiving a Pell
    Grant?
        Answer. The maximum Pell Grant would increase by $100 in fiscal
    year 2006 and by $500 over the next 5 years. The Administration's
    budget invests $19 billion in new funding over the next 10 years to
    increase grants to low-income students, helping them finance their
    postsecondary education
        Question. How will you pursue this important investment if the
    Higher Education Act is not reauthorized this year?
        Answer. The Department's comprehensive student aid proposals would
    best be implemented through the reauthorization of the Higher Education
    Act; we will work closely with Congress on these important changes.

                         LOANS FOR SHORT-TERM TRAINING

        Question. The fiscal year 2006 budget includes $10 million for a
    new loan program to help dislocated, unemployed, or older workers
    upgrade their skills. These individuals are not eligible for Federal
    student loans. This program will be jointly administered with the
    Department of Labor and could help more than 350,000 individuals
    acquire the skills they need for work. Madam Secretary, I applaud the
    Department for this important new initiative, since these individuals
    are not eligible for Federal student loans and many need help to
    upgrade their skills. If this new program is approved, how quickly
    could this new program be implemented?
        Answer. If this new program is approved, the Department expects to
    make loans in fiscal year 2006.
        Question. How will your Department coordinate with the Department
    of Labor on this program?
        Answer. The two departments will soon be submitting details on this
    program specifying each agency's roles and responsibilities. The
    proposal envisions the Departments of Labor and Education as operating
    partners, each bringing their particular expertise to the process of
    expanding training opportunities for American workers.

                  TEACHER INCENTIVE FUND AND TEACHER TRAINING

        Question. The budget request proposes to create a new $500 million
    Teacher Incentive Fund, which would change the way teachers are paid
    and allow schools to use funds to recruit teachers to high-need
    schools. The existing $2.9 billion Teacher Quality State Grant program
    allows school districts to use funds for both of these activities. The
    Administration should be commended for the proposed increase in funding
    to support our nation's educators. Why have you proposed to create a
    new $500 million program that is the same as an existing program?
        Answer. The Administration is requesting $500 million for the
    Teacher Incentive Fund initiative to allow States and school districts
    to develop and implement innovative ways to provide financial
    incentives for teachers who raise student achievement and close the
    achievement gap in some of our Nation's highest-need schools, to
    attract highly qualified teachers to those schools, and to redesign
    teacher compensation systems in order to align pay with performance.
    This is a different mission from that of the Improving Teacher Quality
    State Grants program, which focuses mostly on enabling teachers to
    become ``highly qualified.''
        Under No Child Left Behind, all States are working to ensure that,
    by the end of the 2005-2006 school year, all classes of the core
    academic subjects are taught by highly qualified teachers. Funds are
    available under several formula grant programs, including Improving
    Teacher Quality State Grants, for professional development and other
    expenses needed to enable States and school districts to achieve that
    objective. But the Teacher Incentive Fund will take the national
    commitment to ensuring a continued high-quality teaching force one
    important step further by providing significant, dedicated Federal
    support for rewarding teachers for strong performance, encouraging
    highly qualified teachers to enter classrooms with concentrations of
    low-income students, and developing and implementing performance-based
    teacher compensation systems.

                             TEACHER INCENTIVE FUND

        Question. Can you explain why States and school districts need
    another source of Federal funds for recruiting teachers and reforming
    teacher pay systems?
        Answer. Although States and school districts are authorized to use
    Title II Improving Teacher Quality State Grants funds to recruit
    teachers to high-need schools and to reform teacher pay systems, the
    Department has found that they seldom use Title II funds for those
    purposes. For example, a Department survey of districts' use of Title
    II funds in the 2002-2003 school year indicates that most of the funds
    were being used for professional development (25 percent) and for
    teacher salaries to reduce class size (58 percent), and the study also
    found that, of the remaining allowable activities, no single activity
    accounted for more than 3 percent of all reported Title II school
    district funds. In addition, recent monitoring visits to States and
    school districts suggest that States and school districts continue to
    spend most of their Title II funds on professional development. Based
    on these findings, it appears that States and school districts are not
    using their Title II funds to recruit teachers to high-need schools and
    to reform teacher pay systems, particularly given other competing needs
    for Title II funds to improve teacher quality.
        Because the Administration believes that it is important for States
    and school districts to continue to conduct their existing Title II
    activities at current levels to improve teacher quality, the
    Administration is proposing additional funds, through the Teacher
    Incentive Fund, for efforts dedicated to rewarding effective teachers,
    offering incentives for highly qualified teachers to teach in high-need
    schools, and designing and implementing performance-based compensation
    systems that change the way school districts pay teachers. The $500
    million requested for the Teacher Incentive Fund will permit many more
    school districts to implement these types of reforms and provide a
    major incentive for needed changes in teacher compensation systems
    nationally.
        Question. Why not add the $500 million to the existing program?
        Answer. The Administration believes that, by dedicating $500
    million specifically for teacher incentive efforts, many more States
    and school districts will develop and implement much-needed reforms in
    the way teachers are compensated in order to further improve teacher
    quality. Under the existing program, States are much less likely to
    implement these reforms.

                      NO CHILD LEFT BEHIND AND FLEXIBILITY

        Question. While I support the No Child Left Behind Act, I believe
    there needs to be more state flexibility in the implementation of the
    Act, because each state has the knowledge of the particular challenges
    facing its education system, including accounting for students with
    learning, emotional and English language difficulties. Madam Secretary,
    you stated in your January 6, 2005 nomination hearing before the Senate
    Health, Education, Labor and Pensions Committee that, ``We must stay
    true to the sound principles of leaving no child behind. But we in the
    administration must engage with those closest to children to embed
    these principles in a sensible and workable way.'' Will you provide
    needed flexibility to Pennsylvania and other States?
        Answer. I remain committed to my January 6 statement, Mr. Chairman.
    We are willing to carefully consider requests from States and school
    districts for additional flexibility in implementing No Child Left
    Behind, and we will work very hard to try and provide that flexibility.
    However, we must remain true to the law's core principles. Just to give
    you a couple of examples, I believe it would be very difficult--
    impossible really--to eliminate key requirements like annual testing or
    the use of subgroup accountability to determine adequate yearly
    progress.
        On the other hand, I think you have already seen that we are
    willing to work with States in areas like the assessment of special
    education and limited English proficient students, and in ensuring that
    all teachers are highly qualified. I have met with experts in these
    areas and am working with senior Department officials to clarify our
    policies. So in answer to your question, we will provide flexibility
    wherever we can do so consistent with the law.

           COLLEGE ENROLLMENT GAP--FEDERAL TRIO AND GEAR UP PROGRAMS

         Question. Last year, I asked Secretary Paige what initiatives the
    fiscal year 2005 President's Budget supports to reverse the increasing
    college enrollment gap between low- and high-income students. As part
    of that response, Secretary Paige wrote that, ``The Administration also
    supports strong academic preparation for postsecondary education and
    training through the Federal TRIO and GEAR UP programs. The
    Administration is proposing in fiscal year 2005 to spend $1.13 billion
    for these two programs.'' Why are TRIO's Talent Search and Upward Bound
    programs and GEAR UP now proposed for elimination?
        Answer. The Administration has not requested funding for Upward
    Bound, Talent Search, and GEAR UP in the fiscal year 2006 budget
    because we believe our proposed $1.2 billion High School Intervention
    initiative would do a better job of improving high school education and
    increasing student achievement. Today, just 68 out of 100 9th graders
    will receive their diplomas on time. Moreover, only 51 percent of
    African-American students and 52 percent of Hispanic students will
    graduate from high school, and less than a third of students will leave
    high school ready to attend 4-year colleges. We believe a targeted and
    comprehensive approach is necessary to overcome these challenges.

                      HIGH SCHOOL INTERVENTION INITIATIVE

        The new High School Intervention initiative would require each
    State to develop a plan for improving high school education and
    increasing student achievement, especially the achievement of low-
    income students and students who attend schools that fail to make
    adequate yearly progress. States would be held accountable for
    improving the academic performance of at-risk students, narrowing
    achievement gaps, and reducing dropout rates, but States would have
    flexibility to provide the full range of services students need to
    ensure they are academically prepared for the transition to
    postsecondary education and the workforce. The initiative also would
    deepen the national knowledge base on what works in improving high
    schools and high school student achievement by supporting
    scientifically based research on specific interventions that have
    promise for improving outcomes.
        We believe this High School Intervention initiative would be more
    effective than our current, disjointed approach that has not served all
    students well. Replacing Upward Bound, Talent Search, and GEAR UP with
    a more targeted and comprehensive initiative would help us reach our
    strategic goals of improving the performance of all high school
    students and increasing access to postsecondary education. However, in
    the interest of minimizing the disruption of services to students,
    funding for the High School Intervention initiative would support
    existing TRIO and GEAR UP projects that would be eligible for
    continuation funding in fiscal year 2006.

          UPWARD BOUND, TALENT SEARCH AND GEAR UP PROGRAM ASSESSMENTS

        Question. What specific evidence leads you to a different
    conclusion about the importance of these funded activities?
        Answer. While we agree that the activities supported by Upward
    Bound, Talent Search, and GEAR UP are important, the Administration's
    assessments of these programs have not found evidence that the programs
    are effective overall in helping disadvantaged students enroll in
    college. Moreover, we believe the new High School Intervention
    initiative would incorporate the best elements of these programs to
    achieve better results.
        Evaluation findings demonstrate that Upward Bound projects serve
    low-income students who have unusually high educational expectations
    and who would enroll in college regardless of their participation in
    the program. The high college enrollment rate for these Upward Bound
    students (65 percent) hides the reality that only 34 percent of the
    neediest students served by Upward Bound enroll in college. Although
    the program could have a significant impact if it served more students
    who truly need help, we do not have evidence to show that our efforts
    to target more of the neediest students have been successful.
        Similarly, we do not have evidence to demonstrate that GEAR UP and
    Talent Search increase college enrollment rates, even though both
    programs appear to have some positive effects. Data for GEAR UP and
    Talent Search show that both programs are meeting their short-term
    performance goals, evaluation findings for GEAR UP suggest that it has
    positive effects on middle school course-taking behavior and student
    and parent knowledge of postsecondary education.

                      HIGH SCHOOL INTERVENTION INITIATIVE

        The new High School Intervention initiative would provide a more
    coordinated approach at the State level to ensure that the types of
    services currently provided under programs like GEAR UP, Talent Search,
    and Upward Bound are part of a broader effort to provide students with
    the full range of services they need in order to succeed. The
    initiative's emphasis on supporting scientifically based research would
    help ensure that resources are focused on those activities that are
    shown to have the most positive effects.
                                     ______

                   Questions Submitted by Senator Mike DeWine

                       SAFE DRUG-FREE SCHOOL COMMUNITIES

        Question. The recommendation in the President's fiscal year 2006
    budget request to ``zero out'' the State Grants portion of the Safe and
    Drug-Free Schools and Communities program will leave most of America's
    schools and K-12 students with absolutely no substance abuse prevention
    and intervention services. With drug use finally on the decline, isn't
    this the wrong time to get rid of the prevention program that provides
    America's school aged youth with drug prevention programming?
        Answer. The Administration proposes to terminate funding for Safe
    and Drug-Free Schools and Communities (SDFSC) State Grants because of
    the program's inability to demonstrate effectiveness and the fact that
    funds are spread too thinly to support quality interventions. For
    example, SDFSC State Grants provides about 60 percent of local
    educational agencies (LEAs) with allocations of less than $10,000,
    amounts typically too small to mount comprehensive and effective drug
    prevention and school safety programs.
        By comparison, under SDFSC National Programs the Department has
    greater flexibility to provide large enough awards to support quality
    interventions. In addition, the National Programs authority is
    structured to permit grantees and independent evaluators to measure
    progress, hold projects accountable, and determine which outcomes are
    most effective. We are requesting $317. 3 million for SDFSC National
    Programs, an $82.7 million or 35 percent, increase over 2005.

     SAFE DRUG-FREE SCHOOL COMMUNITIES--UNIFORM MANAGEMENT INFORMATION AND
                                REPORTING SYSTEM

        Question. To date, the Department has failed to implement the
    requirements in H.R. 1 (No Child Left Behind Act) for a Uniform
    Management Information and Reporting System (UMIRS) under the State
    Grants portion of the Safe and Drug Free Schools and Communities
    program. This system was intended to collect uniform data and outcome
    measures for drug use and violence across all States. The poor PART
    score this program received is largely due to the failure of the
    Department to collect this required information and is one of the
    reasons being given for the zeroing out of the program. What do you
    intend to do to comply with the requirements of H.R. 1 as far as
    implementation of the UMIRS?
        Answer. We have issued non-regulatory guidance to States concerning
    implementation of the Uniform Management Information Reporting System
    (UMIRS) requirements contained in Section 4113 of the Elementary and
    Secondary Education Act (ESEA) as reauthorized by the No Child Left
    Behind Act of 2001 (NCLB). Consistent with NCLB's emphasis on
    flexibility and discussions with House and Senate staff during
    reauthorization, the guidance reiterates the data elements that must be
    included in the UMIRS, as well as the kinds of data sources that must
    included as part of the system. It also addresses the issue of which
    entity within a State is responsible for implementation of the UMIRS,
    and covers questions about funding for the system, and periodicity of
    data collection.
        We should also clarify that lack of progress on implementation of
    UMIRS was not a major factor in the ineffective PART rating received by
    the program. Safe and Drug-Free Schools and Communities State Grants
    received this rating because the program is not well designed to
    accomplish its objectives and because it cannot demonstrate results,
    among other factors. UMIRS was not really an issue.

           TITLE IV INFORMATION COLLECTION AND REPORTING REQUIREMENTS

        Question. The Department of Education has neglected to implement
    any of the data collection and reporting requirement reforms that
    Congress specifically included in Title IV of H.R. 1, including the
    Uniform Management Information and Reporting System and a minimum data
    set, to be reported on by all States to the Secretary. States and local
    education agencies (LEA's) across the Nation have exercised due
    diligence and are working to document what they think is required by
    Title IV, but have had to do this without any guidance at all from the
    Department. How and when do you intend to rectify this situation,
    especially given that this failure on the Department's part is one of
    the main reasons this program has not been able to ``demonstrate
    results'' and is slated for elimination?
        Answer. We have requested information from States concerning
    implementation of the Safe and Drug-Free Schools and Communities Act
    State Grants programs as part of the Department's Consolidated Report
    for NCLB Programs. As you know, ESEA Section 9303 authorizes the
    creation of the consolidated report and mandates that the report
    collect information on the performance of the States under ``covered
    programs.'' The consolidated report replaces pre-NCLB individual,
    program-specific reports.
        The first consolidated report covering the SDFSCA State Grants
    program was due to the Department in June 2004. The Department
    requested information from the States about the performance measures
    and targets they established for the SDFSCA State Grants program. In
    this initial report, covering school year 2002-2003, States provided
    baseline information for the performance measures that they established
    for the program. In the next consolidated report, scheduled to be
    submitted to the Department in April 2005, States will report data for
    their targets for the 2003-2004 school year.
        In addition to information about performance measures and progress
    toward achieving targets, the Department also asked States to provide
    information about the number of out-of-school suspensions and
    expulsions by school type (elementary, middle/junior high, or high
    school) for alcohol or drug-related offenses, or for fighting or
    weapons possession.

               INFORMATION COLLECTION AND REPORTING REQUIREMENTS

        We are very sensitive to the issue of creating burden related to
    information collection and reporting, and have worked hard to select
    the smallest possible data set that will permit us to assess the extent
    to which States are meeting their established targets to prevent youth
    drug use and violence. We believe that our focus on progress toward
    identified targets and suspension and expulsion data is consistent with
    that goal. While this information cannot provide scientific evidence
    about the effectiveness of the SDFSCA State Grants Program (only
    research studies that include experimental designs are capable of
    demonstrating the effectiveness of an intervention), it does provide an
    important tool for States to use in assessing their progress in
    addressing youth drug use and violence.
        Our experience in administering the SDFSCA State Grants program and
    other NCLB provisions, including the Unsafe School Choice Option (USCO)
    requirements, indicates that States need to focus additional attention
    and resources on improving the quality and consistency of data they
    collect concerning youth drug use and violence, and to take steps to
    improve the way in which such data are used to manage youth drug and
    violence prevention initiatives. Accordingly, in fiscal year 2004, we
    held a competition for Data Management Improvement Grants to help
    States develop, enhance, or expand the capacity of States and LEAs (and
    other State agencies and community-based entities that receive SDFSC
    State grant funds) to collect, analyze, and use data to improve the
    management, and report the outcomes, of drug and violence prevention
    programs. We awarded 11 such grants in fiscal year 2004 and estimate
    making an additional 7 awards in fiscal year 2005. Among other things,
    these grants will assist recipients of SDFSC State grant funds to use
    data to assess needs, establish performance measures, select
    appropriate interventions, and monitor progress toward established
    performance measures.
        As a complement to these grants, we have awarded a contract to help
    support the development of a model data set that includes, at a
    minimum, the UMIRS elements. This technical assistance effort will
    build on the work done by the Department of Health and Human Services
    Office of Substance Abuse Prevention, as well the activities of other
    Federal agencies that either collect youth drug use and violence data
    or use that data in policymaking, including the Centers for Disease
    Control and Prevention, the National Institute on Drug Abuse, the
    National Institute on Alcohol Abuse and Alcoholism, the Office of
    Juvenile Justice and Delinquency Prevention, and the Office of National
    Drug Control Policy. We will be working with these Federal agencies and
    all of the States to develop a model data set that can be adopted by
    States. The initiative also includes technical assistances services for
    the States, as well as activities designed to identify and disseminate
    best practices in this area. We believe that this approach provides the
    appropriate balance between State flexibility and leadership in this
    area.

          TEACHER INCENTIVE FUND--STATE GRANTS AND COMPETITIVE GRANTS

        Question. In the President's Budget there is a proposal for a $500
    million new Teacher Incentive Fund. It would encourage States to adopt
    and implement performance-based compensation systems for teachers.
    Could you describe your idea for this program a bit more; specifically,
    how do you see States determining who deserves ``merit'' pay?
        Answer. The Teacher Incentive Fund would provide formula grants to
    State educational agencies (SEAs) to reward effective teachers and to
    offer incentives for highly qualified teachers to teach in high-need
    schools. In addition, the Department would make competitive grants to
    SEAs, local educational agencies (LEAs), and non-profit organizations
    to design and implement performance-based compensation systems that
    change the way school districts pay teachers. The Department would use
    $450 million for the formula grants and $50 million for the competitive
    grants.
        Under the formula component of the initiative, the Department would
    provide grants to SEAs by a formula. States would use these funds to
    give monetary awards to: (1) teachers who raise student achievement or
    make significant progress in closing the achievement gap among groups
    of students; and (2) highly qualified teachers who agree to teach in
    high-need schools.
        SEAs would develop their own strategies for identifying the
    teachers who have done the best job at raising achievement or narrowing
    achievement gaps, or both, and, thus, qualify for a monetary award. A
    State might give awards directly to individual teachers, or reward all
    of the teachers in a high-performing school, or both. An SEA could also
    choose not to offer monetary awards directly to teachers and, instead,
    make competitive grants to LEAs to provide monetary awards to teachers
    who are raising student achievement or closing the achievement gap. An
    SEA would specify in its application to the Department the procedures
    and criteria it would employ.
        States would have similar flexibility in designing programs to
    attract highly qualified teachers to schools that face the greatest
    challenges in meeting the objectives of No Child Left Behind and then
    rewarding those who take positions in those schools. A State might use
    funds at the State level to create a statewide system providing
    rewards, or higher salary, to those teachers. The Department's
    expectation, however, is that SEAs would use most of the money for
    competitive grants to LEAs that have the best strategies for using the
    funds to recruit qualified teachers to high-need schools. The States
    would describe in their applications the procedures and criteria they
    would use to implement the program, including the State's definition of
    a ``high-need school'' (generally a school with a high poverty rate and
    poor performance on State assessments). All public school teachers who
    receive a monetary award under this activity would be required to meet
    the ``highly qualified teacher'' requirements under the Elementary and
    Secondary Education Act, and the Department would also encourage States
    to include additional criteria to ensure that salary increments go to
    teachers who have demonstrated a high level of performance.
                                     ______

                   Questions Submitted by Senator Tom Harkin

                  ADEQUACY OF NCLB FUNDING--STUDIES SUPPORTING

        Question. The Administration has repeatedly claimed that there is
    more than enough money available to States to fully implement the
    requirements of the No Child Left Behind Act. However, many reports and
    studies--including those done by the National Conference of State
    Legislatures, the Ohio Department of Education, and the New Hampshire
    Association of School Administrators--have found that Federal funding
    is falling significantly short of the costs of implementing NCLB and
    providing the remediation efforts to improve student achievement. Can
    you please provide us with specific studies and analyses you have used
    to justify your confidence that the funding provided is fully
    sufficient for States and school districts to meet all the provisions
    of NCLB?
        Answer. No Child Left Behind was met with charges of underfunding
    almost from the moment it was signed by President Bush, despite the
    fact that it was accompanied by a $4.6 billion increase in funding in
    its first year alone. Many of the early so-called studies of the costs
    of the new law have been little more than summaries of authorized
    funding levels, while others were based on assumptions that applied to
    only one or two States, ignoring that fact that implementation costs
    vary greatly according to how far along a given State was in its own
    standards-based reform efforts. Some studies also ignored the fact that
    many of the requirements of No Child Left Behind--such as annual
    assessment, determining adequate yearly progress, and school
    improvement--were not new at all, but expansions or enhancements of the
    previous law.
        What is most striking to me, however, is that 3 years into No Child
    Left Behind, I have yet to see a comprehensive, convincing study or
    report documenting the real costs of the law, even for a single State
    or school district. For example, the National Conference of State
    Legislatures Task Force on No Child Left Behind recognized that (1)
    ``the federal government has dramatically increased funding to K-12
    education since passage of No Child Left Behind;'' (2) that while
    ``estimates vary widely,'' Federal funding ``covers the costs'' of
    administrative compliance with NCLB; and (3) a key step to meeting NCLB
    proficiency goals involves reallocating current resources, and not just
    increasing the Federal contribution, which is dwarfed by State and
    local spending on education.
        Interestingly, even after a thorough review of existing cost
    studies, the Task Force did not attempt to provide an authoritative
    estimate of its own. Rather, it concluded that because each State's
    experience with NCLB is unique, ``Cost estimates must be made on a
    state-by-state basis.''
        On the basis of what we know now, I think it is reasonable to
    conclude that cost is not, at least not yet, a major obstacle to
    implementing No Child Left Behind. It may well be that in the future
    States and school districts will be able to provide more reliable and
    persuasive data on the costs of moving their students toward NCLB
    proficiency goals. But we have yet to see such data and, in their
    absence, I believe demands for more money are more of a political than
    an educational or analytical exercise.

                            HIGH SCHOOL ASSESSMENTS

        Question. Your proposal to expand NCLB reading and math tests in
    high schools raises the question of what consequences would be imposed
    on schools based on those test results. Currently, under NCLB,
    federally mandated sanctions for failure to make AYP apply only to
    schools that receive Title I funds. Since less than 10 percent of high
    schools get Title I funds, are you proposing to expand the scope of
    Federal consequences for failure to make AYP to all high schools,
    regardless of whether they get Title I funding?
        Answer. No, we are not proposing to expand the current school
    improvement requirements to non-Title I high schools. As is the case
    under current law, only high schools receiving Title I funds would be
    subject to improvement requirements, including the provision of public
    school choice and supplemental educational services, if they do not
    make adequate yearly progress.
        The expanded assessments would provide a uniform, objective
    mechanism for measuring student achievement and for holding high
    schools accountable under the President's High School Intervention
    initiative. They would also offer information about individual student
    progress and help educators make informed decisions for helping
    students advance through high school.

                    ASSISTIVE TECHNOLOGY STATE GRANT PROGRAM

        Question. Last October, President Bush signed Public Law 108-364,
    the Assistive Technology Act. I was the lead co-sponsor in the Senate.
    This legislation supports services that ensure that people with
    disabilities will have access to the assistive technology they need--
    technology that makes independent living possible in many cases. This
    legislation was one of few bipartisan successes we had last year, being
    unanimously endorsed by Republicans and Democrats alike in both the
    House and the Senate. Yet less than 5 months after the President signed
    the new law, his budget zeroes it out. The reason given in the budget
    is that ``the Department has been unable to identify and document any
    significant benefits.'' It is my understanding that the Department has
    collected data from every State funded under this law, yet not once in
    15 years issued the statutorily required report to Congress that would
    document the impact of these programs. It seems to me like you are
    punishing people with disabilities who get services from these programs
    because the Department has failed to do its job. How would you respond?
        Answer. The President signed the reauthorization of the AT Act
    because its goal is consistent with the goals of the New Freedom
    Initiative, that is, to promote the full participation of people with
    disabilities in all areas of society by expanding education and
    employment opportunities, promoting increased access into daily
    community life, and increasing access to assistive and universally
    designed technologies. The kinds of activities authorized by the bill,
    particularly the Alternative Financing Program (AFP), have the
    potential of enabling individuals with disabilities to have more
    control over their lives and greater participation in schools, work
    environments, and communities, through increased access to assistive
    technology. State interest in the AFP is very high; during the last
    competition we awarded $35.8 million, but received requests for $42.3
    million. In fiscal year 2005, the Department received just over $4
    million for the AFP and our fiscal year 2006 budget request includes
    $15 million.
        The design of the AT State grant program, however, is not ideal
    because it mandates four specific activities that States must carry
    out. States are unable to focus their efforts on those activities most
    needed to increase consumer access to, and ownership of, assistive
    technology within their State. Further, the new State formula grant
    program permits States to spend up to 40 percent on activities that
    have not been shown to have direct benefits to individuals with
    disabilities. Therefore, we targeted our 2006 request to funding for
    the AFP rather than the new AT State grant program.
        The Department recently sent the required annual report to Congress
    for the AT State grant program. This report, dated February 2005,
    provides a compilation of data for fiscal years 2001, 2002, and 2003
    that States provided to NIDRR using a web-based data collection
    instrument. Among other things, the report contains data required by
    the AT Act on such activities as improving interagency coordination
    relating to assistive technology, streamlining access to funding for
    assistive technology, and producing beneficial outcomes for users of
    assistive technology. In fiscal year 2001, the first year in which
    States reported data using this web-based system, NIDRR received data
    from 51 of the 56 grantees, but all 56 States reported for fiscal years
    2002 and 2003. This report is also available at http://www.ed.gov/
    about/offices/list/osers.

               EVIDENCE ON THE EFFECTIVENESS OF THE REGIONAL LABS

        Question. The enactment of two pieces of legislation, the No Child
    Left Behind Act (NCLB) and the Education Sciences Reform Act, have
    brought scientifically based research, development, dissemination, and
    technical assistance to the forefront of K-12 education. Yet for the
    last 3 years, President Bush has eliminated funding for the important
    research conducted by regional education laboratories in his budget
    request. The Administration has indicated in justification documents
    that the labs ``have not consistently provided high quality research
    and development products or evidence-based training and technical
    assistance.'' Can you cite specific evaluations studies that support
    this justification?
        Answer. Our budget request is based on the fact that we do not have
    comprehensive, rigorous evaluations of the products and services
    developed by the regional educational laboratories to warrant further
    investment beyond the more than $1.5 billion in Federal funds the
    program has received since 1966. The most recent Federal evaluation of
    the program was conducted in 1998 by Decision Information Resources,
    Inc. Panels of peer reviewers assessed the performance of each
    laboratory in meeting the duties outlined in their contract, and
    provided information to guide program improvement for the remainder of
    the contract period. Although it provided useful feedback on the
    strengths and weaknesses of each laboratory, the findings could not be
    generalized across laboratories and did not provide an assessment of
    the performance of the program as a whole.
        In June 1993, Maris Vinovskis, an outside analyst brought in by
    Diane Ravitch, then Assistant Secretary for Education Research and
    Improvement, examined the quality of research and development at 5
    regional educational laboratories, 4 of which are part of the 10
    current regional education laboratories. Dr. Vinovskis, currently a
    professor at the Department of History and Institute for Social
    Research at the University of Michigan, focused on many of the issues
    of concern to education research generally. He found that much of the
    applied research conducted by the laboratories was based solely upon
    case studies, limiting the applicability of the findings to school
    settings generally. Although Dr. Vinovskis praised some of the work
    conducted by the laboratories, particularly that of the Far West Lab,
    now WestED, he questioned both the underlying methodology and the
    practical implications of many of the other laboratory products for
    classroom use.
        Since its creation in 2002, the Institute of Education Sciences has
    addressed the issues Dr. Vinovskis raised over a decade ago by
    significantly expanding its support of applied research that uses
    rigorous scientifically based methods to find solutions to the problems
    faced by educators and policymakers. As we stated in our budget
    request, achieving the Department's strategic goal of transforming
    education into an evidence based field will require not only more and
    better research but also new and better ways to use research-based
    knowledge and translate research to practice. To reach this goal, the
    Administration is improving the way we foster knowledge utilization by
    establishing the What Works Clearinghouse, revamping the Education
    Resources Information Center, and significantly expanding the capacity
    of the Comprehensive Centers to provide technical assistance that helps
    schools apply research findings in classrooms. We believe these
    investments are more tailored to the needs of States, districts, and
    schools than the regional educational laboratories.

                             COMPREHENSIVE CENTERS

        Question. I am pleased that the Department has requested funds for
    new comprehensive centers, which will work with States and districts in
    helping schools implement No Child Left Behind. A new Request for
    Proposals for the Comprehensive Centers will be released this summer.
    The statute calls for a center in each of the 10 designated regions and
    at least 10 additional centers to be structured on a variety of
    criteria. Can you tell us what your plans are for structuring the
    second ten centers; will they be based on population or topic, or a
    combination thereof?
        Answer. The statute calls for a total of not less than 20 new
    Comprehensive Centers, while requiring that the Department establish at
    least one center in each of the 10 geographic regions served by the
    regional educational laboratories. The locations of the other centers
    will be determined through the competition, which will take into
    consideration elements identified in the law, including the number of
    school-aged children, the proportion of disadvantaged students in the
    various regions, the increased cost burdens of service delivery in
    sparsely populated areas, and the number of schools identified for
    improvement under Title I.
        The centers other than the required 10 will likely be a combination
    of additional regional centers in high-need jurisdictions and a few
    ``content'' centers with responsibilities across States and across
    Centers in major priority areas related to NCLB implementation. The
    Department has not yet made final decisions on this issue.

                    REGIONAL ADVISORY COMMITTEE ASSESSMENTS

        Question. Specifically, how will the needs assessments conducted by
    the Regional Advisory Committee process factor into your plans for
    these new Centers?
        Answer. In designing the competition for awards to the new
    Comprehensive Centers, the Department is required to consider the
    findings of 10 Regional Advisory Committees (RACs), convened to assess
    regional needs for technical assistance to support high-quality
    implementation of No Child Left Behind. The Department established the
    RACs in November 2004 and expects to receive written reports from each
    committee by the end of March 2005.
        The Department will consider the RAC assessments in drafting the
    request for proposals establishing priorities for the new centers,
    which the Department expects to publish in May. Also, the written
    reports from the RAC needs assessments will be available on the
    Department's web page so that applicants can use them to as a resource
    in designing their proposals for new Comprehensive Centers.

                          ADULT EDUCATION STATE GRANTS

        Question. The President's proposed budget calls for large cuts in
    the Adult Basic and Literacy Education program because it did not
    demonstrate results under the Program Assessment Rating Tool (PART).
    The Department says the program shows modest impacts on adult literacy
    and skill attainment but data quality problems and the lack of a
    national evaluation made it difficult to assess the program's
    effectiveness. How does that assessment justify a 75 percent cut in
    funding?
        Answer. We have requested a reduction in the Adult Education
    program due to severe budget constraints that the Federal Government
    now faces and in order to direct funds to a new initiative to
    strengthen high schools. In addition, the PART review of the program
    shows that the program does not demonstrate strong program performance
    outcomes. Currently, the program has failed for three consecutive years
    to reach performance targets measuring skill attainment of both Adult
    Basic Education and English as a Second Language students.

                            ADULT EDUCATION RESEARCH

        Question. Wouldn't it instead point first toward gathering better
    data and calling for a national evaluation through WIA reauthorization?
        Answer. Due to the diversity in age, skill level, learning
    disability status, and level of English proficiency of the adult
    education student body, a national evaluation would be extremely cost-
    intensive and would not likely produce results that could be
    generalized across States or localities. Adult Education providers also
    vary considerably and include community-based organizations, local
    educational agencies, correctional facilities, community colleges, and
    other entities. However, the Department actively conducts research
    targeting specific areas of instruction, curriculum, data collection,
    and program characteristics. For instance, we use Adult Education
    national leadership funding to address such issues as explicit literacy
    instruction for adult English as a Second Language participants and the
    use of technology to support adult education programs.

                     ENHANCED ASSESSMENT INSTRUMENTS GRANTS

        Question. Madame Secretary, as we discussed at the hearing, the
    Senate included report language urging the Department, when awarding
    enhanced assessments grants, to give special attention to the needs of
    students with disabilities and students with limited English
    proficiency. Do you plan to specify this priority in the request for
    proposals for this grant application?
        Answer. Yes. We have revised the notice inviting applications to
    give competitive priority to projects that will address the use of
    accommodations or alternate assessments in assessing limited English
    proficient students and students with disabilities.
                                     ______

                Questions Submitted by Senator Daniel K. Inouye

                           NATIVE HAWAIIAN EDUCATION

        Question. On the subject of Native Hawaiian Education, there were
    reports that the Native Hawaiian Education Council was not getting
    information from the Department of Education. Is your department now
    working with the Native Hawaiian Education Council and providing them
    with information?
        Answer. The Department has been working to improve communications
    with the Council. Department officials met with a number of Council
    members on February 15, 2005 to discuss ways to improve communication
    between the Council and the Department. The meeting also addressed ways
    to improve the Council's effectiveness and its technical assistance
    activities. We will continue to communicate with the Council and assist
    its members in fulfilling their duties.

                                CHARTER SCHOOLS

        Question. Charter schools are an important addition to Hawaii's
    education system. How do you feel about charter schools, and are there
    additional funding opportunities for charter schools?
        Answer. Charter schools are an important reform, and a key element
    of the Administration's efforts to expand school choice for students
    and parents. This is reflected in the strong support for charter school
    programs contained in the 2006 budget request. This request would
    support planning, development, and initial implementation activities
    for approximately 1,200 charter schools, as well as enhanced
    dissemination activities by schools with a demonstrated history of
    success. Further, a portion of the funds are available to States for
    subgrants to assist charter schools with their facilities financing.
    This program component, the Charter Schools Per-Pupil Facilities Aid
    program, complements an additional source of funding for charter
    schools, the Credit Enhancement for Charter School Facilities, which
    provides assistance to help charter schools meet their facility needs.
    Additionally, many charter schools are eligible for Federal funds under
    both discretionary and formula grant programs, such as the Teaching
    American History and Rural Education Achievement programs.

             PERKINS VOCATIONAL EDUCATION AND PERKINS LOAN PROGRAMS

        Question. In the President's budget he plans to cut Perkins
    vocational education and loan programs. Is there some alternative
    proposal for these programs?
        Answer. The President's fiscal year 2006 budget does not request
    funding for Vocational Education programs because those programs have
    not demonstrated effectiveness and in order to direct funds to a new
    initiative to strengthen high schools. The President believes that a
    targeted initiative will be more effective than current programs in
    meeting the major need for reform and improvement of American high
    school education. The new program would give States and districts more
    flexibility in designing and implementing services and activities to
    improve high school education and raise achievement, particularly the
    achievement of students most at risk of failure. States and school
    districts would be able to use funds for vocational education, tech-
    prep programs, and other purposes, depending on State and local needs
    and priorities. The Department would use part of the money to conduct
    carefully designed research in order to identify the most effective
    strategies for raising high school achievement and eliminating
    achievement gaps.
        The President's budget requests $1.24 billion for the new high
    school intervention program and $250 million to ensure that students
    are assessed in reading/language arts and mathematics at least three
    times during high school. The 2006 budget also includes more than $400
    million for related programs to strengthen high school achievement,
    including $200 million to expand the use of research-based
    interventions for secondary school students who read below grade level
    and thus are at greater risk for dropping out of school, $120 million
    to accelerate the mathematics achievement of secondary school students
    through research-based professional development for math teachers, $52
    million to increase the availability of Advanced Placement and
    International Baccalaureate programs in high-poverty schools, $12
    million to encourage students to take more rigorous courses through the
    State Scholars program, and $33 million in enhanced Pell Grants for
    State Scholars as they pursue higher education.
        The budget request also includes a $125 million Community College
    Access grants initiative, which would support expansion of ``dual-
    enrollment'' programs under which high school students take
    postsecondary courses and receive both secondary and postsecondary
    credit. It would also help ensure that students completing such courses
    can continue and succeed in 4-year colleges and universities.

                         FUTURE OF VOCATIONAL EDUCATION

        Question. In your opinion what is the future for vocational
    education?
        Answer. Vocational education is predominantly funded with State and
    local dollars and will continue without a Federal categorical aid
    program. Secondary vocational education will thrive if the field
    responds promptly and aggressively to demands from the business
    community and postsecondary education that it provide students with a
    more rigorous academic education, particularly in mathematics and
    science. All of our youth, regardless of their post-graduation plans,
    need a rigorous academic foundation. As the American Diploma Project
    documented in its research, ``[s]uccessful preparation for both
    postsecondary education and employment requires learning the same
    rigorous English and mathematics content and skills. No longer do
    students planning to go to work after high school need a different and
    less rigorous curriculum than those planning to go to college.'' If the
    field fails to respond to this new imperative, policy-makers, business
    leaders, postsecondary educators, and parents and students will
    increasingly question the value and relevance of secondary vocational
    education.
        Question. Will it become part of the President's Higher Education
    Act?
        Answer. Eligible recipients of grants, loans, and college work-
    study assistance under HEA student aid programs have long been eligible
    to use that assistance to pursue vocational degrees and certificates.
    The President's proposals for HEA reauthorization would allow that type
    of assistance to continue.
                                     ______

                    Questions Submitted by Senator Herb Kohl

                        FUNDING FOR NO CHILD LEFT BEHIND

        Question. I supported No Child Left Behind because it guaranteed
    that flexibility and accountability would come with more Federal
    funding to make it work. Instead, funding levels have fallen billions
    short of what was authorized. These cuts cause real hardship. To make
    ends meet, schools are being forced to cut staff and important programs
    like summer school, class size reduction, arts and foreign languages.
        Last year, Secretary Paige suggested that funding has no connection
    to student achievement. He seemed to believe that schools receive
    plenty of money to meet these requirements--even though
    superintendents, school boards, state legislatures and teachers
    consistently say otherwise. If we want this law to work--a goal which
    most of us share--don't you think it's time that the Administration
    become more responsive to these funding concerns; isn't it time to
    provide the funding that was authorized?
        Answer. As I stated earlier in response to a question from Senator
    Harkin, I believe there is little evidence for the claim that lack of
    funding is the central obstacle to effective implementation of No Child
    Left Behind. With national spending on elementary and secondary
    education roughly doubling over the past decade, from about $260
    billion to more than $500 billion, it's hard to make the case that
    we're not spending enough on education. I realize that circumstances
    vary from State to State and district to district, and that many areas
    are dealing with tight budgets, but from a national perspective, as I
    said, I don't think funding is the primary problem.
        On the issue of authorization levels, the Members of this
    Subcommittee know as well as I do that these are just targets--wish-
    lists, really--established by the authorizing committees when they pass
    new legislation. They rarely are accompanied by any careful analysis of
    what it actually costs to make a program work as intended, and the
    situation is the same with No Child Left Behind. And in the absence of
    any reliable data on the actual or prospective costs of No Child Left
    Behind, merely pointing to authorization levels is not a very
    persuasive argument for higher funding levels, particularly at a time
    of fiscal constraint at the Federal level.
        The Administration, just like the Appropriations Committees, has
    had to make hard-nosed judgments about how much we can afford for NCLB
    and other programs in light of tight fiscal constraints. Last year, for
    example, the Administration asked for substantially more funding for
    both Title I and IDEA--the two programs most frequently identified by
    critics as being underfunded--than the appropriators provided in their
    final 2005 appropriations act.

                         SPECIAL EDUCATION FULL FUNDING

        Question. Many of us here have worked hard every year to increase
    funding for Special Education. Year after year, school districts in
    Wisconsin tell me that this is one of their top concerns. They think
    it's wrong that the Federal Government continues to ignore its
    commitment to pay 40 percent of the costs as authorized in the original
    IDEA law. Just last December, the President signed the IDEA
    Reauthorization into law with an authorized funding level of $12.4
    billion for 2005. Just days later, he signed the Omnibus Appropriations
    bill which only provided $10.6 billion. This year, the President's
    budget only proposes $11.1 billion for fiscal year 2006--still $3.5
    billion short of what is authorized for 2006. This trend begs the
    question: does the Administration plan to fully fund IDEA and do you
    have a plan to get there?
        Answer. The Administration is committed to assisting States and
    school districts with meeting the costs of special education. This
    President has requested record-level increases for special education
    since he entered office.
        The 2006 President's budget request for $11.1 billion includes an
    increase of $508 million over the 2005 level. It would maintain the
    Federal contribution at its highest level--19 percent of the national
    average per pupil expenditure. If enacted, the request would result in
    an increase of $4.8 billion or 75 percent since 2001.
        The President has opposed mandatory full funding for special
    education because of the importance of taking into account competing
    budget priorities during the formulation of the budget each year. In
    the current fiscal environment, there are limited resources for Federal
    discretionary programs not related to national defense or homeland
    security. In this environment, the 4.8 percent increase requested for
    the Special Education Grants to States program is significant.

                                     E-RATE

        Question. E-rate is a vital program that provides classrooms with
    the technology they need to enhance teaching and learning. E-rate
    grants give students more opportunities to develop the skills they need
    to compete in the 21st Century. This past year, Wisconsin received over
    $24 million from this program. However, as you know, e-rate grants were
    in jeopardy last year because of new rulings related to the Anti-
    deficiency Act. Congress was able to fix the problem last year and e-
    rate grants have resumed. But that was just a one-year fix and we need
    to pass legislation to fix it permanently in order to fully cover all
    pending applications for E-rate. I look forward to working with my
    colleagues in the Senate to meet this goal. Can we count on your
    support for the E-rate program?
        Answer. I understand that the Administration has not yet taken a
    policy position on legislative initiatives regarding the E-rate. That
    said, the financial management responsibilities required by the
    Antideficiency Act are designed to protect taxpayers and beneficiaries
    of U.S. Government programs by ensuring that spending agreements do not
    exceed available resources. The PART review by OMB and recent reports
    from GAO have identified fiscal and managerial problems with the
    program. The FCC has taken some steps to address these problems,
    including collaborating with our Department on more accurate
    measurement of E-rate effectiveness.

                              READING FIRST GRANTS

        Question. I supported No Child Left Behind because I believed in
    the combination of more funding, more flexibility, and more
    accountability for results. However, many believe that the flexibility
    piece has not lived up to its promise and that certain No Child Left
    Behind regulations are overly proscriptive. One example that has been
    brought to my attention is the Reading First grant program. Last
    October, the Madison School District decided to pass on an additional
    $2 million in Reading First grants because new Federal guidelines would
    have required a substantial change in a curriculum that had already
    been successful with 80 percent of students. Can you explain why
    schools with successful programs are being forced to change in order to
    qualify for Federal funds?
        Answer. One of the advantages of the Reading First program is that
    local education agencies (LEAs) retain considerable flexibility in the
    selection of a reading program. Schools are permitted to implement the
    core reading curriculum of their choosing, so long as it addresses the
    five critical factors, identified by the 2000 Report of the National
    Reading Panel, upon which the Reading First program is based: phonemic
    awareness, phonics, vocabulary, fluency, and comprehension. Although
    the reading program used by Madison Metropolitan Public Schools (MMPS)
    proved successful with many of its students, the Wisconsin
    Superintendent of Public Instruction awarded a Reading First subgrant
    due to a gap of 2 to 4 years in reading levels between third graders in
    five elementary schools.
        A Federal review of the MMSD curriculum, undertaken as a part of
    Reading First monitoring for the 2004-2005 school year, revealed that
    the MMSD program failed to address all of the required elements of a
    scientifically based reading program. The district worked with
    technical assistance providers to address these gaps through the
    addition of supplementary materials, lesson plans, and exercises but
    ultimately decided to continue its own reading curriculum.
        Question. Why were new Federal guidelines issued?
        Answer. The Department issued non-regulatory guidance for the
    Reading First program in April 2002. States and local educational
    agencies have used this guidance as a resource to guide successful
    implementation of Reading First. We have not issued any additional
    guidance since that time.
                                     ______

                  Questions Submitted by Senator Patty Murray

                              D.C. VOUCHER PROGRAM

        Question. Secretary Spellings you are more than aware of the tight
    budget this country is facing. Education is facing a cut for the first
    time in decade. The President has proposed elimination of 48 programs
    including some very popular programs. I understand that the
    determination for which programs were eliminated comes from the
    evaluations of the Program Assessment Rating Tool (PART) administered
    by OMB. And that evaluation includes which programs are ineffective so
    that funds can be redirected to effective programs. As an appropriator,
    I agree that the government should only be funding programs that are
    effective and serving their intended purpose.
        However the President has continued to fund in his budget a program
    that is not serving its intended purpose--the D.C. voucher program. As
    I understand it, only about 75 students out of roughly 1,350 students
    receiving vouchers come from schools labeled in need of improvement--
    the highest priority of students in the original legislation. That is
    less than 6 percent of the participating students. Further, over 200
    students receiving vouchers were already attending private schools.
    According to the Washington Post, this number includes a student who is
    an 8th grader at Sidwell-Friends who had been attending the school
    since 5th grade. Clearly those students are just being subsidized by
    taxpayers, not being provided increased ``choice'' as proponents would
    argue.
        In such tight budget times, how can you justify continuing a
    program that is clearly not serving the intended population?
        Answer. On the contrary, I believe that the program is serving the
    students who Congress intended it to serve and that, as the program
    matures, it will be even more successful in providing educational
    opportunities to low-income students attending schools identified for
    improvement.
        All of the students receiving scholarships this year met the
    statutory eligibility requirements; they are from families with incomes
    of less than 185 percent of the poverty level, or roughly $35,000 for a
    family of four [correct?] Raising a family on that income is certainly
    not an easy task. While some of these families were already paying
    private school tuition, you can imagine the kinds of sacrifices they
    were making to provide their children with that opportunity. While we
    believed it was appropriate to limit the number of scholarships going
    to students already attending private schools, and we did so, we also
    did not feel that it would be fair to penalize families who had been
    making such a sacrifice.
        The Department also faithfully implemented the requirement to give
    priority to students enrolled in D.C. public schools identified for
    improvement under No Child Left Behind. However, only 15 schools were
    in NCLB ``needs improvement'' status last year, and seven of the
    schools, enrolling the great majority of those students, were high
    schools. D.C. private high schools had only a small number of slots
    they could make available to scholarship recipients during the first
    year of the program, in part because Congress was very late in passing
    the fiscal year 2004 appropriations act and, thus, the program was slow
    in getting underway. (Most D.C. private high schools accept
    applications and make enrollment decisions in the fall and early
    winter. Because of the late Congressional appropriations process and
    then the time needed to select an organization to administer the
    program and then select scholarship recipients, the program could not
    link recipients with schools until late spring.
        Further, the great majority of students who applied for
    scholarships were in elementary and middle schools, in part because
    there are just more students in those grades and in part because upper-
    grade high school students who are nearing the end of their high school
    careers are typically less interested in changing schools. For these
    reasons, the number of students receiving scholarships who came from
    schools in need of improvement was, I think, understandable given the
    circumstances.
        I am very confident that the number of students from those schools
    who participate in the program will rise very significantly during the
    next school year. For one thing, a total of 68 D.C. schools have now
    been identified for improvement, including many elementary schools.
    Secondly, our grantee, the Washington Scholarship Fund, has more time
    this year to recruit students from those schools and to recruit private
    schools to accept those students.
        Further, of the 15 schools identified for improvement last year,
    seven were high schools. High-school students are less likely than
    elementary- and middle-school students to want to change schools. In
    addition, because of the late passage of the appropriations bills and
    the need to select competitively a grantee to administer the program,
    it was not until March 2004 that the Washington Scholarship Foundation
    (WSF) was selected to operate the program and begin to solicit
    applications from parents on behalf of students. This is well past the
    time when many of the area's private high schools require students to
    apply for the following school year. As a result, few private high
    schools had places remaining for D.C. Choice participants.
        I feel confident that, with more time for the WSF to publicize the
    program and to assist parents in completing applications and more
    schools (particularly elementary schools) identified for improvement,
    the program will be even more successful in providing low-income
    parents of students who attend low-performing schools with expanded
    options for their children's education.

                         D.C. VOUCHER PROGRAM EVALUATON

        Question. What evaluations has OMB done on the D.C. voucher
    programs and can you make that information available?
        Answer. The D.C. Choice initiative has not been reviewed using the
    PART instrument. The program is in its first year of operation so it is
    too early to determine its effectiveness or undergo a PART review.
    However, the Department has moved ahead with the required evaluation of
    the program.
        Question. Part of the law also says that you must do evaluations of
    the students receiving the vouchers as compared to students in D.C.
    public schools and compared to students who applied for and did not
    receive vouchers. What is the status of the evaluations required in the
    original statute?
        Answer. The evaluation of the D.C. Opportunity Scholarship Program
    has been underway since spring 2004, when the Department's Institute of
    Education Sciences awarded a contract to a team of researchers from
    Westat, Georgetown University, and Chesapeake Associates. The
    evaluators collected information on program applicants in spring 2004,
    conducted lotteries to fairly allocate scholarships and placements at
    the grade levels and schools where there were more applicants than
    space available, and drafted a report examining the extent and
    characteristics of student and school participants in the program's
    first year. In the next few months the evaluators will be collecting
    data on academic achievement, on other student outcomes, and on parent
    satisfaction for the first group of applicants. The evaluators will, at
    the same time, be collecting applicant information, conducting
    lotteries, and beginning a descriptive analysis of the spring 2005
    applicants.
        Question. When can Congress expect to see the results of the
    analysis?
        Answer. The evaluators are finalizing their first year report and
    it should be available to Congress this spring. While the focus of the
    evaluation is on examining the effectiveness of the D.C. Opportunity
    Scholarship Program, no impact information is available at this point
    because the initial group of program participants--those who applied in
    spring 2004 to receive scholarships for the 2004-2005 school year--have
    only recently matriculated at their new schools. Instead, this report
    examines the extent of student and school interest in the program and
    the characteristics of those participating. The report provides an
    important foundation for the later examination of program impacts.

                     HIGH SCHOOL INTERVENTION/PREPAREDNESS

        Question. Secretary Spellings, as you and I have discussed before,
    I have always seen the Department of Education as a resource for
    schools, other education agencies, parents, and students. However, in
    the administration of this program, I understand that the Department
    sent an email to the Washington Scholarship Fund asking them to alter
    one of their Frequently Asked Questions on whether or not a school
    affiliated with the voucher program can still apply its own admissions
    standards. The following email was sent to WSF from the Department:
    ``the House Ed Committee has been reluctant to put this answer in
    writing. Many members (of Congress) are unaware that the schools can
    pick the students . . . I am not sure how to fix the answer but if this
    document is made public, it may damage their vote count.'' Clearly the
    Department was concerned that the reality that vouchers provide choices
    to schools not students and their families would become better known.
        How does providing incomplete information to families on the
    program increase a parent's ``choice'' about where their child can
    attend school?
        Answer. After Congress enacted the D.C. School Choice Incentive
    program, the Department moved quickly and aggressively to provide
    parents with complete information on the choices that would be
    available to eligible students. We did nothing to prevent parents of
    eligible students from receiving that information.
        The e-mail message included in the recent People for the American
    Way report fails entirely to present a full or balanced picture on the
    actions taken by the Department and its grantee, the Washington
    Scholarship Fund (WSF), during this period. The e-mail concerns the
    language WSF would include in an informational package mailed to
    private schools about participation in the program. Although the
    Department and WSF discussed different options for explaining policies
    regarding schools' admissions criteria, the package that WSF mailed to
    the schools asks the question, ``Can a school apply its own admissions
    criteria?,'' answers ``Yes,'' and then explains how a school may test
    eligible students to determine whether they are admissible and, if so,
    how they should be placed in grades or classes within the school. The
    Department made no attempt to prevent this information from reaching
    both the schools and the parents.

                   EFFECTS OF PROPOSED HIGH SCHOOL INITIATIVE

        Question. Secretary Spellings, you and I have previously discussed
    our mutual interest in improving our Nation's high schools and I hope
    we can continue that conversation. As you know, I have my own bill on
    high school reform called the Pathways For All Students to Succeed Act
    that I will be reintroducing this Congress. My bill focuses on reading
    and writing skills, academic counseling including creating graduation
    plans with students and their families, accurate calculations and data
    collection on high school graduation rates, and funding to turn around
    low performing schools using best practices.
        The President's budget eliminates the Perkins program, GEAR UP, and
    part of the TRIO program and effectively creates a block grant and
    would require more testing at the high school level. You and the
    President have said that the idea would be to allow States to determine
    how to spend that block grant--if they determine career and technical
    education to be most needed to fund that, if it's GEAR UP, fund that.
    The problem with that theory is that all of these programs are needed
    along with new ways and investment to improve our high schools.
        Considering that the President is proposing a high school block
    grant to States, how does he think that will improve problems in high
    schools such as high dropout rates amongst poor and minority students
    or a lack of academic preparedness for postsecondary education?
        Answer. It sounds like your bill would support a number of
    potentially useful strategies to improving the performance of our
    secondary schools, and I believe that States and school districts would
    be able to support many of them under the President's High School
    Intervention proposal. Where I would have to disagree is with your
    assertion that ``all of these programs are needed,'' including the grab
    bag of currently authorized programs, to improve our high schools. The
    problem with categorical programs like Perkins, TRIO, and GEAR UP is
    that they only support specific educational strategies, and thus if
    those strategies don't meet the needs of your school or district, those
    programs can't help you. Under the President's more flexible proposal,
    districts and schools choose the best strategy for meeting the
    educational needs of their students, and the High School Intervention
    initiative helps pay for it. This broader flexibility would be
    accompanied by much stronger accountability for results than is found
    in the current programs. We think that's a better way to get the
    results we need in our high schools.

                       DISADVANTAGED HIGH SCHOOL STUDENTS

        Question. One of my constituents, Bill Gates, spoke to the National
    Governor's Association High School Summit. As you know, the Gates
    Foundation is doing critical work with our Nation's high schools. He
    talked about our Nation's high schools as a question of morals and
    values and I couldn't agree more. The Federal role in education has
    traditionally been to ensure that disadvantaged students are receiving
    an equal education but it is exactly those students, poor and minority
    students, who are dropping out at the highest rates. What is the
    Department of Education doing at the high school level to target
    improving education for those students?
        Answer. The President's High School Initiative, including $1.24
    billion for High School Intervention and $250 million for High School
    Assessments, is specifically targeted at the students you describe,
    particularly those students most at risk of dropping out, who tend to
    be poor and minority. In particular, the combination of individual
    education plans based on 8th-grade assessment data and more regular
    assessment throughout high school would help principals and teachers
    focus on the students with the greatest need for assistance.
        In addition, our 2006 budget includes proposals like the expansion
    of the Striving Readers program, which target students who are falling
    behind and at risk of dropping out.

             HIGH SCHOOL INTERVENTION PROGRAM AND STRIVING READERS

        Question. As the public conversation about education focuses on
    high school reform, it's important to recognize that improving the
    literacy skills of our Nation's youth is the key to really improving
    the success of our high schools in preparing students for the 21st
    century. If our Nation's high school students do not have adequate
    literacy skills, they will not be able to graduate prepared for college
    and the workplace no matter what other supports and programs are put in
    place. Such interventions need to take place in 9th grade before
    students drop out or become disengaged in their academic future. The
    President has requested $200 million to expand the Striving Readers
    program to support interventions to improve the skills of struggling
    adolescent readers.
        How does the Administration plan to engage the education policy and
    literacy communities in this initiative to ensure that this money is
    spent efficiently on high-quality interventions that not only help
    struggling adolescent readers, but complement and support real high
    school reform?
        Answer. Department staff have met with several organizations to
    solicit their suggestions on implementing the Striving Readers program.
    For example, staff met with representatives of the National Association
    of School of School Boards of Education and the Alliance for Excellent
    Education, which published the recent Reading Next report on adolescent
    literacy. In addition, the Department has received input from
    developers of adolescent literacy programs. The Department plans future
    outreach efforts in planning and promoting the Striving Readers
    program.

                            HIGH SCHOOL INTERVENTION

        Question. Only one-in-three 18 year olds is even minimally prepared
    for college and the picture is bleaker for poor and minority students.
    High school students--especially those most at risk of dropping out of
    school--need sound advice, strong support and an advocate to ensure
    they are getting all the support and services they need to take
    rigorous courses and have a plan in place for graduation and life after
    high school. Every student must have a clear graduation plan that
    assesses their needs and identifies coursework, additional learning
    opportunities and other supports to make their goals a reality. The
    President's budget includes $1.24 billion for a High School
    Intervention which would require districts to ``ensure that targeted
    high schools develop and implement individual performance plans for
    entering students based on 8th-grade assessment data.'' My bill, the
    PASS Act contains a similar proposal.
        Would this plan be a mandatory activity for recipients, and would
    the money be required to be used not just for identifying needs, but
    providing supports and interventions?
        Answer. Under the Administration's High School Intervention
    proposal, each grantee would be responsible for developing and
    implementing individual performance plans for entering students.
    Schools would use those plans to select interventions and strategies
    with the greatest potential for improving the achievement of their
    students. In addition to developing those plans, districts would use
    the funds to implement specific interventions designed to strengthen
    instruction and improve the academic achievement of students,
    particularly those students at the greatest risk of failing to meet
    challenging State academic standards and dropping out of high school.
    The High School Intervention proposal would provide districts with the
    flexibility to use their funds to meet their specific needs without
    having to apply for several discrete grants.

          SPECIAL ALLOWANCE ON LOANS FUNDED FROM TAX-EXEMPT SECURITIES

        Question. In its fiscal year 2005 budget, the Administration
    proposed eliminating a 9.5 percent guarantee on all new student loans.
    But in this year's budget, the Administration simply says it proposes
    to make the Taxpayer--Teacher Protection Act's provisions permanent.
    But the Taxpayer--Teacher Protection Act still leaves a $100 million a
    year 9.5 percent loan loophole. That remaining loophole allows the
    holders of 9.5 percent loans to ``recycle'' loan payments from students
    and the Government back into new loans that some lenders claim are also
    entitled to a 9.5 percent rate of return.
        Do you support shutting down completely and permanently the 9.5
    percent loan loophole once and for all so that ``no new loans have a
    9.5 percent guaranteed rate of return?''
        Answer. The Taxpayer-Teacher Protection Act prohibits lenders from
    using refunding and transferring to increase student loan volume
    receiving the 9.5 percent guaranteed yield, but allows lenders to
    continue to recycle repayments of existing 9.5 percent loans into new
    9.5 percent loans. Those new restrictions are in effect through
    December 2005; the Administration's proposal would make them permanent.
        In adopting the Taxpayer-Teacher Act, Congress and the
    Administration balanced the needs of current bondholders for a stable
    and predictable revenue stream against the need to minimize unnecessary
    subsidy payments. Existing bonds, used for recycling, are maturing and
    will be retired in the near future.
        Question. Washington State has seen many brave men and women
    deployed to serve in the conflicts in Afghanistan and Iraq over the
    last 3 years. Unfortunately too many have returned as amputees,
    necessitating a difficult and uncertain recovery process. I was very
    disheartened to learn that the Department of Education, through the
    Rehabilitation Services Administration (RSA), has decided not to
    support training grants for students in prosthetics or orthotics. There
    are a very limited number of prosthetics and orthotists across the
    country who can build the artificial limbs and braces that our
    returning war veterans will need to return to a productive lifestyle.
    Less Government support to these students will mean fewer practitioners
    and more difficulty for our newly injured veterans to secure the
    quality devices they so desperately need and deserve.
        Given the significant and growing needs of our returning veterans
    for these prosthetic or orthotic devices, why did the RSA discontinue
    these critically needed training grants?

           REHABILITATION SERVICES ADMINISTRATION'S TRAINING PROGRAM

        Answer. The purpose of the Rehabilitation Services Administration's
    (RSA) Training program is to ensure that skilled personnel are
    available to serve the rehabilitation needs of individuals with
    disabilities assisted through the vocational rehabilitation (VR),
    supported employment, and independent living programs. The Training
    program provides grants for Long-Term Training, In-Service Training,
    Continuing Education, Experimental and Innovative Training, Short-Term
    Training, and Training of Interpreter for individuals who are Deaf and
    Individuals who are Deaf-Blind.
        In fiscal year 2005, the Training program received an appropriation
    of $38.8 million, of which $18.6 million (48 percent) will be directed
    toward the Long-Term Training (LTT) program. Under the LTT program,
    grants (averaging $100,000 annually for 5 years) are competitively
    awarded to institutions of higher education. Seventy-five percent of
    these grant funds must be used for direct scholarship support. RSA may
    support as many as 31 academic fields under the LTT program but, as
    required by the authorizing statute, directs funding toward the
    personnel fields with the greatest training needs and/or personnel
    shortages. As the cost of tuition has increased over time, the impact
    of the support provided has been reduced. Specifically, over the past
    12 years college tuition has more than tripled while level funding (and
    rescissions since 2003) for the Training program have required RSA to
    reduce the number of LTT fields supported.
        Our primary partners for delivery of rehabilitation services to
    people with disabilities are the State VR agencies. They are faced with
    an incredible staffing shortage. A study in progress, being conducted
    by the American Institutes of Research, has reported that it is likely
    that the supply of graduates of rehabilitation counseling programs may
    meet less than half of the number needed to replace retiring counselors
    in State VR agencies.
        To help develop a larger recruiting pool, RSA has focused the LTT
    program on counselor programs. In 1998, RSA funded LTT program grants
    in 17 areas. In 2005, it will fund 11, and may fund fewer in the
    future. RSA is very aware of the need for Prosthetists and Orthotists
    and many other rehabilitation professionals. However, given the
    Training program's level of resources, the reduced buying power of its
    scholarship dollars, and the tremendous demand for counselors in State
    VR agencies, RSA will continue to focus the LTT program on personnel
    fields that directly link to the provision of VR counseling.
        Question. Will the Department of Education reinstitute these
    training grants to support those students studying to be the next
    generation of providers of artificial limbs and braces?
        Answer. As discussed earlier, the tremendous shortage of VR
    counselors that the State agencies face make changes in the number of
    fields supported under the LTT program not feasible. RSA must continue
    to target the grants under the LTT program to the largest professional
    field--VR counselors.

     VOCATIONAL/TECHNICAL EDUCATION--POSTSECONDARY STUDENTS ATTAINMENT AND
                               COMPLETION TARGETS

        Question. According to Sec. 113(b)(3)(A)(i) of Perkins, the State
    eligible agency, with input from eligible recipients, shall establish
    the level of performance for each of the core indicators, and the State
    eligible agency may express the level in ``a percentage or numerical
    form, so as to be objective, quantifiable, and measurable . . .''
        The Washington State eligible agency, with the support of the State
    community and technical college system, has expressed the State's
    targets for the core indicators for postsecondary student attainment
    and completion as numerical targets (e.g., the number of students
    completing postsecondary career and technical education). The State has
    chosen to express the targets numerically because the State's goal is
    to increase the number of trained workers in order to meet employer
    demand. The Office of Vocational and Adult Education has rejected the
    choice of the State, and refused to accept any target not expressed as
    a percentage.
        Why has the Department of Education ignored the discretion that
    Congress clearly granted State eligible agencies when Washington State
    is fully and demonstrably committed to improving the performance of its
    vocational and technical education programs and to meeting the skill
    needs of State employers?
        Answer. As you indicate, eligible agencies are free under the law
    to express their performance levels in a percentage or numerical form.
    Regardless of how eligible agencies choose to express their performance
    levels, however, the Department has asked each eligible agency, in
    guidance that we issued after providing an opportunity for public
    comment, to define both a numerator (number of individuals achieving an
    outcome) and a denominator (number of individuals seeking to achieve an
    outcome) in submitting their proposed performance levels to us for
    review.
        We cannot fulfill the requirements of the Perkins statute without
    this information. Section 113(b)(3)(A)(i)(II) of Perkins mandates that
    each proposed performance level ``require the State to continually make
    progress toward improving the performance of vocational and technical
    education students.'' We cannot determine whether a State has satisfied
    this requirement if an eligible agency only provides numbers or
    percentages. Though the number of individuals who achieve an outcome
    may increase from year to year, this may not indicate that the
    performance of vocational and technical education students has
    improved. It may instead be the result of an increase in population.
    Similarly, an increase in the percentage of individuals achieving an
    outcome may or may not reflect improvement in the performance of
    vocational and technical education students; changing the definitions
    of the numerator and denominator could also cause it.
        In reaching agreement with eligible agencies on their performance
    levels, the Department also is required by the Perkins Act to consider
    ``how the levels of performance involved compare with the State
    adjusted levels of performance established for other States taking into
    account factors including the characteristics of participants when the
    participants entered the program and the services or instruction to be
    provided.'' (See section 113(b)(3)(A)(vi) of the Act). It would be
    inequitable for the Department to consider only the number of
    individuals achieving an outcome in making comparisons across States
    and determining appropriate performance levels. Given the significant
    differences in the sizes of their populations, Rhode Island, Washington
    State, and California, for example, should not be expected to reach
    performance levels that require same numbers of individuals to achieve
    certain outcomes.
        For these reasons, we have given each eligible agency the
    flexibility to express its performance levels however it chooses, but
    asked all agencies to define both a numerator and a denominator in
    their submission of proposed performance levels. We cannot implement
    the law the Congress has enacted without this information.
        Washington is the only State that has expressed periodic misgivings
    about providing all of the information that we have sought from States
    to evaluate their proposed performance levels consistent with the law's
    requirements. However, the Washington State eligible agency, the
    Washington State Workforce Training and Education Coordinating Board,
    has acknowledged recently that it is inappropriate and misleading to
    measure performance, either at the secondary or postsecondary level,
    simply on the basis of the number of students who achieve an outcome.
    In February 2005, the Washington State Workforce Training and Education
    Coordinating Board issued a report on behalf of itself and agencies in
    Florida, Michigan, Montana, Oregon, and Texas that made recommendations
    to States on how best to measure performance in education and training
    programs. Integrated Performance Information for Workforce Development:
    A Blueprint for States recommends that States express performance
    levels as percentages, with clearly defined numerators and
    denominators.

                               IMMIGRANT LITERACY

        Question. According to the Aspen Institute, immigrants supplied
    half of our workforce growth in the 1990s and will account for all of
    our net workforce growth over the next 20 years. More immigrants
    arrived in the 1990s--13 million--than in any other decade in U.S.
    history. Demographers and employers are warning Members of Congress
    about a severe worker shortage in the United States in the next decade.
    They have told me we must increase our investments in these newly
    arriving workers with literacy training and other support services. If
    we do not, we run the very real risk of losing our worldwide economic
    competitiveness.
        The President's proposed budget cuts to Adult Basic and English
    Literacy, coupled with his efforts to reduce funding for workforce
    programs, do just the opposite.
        What steps is the Department of Education taking to provide the
    kinds of resources needed to ensure that the employers and the new
    immigrant workers in Washington State will have ready access to a
    literate and well-trained workforce?
        Answer. The Department agrees that the health and success of our
    workforce require emphasis on English language education, particularly
    in those areas most affected by increased immigration. The Department
    continues to address actively the language and education needs of
    immigrant students, at the elementary and secondary levels as well as
    at the adult level. The request includes level funding at $68.6 million
    for English Literacy and Civics Education (EL/Civics) grants, which
    serve a vital purpose in States with large numbers of non-English-
    speaking immigrants. According to the Educational Testing Service
    study, ``A Human Capital Concern: The Literacy Proficiency of U.S.
    Immigrants,'' the average literacy level of immigrants is far below
    that of U.S. adults. The report also found that immigrants with higher
    literacy proficiencies have improved labor market outcomes and were
    less likely to be poor and in need of Government support. This
    population comprises approximately 40 percent of those served by Adult
    Education State grants, including EL/Civics grants. Unlike regular
    Adult Education State grants, which rely upon decennial U.S. Census
    data, EL/Civics grants utilize a formula based on a combination of 10-
    year Census averages and recent population data and are, therefore,
    more responsive to fluctuations in immigration patterns.
        According to a 2005 report by the National Clearinghouse for
    English Language Acquisition, 54 percent of LEP students in the United
    States are foreign born. ESEA Title III, Part A authorizes Language
    Acquisition State grants to serve limited English proficient (LEP) and
    immigrant students at the elementary and secondary level. The
    President's fiscal year 2006 budget request for Title III includes $627
    million for that program. In fiscal year 2004, Washington State's
    allocation under Language Acquisition State Grants was $9,607,031, and
    preliminary estimates for 2005 and 2006 indicate that the State will
    receive increases in both years (assuming enactment of the President's
    budget request for 2006). This program is similarly responsive to
    fluctuations in immigrant populations and requires States to reserve at
    least 15 percent of their funding each year to increase grants to
    districts that have experienced a significant increase in the
    percentage or number of recent immigrant students over the preceding 2
    years. Through both the EL/Civics program and the Title III program,
    Washington and other States have numerous options for addressing the
    literacy needs of LEP adults and youth.

                      TEACHER QUALITY ENHANCEMENT PROGRAM

        Question. Funding for Title II of the Higher Education Act--Teacher
    Quality--is the only dedicated source of Federal support to reform and
    strengthen teacher preparation available to higher education
    institutions. Grants awarded under this program enable partnerships
    between Schools of Education, Arts and Sciences Departments at colleges
    and universities and local schools to work together to achieve the
    requirement that all students be taught by highly qualified teachers,
    as mandated by the No Child Left Behind Act.
        Given the well-documented shortages of highly qualified teachers in
    certain disciplines and in rural and hard to serve urban communities,
    why has the Administration eliminated all funding for Title II of HEA
    in their fiscal year 2006 budget proposal to the Congress?
        Answer. The Administration understands that the quality of the
    teacher is one of the most significant determinants of student learning
    and, as such, the Department of Education's budget supports major
    efforts to meet the President's goal of placing a qualified teacher in
    every classroom in America in order to ensure that no child is left
    behind. Spending on programs that are designed to improve teacher
    quality was more than $3 billion in fiscal year 2005 and the
    Administration's budget request increases this amount to more than $3.6
    billion in fiscal year 2006. Included in this request is $500 million
    for a major new initiative designed to improve teacher quality. The
    Teacher Incentive Fund would reward teachers whose students make the
    most achievement gains, provide incentives for teachers to teach in the
    most challenging schools, and encourage States and LEAs to adopt
    performance-based pay plans. These measures will do even more to ensure
    that effective teachers are available to teach our children. Even with
    proposed program eliminations, spending on teacher quality would
    increase substantially in fiscal year 2006 under the Administration's
    budget request.
        In reviewing the portfolio of programs within the Department
    dedicated to achieving the goal of improving teacher quality, the
    Administration concluded that providing additional funds to the Teacher
    Quality Enhancement program would not be the most effective use of
    funds. State and local entities may already use funds they receive
    under a number of other Department programs, including the Improving
    Teacher Quality State Grants program and the Transition to Teaching
    program, to carry out the kinds of activities supported through the
    Teacher Quality Enhancement program.

                     IMPROVING TEACHER QUALITY STATE GRANTS

        For example, the Improving Teacher Quality State Grants program
    focuses on preparing, training, and recruiting high-quality teachers.
    Under that program States may use funds to reform teacher and principal
    certification and licensing requirements, support alternative routes to
    State certification, support teacher and principal recruitment and
    retention initiatives, and initiate innovative strategies to improve
    teacher quality.
        Additionally, under that program States are required to award
    subgrants on a competitive basis to partnerships that are structured
    similarly to the partnerships mandated under the Teacher Quality
    Enhancement program and consisting of at least one institution of
    higher education, one high-need local educational agency, and one other
    entity. Partnerships may receive funds to support new teacher and
    principal recruitment and retention initiatives as well as to support a
    broad range of innovative initiatives to improve teacher quality,
    including signing bonuses and other financial incentives, teacher and
    principal mentoring, reforming tenure systems, merit pay, teacher
    testing, and pay differentiation initiatives.

                         TRANSITION TO TEACHING PROGRAM

        The Transition to Teaching program is also intended to help
    mitigate the shortage of qualified licensed or certified teachers in
    many of our Nation's schools by, among other things, encouraging the
    development and expansion of alternative routes to certification. The
    program provides funds to States, local educational authorities, and
    partnerships to support efforts to recruit, train, and place high-
    quality teachers in high need schools and school districts.

                      TEACHER QUALITY ENHANCEMENT PROGRAM

        In light of the serious programmatic deficiencies identified
    through the PART process when the Teacher Quality Enhancement program
    was assessed in 2003, the Administration has concluded that the
    resources previously used to support this program should be shifted to
    higher-priority programs and initiatives that have greater potential to
    be effective in improving teacher quality. The Administration's budget
    request for programs in the Department designed to improve the quality
    of teachers demonstrates its commitment to ensuring that all American
    students have access to the highest quality teachers.

               ELEMENTARY AND SECONDARY SCHOOL COUNSELING PROGRAM

        Question. As part of the No Child Left Behind Act, Congress
    expanded the Elementary and Secondary School Counseling Program (ESSCP)
    to include secondary school activities. However, due to the program's
    statutory funding trigger, secondary schools will not benefit unless
    total funding exceeds $40 million, with the base amount reserved for
    elementary schools. Providing $75 million for the ESSCP will trigger
    the statutory requirement to support secondary school counselors, while
    maintaining funding for elementary school counselors.
        The Elementary and Secondary School Counseling Program is intended
    to provide schools with the necessary resources so that school
    counselors, school psychologists, school social workers, child and
    adolescent psychiatrists, and other qualified psychologists can work
    together to establish a comprehensive counseling program to improve
    academic achievement, provide career/education planning and facilitate
    personal/social development.
        Why did you decide to no longer fund the Elementary and Secondary
    School Counseling Program? It seems contradictory to one of the
    strongest messages from the President's fiscal year 2006 budget
    proposal, i.e., the need for high school reform.
        Answer. The budget request to eliminate funding for the Elementary
    and Secondary School Counseling program is part of an overall budget
    strategy to discontinue programs that duplicate other programs that may
    be carried out with flexible State formula grant funds, or that involve
    activities that are better or more appropriately supported through
    State, local, or private resources. Specifically, the 2006 budget
    proposes termination of 48 programs in order to free up almost $4.3
    billion (based on 2005 levels) for reallocation to higher-priority
    activities within the Department, including high school reform. Under
    the Administration's $1.24 billion High School Intervention initiative,
    school districts will be able to include student counseling services as
    part of comprehensive strategies they adopt to raise high school
    achievement and eliminate gaps in achievement among subgroups of
    students.
        The 2006 President's budget request also reflects the Nation's
    priorities to improve our homeland defenses, strengthen the armed
    forces, and promote economic opportunity. In order to ensure sustained
    economic prosperity, the President believes that it is imperative that
    spending be restrained and that the Nation's budget deficit be cut in
    half by 2009. The 2006 request would put us on track toward achieving
    that goal.

                           SCHOOL COUNSELING SERVICES

        Question. Why would you eliminate the one program that supports the
    school personnel in secondary schools (as well as elementary schools)
    who promote academic achievement, career planning and personal/social
    development which is so desperately needed by high school students?
        Answer. School counseling has, for many decades, been supported
    almost entirely with State and local funds. The very small amount of
    money appropriated for the Elementary and Secondary School Counseling
    program is unlikely to have more than a minimal impact on the
    availability of counseling services nationally. As stated in the answer
    to the previous question, under the Administration's $1.24 billion High
    School Intervention initiative, school districts may include student
    counseling services as part of comprehensive strategies they adopt to
    raise high school achievement and eliminate gaps in achievement among
    subgroups of students.
        In addition, if school districts choose to do so, they may support
    counseling programs with the funds they receive under the State Grants
    for Innovative Programs authority, which allows them to implement
    programs that best meet their needs. Furthermore, the Elementary and
    Secondary Education Act (ESEA) provides school districts with
    additional flexibility to meet their own priorities by consolidating a
    sizable portion of their Federal funds from their allocations under
    certain State formula grant programs and using those funds under any
    other of these authorized programs. A school district that seeks to
    implement a school counseling program in some or all of its schools may
    use funds from those programs to do so.
                                     ______

                Questions Submitted by Senator Mary L. Landrieu

                  EDUCATION PROGRAMS PROPOSED FOR BUDGET CUTS

        Question. Can you please provide justification beyond that given in
    the Department of Education fiscal year 2006 Budget Summary for the
    cuts made to the following programs:
    Educational Technology State Grants
        Answer. Schools and districts have made great gains in educational
    technology in recent years. In 2003, 93 percent of schools reported
    that they had access to the Internet in instructional rooms; just 2
    years prior, only 77 percent of schools offered this access. While many
    schools continue to have technology-related needs, particularly in
    training teachers to integrate technology into instruction, those needs
    can be met with resources available through other Federal programs. For
    example, activities to support technology-based professional
    development as well as school-based reform efforts that include
    technology are allowable under the State Grants for Innovative Programs
    and the Improving Teacher Quality State Grants program. Also, under the
    State and Local Transferability Act, most LEAs may transfer up to 50
    percent of their formula allocation under certain State formula grant
    programs to their allocations under any of the other authorized
    programs or to Part A of Title I. Therefore, an LEA that wants to
    implement technology programs may do so under the authorities granted
    though the individual programs or may transfer funds from, or to, its
    State Grants for Innovative Programs or Improving Teacher Quality State
    Grants allocation, without having to go through a separate grant
    application process.

    Arts in Education
        Answer. The request to eliminate funding for the Arts in Education
    program supports the Administration's policy of increasing resources
    for high-priority programs by eliminating categorical programs that
    have narrow or limited effect. These categorical programs siphon off
    Federal resources that could be used by State and local educational
    agencies to improve the academic performance of all students. However,
    activities in the arts are allowable under larger State formula
    programs such as those mentioned above; by exercising the
    transferability authority, districts may choose to continue successful
    arts programs to fit the unique need of their students.

    Safe and Drug-Free Schools and Communities State Grants
        Answer. The Administration proposes to terminate funding for Safe
    and Drug-Free Schools and Communities (SDFSC) State Grants because of
    the program's inability to demonstrate effectiveness and the fact that
    funds are spread too thinly to support quality interventions. For
    example, SDFSC State Grants provides about 60 percent of local
    educational agencies (LEAs) with allocations of less than $10,000,
    amounts typically too small to mount comprehensive and effective drug
    prevention and school safety programs.
        By comparison, under SDFSC National Programs the Department has
    greater flexibility to provide large enough awards to support quality
    interventions. In addition, the National Programs authority is
    structured to permit grantees and independent evaluators to measure
    progress, hold projects accountable, and determine which outcomes are
    most effective. We are requesting $317.3 million for SDFSC National
    Programs, an $82.7 million, or 35 percent, increase over 2005.
    Alcohol Abuse Reduction program

        Answer. No funding is requested for the Alcohol Abuse Reduction
    program, because it is duplicative of other Elementary and Secondary
    Education Act (ESEA) programs. Local educational agencies (LEAs) that
    receive Safe Schools/Healthy Students grants or the proposed research-
    based grant assistance under SDFSC National Programs may use those
    funds to support similar activities. LEAs may also use their ESEA Title
    V (State Grants for Innovative Programs) funds as well as funds they
    may transfer to ESEA Title V from their ESEA Title II Improving Teacher
    Quality State Grants program) allocation, to support alcohol abuse
    prevention.

    Elementary and Secondary School Counseling
        Answer. The budget request to eliminate funding for the Elementary
    and Secondary School Counseling program is part of an overall budget
    strategy to discontinue programs that duplicate other programs that may
    be carried out with flexible State formula grant funds, or that involve
    activities that are better or more appropriately supported through
    State, local, or private resources. Specifically, the 2006 budget
    proposes termination of 48 programs in order to free up almost $4.3
    billion (based on 2005 levels) for reallocation to higher-priority
    activities within the Department.
        The 2006 President's budget request also reflects the Nation's
    priorities to improve our homeland defenses, strengthen the armed
    forces, and promote economic opportunity. In order to ensure sustained
    economic prosperity, the President believes that it is imperative that
    spending be restrained and that the Nation's budget deficit be cut in
    half by 2009. The 2006 request would put us on track toward achieving
    that goal.
        School counseling has, for many decades, been supported almost
    entirely with State and local funds. The very small amount of money
    appropriated for the Elementary and Secondary School Counseling program
    is unlikely to have more than a minimal impact on the availability of
    counseling services nationally. Under the Administration's $1.24
    billion High School Intervention initiative, school districts may
    include student counseling services as part of comprehensive strategies
    they adopt to raise high school achievement and eliminate gaps in
    achievement among subgroups of students.
        In addition, if school districts choose to do so, they may support
    counseling programs with the funds they receive under the State Grants
    for Innovative Programs authority, which allows them to implement
    programs that best meet their needs. Furthermore, the Elementary and
    Secondary Education Act (ESEA) provides school districts with
    additional flexibility to meet their own priorities by consolidating a
    sizable portion of their Federal funds from their allocations under
    certain State formula grant programs and using those funds under any
    other of these authorized programs. A school district that seeks to
    implement a school counseling program in some or all of its schools may
    use funds from those programs to do so.

    Carl Perkins Vocational and Technical Education
        Answer. The President's fiscal year 2006 budget does not request
    funding for Vocational Education because of severe budget constraints
    that the Federal Government now faces and to eliminate programs that
    have shown little evidence of effectiveness in order to fund a new
    initiative to strengthen high schools. Despite decades of Federal
    investment, the Vocational Education program has produced little
    evidence of improved academic outcomes for students. The most recent
    National Assessment of Vocational Education found no evidence that high
    school vocational courses contribute to academic achievement or
    postsecondary enrollment, and the ``Program Assessment Rating Tool''
    (PART) review rated the program as ineffective. On the most recent NAEP
    assessments, less than 10 percent of vocational students scored at or
    above proficiency in mathematics (2000) and only 29 percent scored at
    or above proficiency in reading (1998).
        A 2002 Public Agenda survey showed that 73 percent of employers
    rate the writing skills of recent high school graduates as fair or
    poor, while 63 percent express dissatisfaction with graduates' math
    skills. All high school students need a solid academic preparation,
    whether they plan to enter the world of work immediately after
    graduation or pursue postsecondary education. The High School
    Intervention program proposed in the budget to replace Vocational
    Education would give States and districts more flexibility to improve
    high school education and raise achievement, particularly the
    achievement of students most at risk of failure. States and school
    districts would be able to use funds for vocational education, tech-
    prep programs, and other purposes, depending on State and local needs
    and priorities. The Administration believes that a targeted initiative
    will be more effective than current programs in meeting the major need
    for reform and improvement of American high school education.
        The budget also includes a Community College Access grants
    initiative to support expansion of ``dual-enrollment'' programs under
    which high school students take postsecondary courses and receive both
    secondary and postsecondary credit. This initiative would also help
    ensure that students completing such courses can continue and succeed
    in 4-year colleges and universities.

    Federal TRIO Programs
        Answer. The President's fiscal year 2006 budget does not include
    funding for TRIO's Upward Bound and Talent Search programs because we
    believe our proposed $1.2 billion High School Intervention initiative
    would do a better job of improving high school education and increasing
    student achievement. Today, just 68 out of 100 9th graders will receive
    their diplomas on time. Moreover, only 51 percent of African-American
    students and 52 percent of Hispanic students will graduate from high
    school. Less than a third of students will leave high school ready to
    attend 4-year colleges. We believe a targeted and comprehensive
    approach is necessary to overcome these challenges.
        The new High School Intervention initiative would require each
    State to develop a plan for improving high school education and
    increasing student achievement, especially the achievement of low-
    income students and students who attend schools that fail to make
    adequate yearly progress. States would be held accountable for
    improving the academic performance of at-risk students, narrowing
    achievement gaps, and reducing dropout rates, but States would have
    flexibility to provide the full range of services students need to
    ensure they are academically prepared for the transition to
    postsecondary education and the workforce. The initiative also would
    deepen the national knowledge base on what works in improving high
    schools and high school student achievement by supporting
    scientifically based research on specific interventions that have
    promise for improving outcomes.
        We believe this High School Intervention initiative would be more
    effective than our current, disjointed approach that has not served all
    students well. Upward Bound has been found to serve low-income students
    who have unusually high educational expectations and who would enroll
    in college regardless of their participation in the program. The high
    college enrollment rate for these Upward Bound students (65 percent)
    hides the reality that only 34 percent of the neediest students served
    by Upward Bound enroll in college. Although the program could have a
    significant impact if it served more students who truly need help, we
    do not have evidence to show that our efforts to target more of the
    neediest students have been successful. And the Administration's
    assessment of Talent Search did not find evidence that it is effective
    in helping disadvantaged students enroll in college.
        Replacing Upward Bound and Talent Search with the new High School
    Intervention initiative would help us reach our strategic goals of
    improving the performance of all high school students and increasing
    access to postsecondary education. The more comprehensive approach
    would give States the flexibility to incorporate the best elements of
    these programs to achieve better results. However, in the interest of
    minimizing the disruption of services to students, funding for the High
    School Intervention initiative would support existing Upward Bound and
    Talent Search projects that would be eligible for continuation funding
    in fiscal year 2006.

    GEAR UP
        Answer. The President's fiscal year 2006 budget proposes to cut
    funding for GEAR UP for the same reasons--the new High School
    Intervention initiative would be a more targeted and comprehensive
    approach to improving high school education and increasing the
    achievement of all students. Although the Administration's assessment
    of GEAR UP found positive early results, there are no data regarding
    the program's effects on high school outcomes and college enrollment.
    The High School Intervention initiative would require States to focus
    on results, and it would provide support for rigorous, scientifically
    based research to determine the best methods for helping all students
    prepare for and succeed in college. In fiscal year 2006, continuing
    GEAR UP projects would be funded under the new initiative. In future
    years, the types of services currently provided under programs like
    TRIO and GEAR UP may be continued by States as part of their
    coordinated plans for improving high school education and increasing
    student achievement.

                 PER PUPIL EDUCATION COSTS IN THE UNITED STATES

        Question. Every year when the budget comes out, there seems to
    always be an uproar from some of us on Capitol Hill that not enough
    funding was dedicated to the Department of Education. I appreciate that
    during this period of record high budget deficits, fiscal
    responsibility is a necessity. It also occurs to me, however, that
    regardless of how ``tight'' the budget is, there is a bottom dollar
    amount that it costs to educate a child. In your opinion, what is that
    amount for an elementary school student, a junior high school student,
    and a high school student? In asking this, I am asking for your expert
    opinion as the Secretary of the Department of Education and am
    referring to the total amount it costs to provide a public school
    student with the most basic education, regardless of funding source
    (i.e. Federal, State, or local government). Also, this question does
    not refer to how much is currently being spent per student, but how
    much do you believe is the bottom dollar amount that we should be
    spending per student.
        Answer. It is not possible to develop such a number for several
    reasons. The most fundamental reason is that what constitutes an
    appropriate education differs from State to State. As each State
    develops its own system of standards, it implicitly creates a different
    system of education needed to meet those standards with different
    costs. Additionally, differences in children mean differences in costs.
    The resources necessary to educate a third-grader who is blind are
    different from that necessary to educate a third-grader whose parents
    have just immigrated from a foreign nation.
        Goods and labor market conditions also affect costs. Fuel costs are
    higher in some States, making bus transportation more expensive. In
    some school districts, distances are great, similarly raising
    transportation costs. Economies of scale make education cheaper in some
    locales. A district that can take bids from several speech-language
    pathologists for services likely will have lower costs than a district
    with only one or two from which to choose. For all of these reasons, it
    is simply not possible to develop a meaningful measure of minimum costs
    necessary to educate a child at any age.

                             READING BY THIRD GRADE

        Question. Numerous studies, including those funded by the
    Department of Education, show that parents' low literacy affects their
    children's performance in school. The single most significant predictor
    of children's literacy is their mother's literacy level. Children of
    parents who have less than a high school education tend to do poorest
    on reading tests, while children of high school graduates do much
    better. These differences in test scores have held constant since 1971,
    and the same differences show up in the scores of 3rd, 8th, and 11th
    graders. We also know that the more literate parents are, the more they
    support and participate in their children's education. With the
    President's proposed cuts to Adult Basic and Literacy Education
    funding, how will parents with low literacy levels or limited English
    skills help their children achieve at the levels established by No
    Child Left Behind?
        Answer. The Department agrees that parents play a vital role in
    determining the success of a child's education. The parental
    involvement requirements under Part A of Title I, Title III, and other
    NCLB programs, encourage parents to become full partners in their
    child's education. NCLB provisions not only require schools to reach
    out to parents, through parental involvement activities, but also to
    provide information on school performance, school choice options,
    supplemental educational services, and other key elements of Title I to
    all parents and in a language and form that parents can understand.
        In addition, the Department remains committed to addressing the
    needs of immigrant and limited English proficient (LEP) students and
    their parents. The fiscal year 2006 request includes level funding at
    $68.6 million for English Literacy and Civics Education grants, which
    serve a vital purpose in States with large numbers of non-English-
    speaking immigrants.

                              IMMIGRANT EDUCATION

        Question. According to the Aspen Institute, immigrants supplied
    half of our workforce growth in the 1990s and will account for all of
    our net workforce growth over the next 20 years. More immigrants
    arrived in the 1990s--13 million--than in any other decade in U.S.
    history. In light of these statistics, based on the 2000 Census and
    Bureau of Labor Statistics projections, the President's proposed budget
    cuts to Adult Basic and English Literacy programs do not make sense.
    Doesn't it appear that English as a Second Language funding for adults
    is more important than ever before?
        Answer. The Department agrees that there is a considerable need to
    address the needs of the immigrant population, both at the elementary
    and secondary levels as well as at the adult level. This is reflected
    in current budget request, which includes level funding at $68.6
    million for English Literacy and Civics Education grants to support
    States with large numbers of non-English-speaking immigrants. Unlike
    regular Adult Education State grants, which rely upon decennial U.S.
    Census data, English Literacy and Civics Education grants are based on
    a combination of 10-year Census averages and recent population data and
    are, therefore, more responsive to fluctuations in immigration
    patterns. English Literacy and Civics Education grants will enable
    limited-English-proficient (LEP) immigrants to attain the language
    skills that are central both to their integration into society and to
    their success as members of the workforce.
                                     ______

                  Question Submitted by Senator Robert C. Byrd

                          ROBERT C. BYRD SCHOLARSHIPS

        Question. President Bush's fiscal year 2006 budget submission
    proposes to eliminate funding for the National Robert C. Byrd Honors
    Scholarship program. The scholarship program, which was established by
    Congress in 1986, makes awards to students in all 50 States, the
    District of Columbia, and Puerto Rico, and is the only merit-based form
    of Federal financial aid. According to the U.S. Department of
    Education, the program has made available a total of 336,525 1-year
    scholarships. The President's budget justification states that the
    National Robert C. Byrd Honors Scholarship program duplicates State,
    local, and private efforts. Madam Secretary, I recognize that the
    President's budget includes an increase in funding for Pell Grants, and
    that is welcome. But does the Bush Administration believe that we
    should not recognize and reward academic excellence, solely because
    some States, localities, and private institutions also recognize
    academic excellence?
        Answer. While the Administration agrees that it is important to
    reward academic excellence, the Administration believes that it is
    critical to focus such merit-based assistance on students with the
    highest financial need in order to target Federal assistance where it
    can be most effective. As a result, the Administration has requested
    $33 million for the Enhanced Pell Grants for State Scholars program.
    This program would provide up to an additional $1,000 in Pell Grants to
    students who complete a rigorous State Scholars curriculum in high
    school.
        The National Robert C. Byrd Honors Scholarship program was assessed
    using the Program Assessment Rating Tool (PART) for fiscal year 2006
    and received a rating of ``Results Not Demonstrated.'' The PART
    assessment identified several major design deficiencies that limit the
    program's effectiveness or efficiency. The PART assessment found the
    Byrd Honors Scholarship program to be duplicative of programs at the
    State, local and institutional level, noting that numerous non-Federal
    programs provide merit-based aid for outstanding students entering or
    continuing postsecondary education. All other Department scholarship
    programs are need-based, supporting those students who have a
    demonstrated financial need. This approach is central to one of the
    Department's strategic plan goals, which calls for the agency to
    increase access to quality postsecondary education especially to
    students with high financial need. The PART assessment noted that there
    is no evidence to suggest that scholarship recipients would otherwise
    be unable to attend college and that this program may subsidize
    activities that would have occurred without the program.
        In response to these findings, the Administration determined that
    the resources previously used to support this program should be shifted
    to higher priority programs that target funds more effectively. The
    Administration's budget request for other Federal student financial
    assistance programs demonstrates its commitment to ensuring that all
    Americans have access to and financial assistance for lifelong
    learning.

                              SUBCOMMITTEE RECESS

        Senator Harkin. Thank you very much, Madame Secretary.
        The subcommittee will stand in recess to reconvene at 10:30
    a.m on Tuesday, March 15 in room SD-124. At that time we will
    hear testimony from the Honorable Elaine Chao, Secretary,
    Department of Labor.
        [Whereupon, at 10:38 a.m., Wednesday, March 2, the
    subcommittee was recessed, to reconvene at 10:30 a.m., Tuesday,
    March 15.]

      DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
              RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2006

                                  ----------

                            TUESDAY, MARCH 15, 2005

                                           U.S. Senate,
               Subcommittee of the Committee on Appropriations,
                                                        Washington, DC.
        The subcommittee met at 10:30 a.m., in room SD-124, Dirksen
    Senate Office Building, Hon. Arlen Specter (chairman)
    presiding.
        Present: Senators Specter, Cochran, Craig, Harkin, and
    Inouye.

                              DEPARTMENT OF LABOR

                            Office of the Secretary

    STATEMENT OF HON. ELAINE L. CHAO, SECRETARY

                   OPENING STATEMENT OF SENATOR ARLEN SPECTER

        Senator Specter. Ladies and gentlemen, the hour of 10:30
    having arrived, the Senate Appropriations Subcommittee on
    Labor, Health, Human Services, and Education will now proceed.
    We have as our witness Secretary Elaine Chao, first Asian-
    American woman appointed to the President's Cabinet in U.S.
    history, a very, very distinguished record prior to coming to
    the position of Secretary of Labor: President and CEO of the
    United Way Foundation; Director of the Peace Corps; Deputy
    Secretary of Transportation for President Bush the first;
    distinguished fellow at the Heritage Foundation; and MBA from
    the Harvard Business School; an undergraduate degree from Mount
    Holyoke College.
        So the Secretary has brought very distinguished credentials
    to the job and now she's in her second term, and has gained a
    lot of experience on how to handle a very tough Department. And
    in the ante room I asked her how she's going to get along on so
    little money, and she said she'd rather answer that question
    only once. So in a few minutes I'm going to ask her that
    question.
        The budget is for $11.6 billion, $425 million below the
    level for fiscal year 2005, which is a 3.5 percent reduction
    and when you figure in the inflation rate, it'll be somewhere
    near 6 percent. There is no doubt that we have to economize,
    but this budget is going to be very, very challenging, Madam
    Secretary, and we will work with you on the priorities.

                               PREPARED STATEMENT

        I see that there is $1.38 billion for worker protection
    programs and $250 million to continue the community college
    initiative. This is most days very busy on Capitol Hill with
    the budget under consideration, and I am due to offer an
    amendment to try to get a little extra funding for this
    subcommittee. So I will ask that my full statement be made a
    part of the record and will yield to the distinguished chairman
    of the full committee, Senator Cochran.
        [The statement follows:]

                  Prepared Statement of Senator Arlen Specter

        This morning, the subcommittee on Labor, Health and Human Services
    and Education will discuss the President's $11.6 billion 2006 budget
    request for the Department of Labor, which is a net reduction of $425
    million below the fiscal year 2005 level. We are delighted to have
    before us the distinguished Secretary of Labor, the Honorable Elaine
    Chao, our Nation's 24th Secretary of Labor.
        This subcommittee is pleased to see several shared priorities
    funded in the fiscal year 2006 budget, including worker protection
    programs, and the Community College Initiative.
        However, I am concerned that at the same time, there is $575
    million of program reductions and eliminations. For example, the $49.4
    million program for Responsible Reintegration of Youthful Offenders is
    eliminated; the $76.2 million program for Training Migrant and Seasonal
    Farmworkers is also eliminated; Dislocated Worker State grants are
    reduced by $132.5 million, and the Job Corps is cut by $34.8 million.
        I know, Madam Secretary, that you can appreciate the difficult
    tradeoffs that this subcommittee will need to negotiate in the coming
    months as we balance the competing pressures of education, biomedical
    research, worker protection programs and continued investment in our
    Nation's youth. Madame Secretary, I look forward to working with you to
    craft an appropriations bill that maintains our commitment to fiscal
    restraint while preserving funding for high priority programs.

                   OPENING STATEMENT OF SENATOR THAD COCHRAN

        Senator Cochran. Mr. Chairman, thank you very much. Madam
    Secretary, welcome to the hearing of our Appropriations
    Committee, specifically the Subcommittee on Labor, Health and
    Human Services. We appreciate your distinguished service as
    Secretary of Labor. It's one of the tough jobs in the
    Government, though we know with your experience you bring a
    great deal of expertise and knowledge that will be very helpful
    to not only the President but our country as you carry out the
    duties of this important office.

                                 BUDGET REQUEST

        We know the budget request is lean and difficult to imagine
    being implemented as it's presented because there's some
    tightening of the budget, because we are working hard to
    control the deficit and make sure that there's room in this
    economy for continued growth, expansion, and creation of jobs.
    The Department of Labor, as much as any Department of
    Government, understands the importance of trying to hold the
    line on spending. And so some very difficult choices are
    obvious.
        We are looking forward to working with you and getting the
    benefit of your advice and suggestions as we proceed to review
    the budget request to make sure that we don't make mistakes and
    cut programs that we shouldn't, but we know we are going to
    have to make some tough choices. So we thank you for your being
    here and your distinguished service.
        Senator Specter. Thank you very much, Mr. Chairman, Senator
    Cochran. Secretary Chao, now we look forward to your testimony.

                    SUMMARY STATEMENT OF HON. ELAINE L. CHAO

        Secretary Chao. Thank you very much. Mr. Chairman, I know
    that you are pressed for time, so I'm just going to summarize
    my----
        Senator Specter. That would be fine, leaving us the maximum
    amount of time for dialogue, questions and answers.
        Secretary Chao. But I do want to emphasize a couple of
    points.
        Senator Specter. Fine.

                               PRESIDENT'S BUDGET

        Secretary Chao. One is that the President's budget will
    enable the Department to continue to build upon our precedent-
    setting record of worker protection, which you have mentioned.
        Senator Specter. Madam Secretary, would you pull the
    microphone a little closer to you? Senator Thurmond always used
    to say, would you pull the machine closer?
        Secretary Chao. I do want to emphasize that the President's
    budget will enable the Department to continue our precedent-
    setting record on worker protection, and it will help us
    implement some bold new training initiatives, which I look
    forward to discussing. And we are looking forward to reforming
    the workforce investment system so that it will serve more
    individuals and achieve even better results.

                               PREPARED STATEMENT

        I've got some--again, some other statements, but I think I
    can submit that for the record in light of the fact that your
    time is so tight.
        [The statement follows:]

                   Prepared Statement of Hon. Elaine L. Chao

        Good morning Mr. Chairman, Senator Harkin, distinguished Members of
    the Subcommittee, ladies and gentlemen. Thank you for the opportunity
    to appear before you today to present the Department of Labor's fiscal
    year 2006 Budget.
        The total request for the Department in fiscal year 2006 is $54.5
    billion and 16,945 FTE, of which, $14.3 billion is before the
    committee. Of that amount, $11.6 billion is requested for discretionary
    budget authority. Our budget request will allow us to build on the
    accomplishments achieved in recent years while meeting the President's
    call to hold Federal programs to a firm test of accountability and to
    focus our resources on top priorities. In fiscal year 2006, the
    Department will continue its record-setting enforcement of worker
    protections and provide innovative and effective training programs to
    help prepare workers for good jobs in the 21st Century economy.
        In his February 2nd State of the Union Address, the President
    underscored the need to restrain spending in order to sustain our
    economic prosperity. As part of this restraint, it is important that
    total discretionary and non-security spending be held to levels
    proposed in the fiscal year 2006 Budget. The savings and reforms in the
    Budget are important components of achieving the President's goal of
    cutting the budget deficit in half by 2009, and I urge the Congress to
    support these reforms. The fiscal year 2006 Budget includes more than
    150 reductions, reforms, and terminations in non-defense discretionary
    programs, of which 11 affect the Department of Labor's programs. The
    Department wants to work with the Congress to achieve these savings.

                             RECENT ACCOMPLISHMENTS

        To set the stage for our fiscal year 2006 budget, I would like to
    highlight some of the Department's accomplishments over the last year.
    I am happy to report that our programs have been getting results and we
    continue to make steady gains in protecting America's workforce.
        Under the Department's new Overtime Security Rule, we strengthened
    overtime protection for 6.7 million workers. Today, more workers are
    getting overtime pay and the rules are clearer and easier to understand
    and apply.
        We have also set records in enforcing worker protection laws. For
    example, worker fatalities are at an all time-low, and the Occupational
    Safety and Health Administration (OSHA) has consistently exceeded its
    inspection targets. Workplace fatalities among Hispanic workers have
    fallen by 11.6 percent since 2001. And fatalities in the mining
    industry have now dropped to the lowest level since records were first
    kept in 1910.
        In 2004, more than 288,000 workers received nearly $200 million in
    back wages, including overtime, as a result of the Wage and Hour
    Division's enforcement.
        The Employee Benefits Security Administration achieved more than $3
    billion in monetary results in fiscal year 2004, protecting workers'
    health, benefit, and retirement plans--a 121 percent increase from
    fiscal year 2003.
        We have also enhanced the transparency and accountability of labor
    union finances so that union member rights are better protected and
    they know much more about how their dues money is being spent. Under
    our union transparency reforms, meaningful information about union
    financial transactions will be available and easily accessible to union
    members

                          FISCAL YEAR 2006 PRIORITIES

        While we are proud of our accomplishments, we realize that more
    must be done to improve the lives of America's workers. Our fiscal year
    2006 budget focuses on four overall priorities: protecting workers'
    safety and health; protecting workers' pay, benefits and union dues;
    protecting veterans' reemployment rights; and preparing workers for new
    opportunities.

                               PROTECTING WORKERS

        In fiscal year 2006, $1.4 billion is requested for DOL's worker
    protection activities. This increase of $27.6 million will enable the
    Department to continue our record-setting protection of workers'
    health, safety, pay, benefits and union dues.
    Occupational Safety and Health Administration
        The fiscal year 2006 budget request for OSHA is $467.0 million and
    2,208 FTE, an increase of $2.8 million over fiscal year 2005.
        OSHA will continue to target inspections on the worst hazards and
    the most dangerous workplaces, while providing compliance assistance to
    workers and employers as they create safe and healthy workplaces. The
    request for OSHA includes an increase of $1.0 million for expanded
    compliance assistance activities in the State plan states. These funds,
    when matched by OSHA's state plan partners, will enable states to
    establish more Voluntary Protection Program sites, develop new
    agreements similar to OSHA Strategic Partnerships and Alliances, and
    provide additional outreach to workers and employers. An additional
    increase of $1.0 million is requested to enhance OSHA's data analysis
    and performance measurement capability.
    Mine Safety and Health Administration
        MSHA protects the safety and health of the Nation's miners through
    enforcement of the Federal Mine Safety and Health Act of 1977. The
    fiscal year 2006 budget request is $280.5 million and 2,187 FTE,
    representing a funding increase of $1.4 million over fiscal year 2005.
        The Administration will seek to strengthen existing enforcement by
    asking Congress for higher civil monetary penalties. Legislation will
    be pursued to increase the fine for mine safety violations from $60,000
    to $220,000.

               PROTECTING WORKERS' PAY, BENEFITS, AND UNION DUES

        The Department will also continue its high priority programs to
    protect workers' pay, benefits and union dues.
    Employment Standards Administration
        The Department's Employment Standards Administration (ESA)
    administers and enforces a variety of laws designed to enhance the
    welfare and protect the rights of American workers. The fiscal year
    2006 budget request before the Committee for ESA is $610.7 million and
    4,282 FTE. This amounts excludes and additional $31.0 million of H1B
    fees and $45.0 million in FECA Fair Share funding available to the
    agency. This represents an increase of $81.7 million and 162 FTE from
    fiscal year 2005, primarily due to the additional responsibilities
    associated with the Energy Employees Occupational Illness Compensation
    Program (EEOICPA).

                Wage and Hour Division
        The fiscal year 2006 budget request for the Wage and Hour Division
    totals $167.4 million and 1,346 FTE which excludes $31.0 million in
    estimated fee revenue from DOL's portion of an H-1B visa fraud
    prevention fee authorized by the 2004 H-1B Visa Reform Act. The
    resources requested will support the Wage and Hour Division's Overtime
    Security Task Force and its ``Off-the-Clock'' Initiative to promote
    compliance through education and enforcement efforts in low-wage
    industries. It will also support Wage and Hour's YouthRules! Initiative
    to promote compliance with the youth employment provisions of the Fair
    Labor Standards Act; enable expansion of enforcement to protect
    vulnerable workers in low-wage industries; and increase technical
    assistance and education to encourage compliance with labor laws. The
    budget also includes a legislative proposal to increase civil monetary
    penalties for violations causing death or serious injury to youths in
    the workplace from $11,000 to $50,000, and to $100,000 for repeat or
    willful violations.

    Office of Federal Contract Compliance
        The fiscal year 2006 budget request for the Office of Federal
    Contract Compliance Programs (OFCCP) totals $82.1 million and 691 FTE.
    OFCCP is responsible for ensuring equal employment opportunity and non-
    discrimination in employment for businesses contracting with the
    Federal Government. OFCCP carries out this mandate by conducting
    compliance reviews to discover instances of systemic discrimination,
    taking appropriate enforcement action, and providing relevant and
    effective compliance assistance programs. During fiscal year 2006, the
    implementation of Active Case Management and Functional Affirmative
    Action Programs will improve OFCCP's results, meaning more workers will
    be protected.

    Office of Workers' Compensation Programs
        The fiscal year 2006 budget request for the Office of Workers'
    Compensation Programs (OWCP) totals $341.8 million and 1,758 FTE and
    supports the Federal Employees' Compensation Act, the Longshore and
    Harbor Workers' Compensation program, and the Black Lung Benefits
    program. Included in this request is a $5 million increase in Fair
    Share funding to effectively implement the new centralized medical bill
    processing contract.
        The OWCP budget also includes $96.1 million and 275 FTE to
    administer Part B of the Energy Employees Occupational Illness
    Compensation Program, and $59.9 million and 219 FTE for the Part E
    program that was established in fiscal year 2005. The two Energy
    programs provide compensation and medical benefits to employees or
    survivors of employees of the Department of Energy, and certain of its
    contractors and subcontractors who suffer from a radiation-related
    cancer, beryllium-related disease, chronic silicosis or other covered
    illnesses due to exposure to toxic substances as a result of their work
    at Department of Energy facilities or those of certain of its
    contractors.
        The 2006 budget also includes two legislative proposals affecting
    OWCP programs. The first is a proposal to reform FECA to update its
    benefit structure, adopt best practices of State workers' compensation
    systems, and strengthen return-to-work incentives. This proposal is
    expected to generate Government-wide savings of more than $720 million
    over 10 years. The second is a proposal to restructure and eventually
    retire the debt of the Black Lung Disability Trust Fund (BLDTF), a debt
    that is estimated to exceed $9.6 billion by fiscal year 2006, absent
    legislative action.

    Office of Labor-Management Standards
        The fiscal year 2006 budget request for the Office of Labor-
    Management Standards (OLMS) totals $48.8 million and 384 FTE. OLMS
    enforces provisions of Federal law that establish standards for union
    democracy and financial integrity. OLMS conducts investigative audits
    and criminal investigations for embezzlement and other financial
    mismanagement; conducts civil investigations of union officer elections
    and supervises remedial elections where required; administers statutory
    union financial reporting requirements; and provides for public
    disclosure of filed reports.
        To help restore OLMS after deep cuts during the 1990s, the budget
    request includes program increases of $6.0 million and 48 FTE to
    enhance union financial integrity, union advisory services, and
    compliance assistance activities. The budget also supports legislation
    that would authorize OLMS to impose civil money penalties on unions and
    others that fail to file required financial reports on a timely basis.

    Employee Benefits Security Administration
        The Department's Employee Benefits Security Administration protects
    the integrity of pensions, health plans, and other employee benefits
    for more than 150 million workers. The fiscal year 2006 budget includes
    a $5.8 million increase to strengthen the retirement security of
    workers and retirees. These amounts include additional resources for
    the E-FAST system to maintain current operations.
        With regard to pension benefits, this Administration believes that
    pension promises made to workers and retirees must be kept. The current
    system does not ensure that pension plans are adequately funded.
    Underfunded plan terminations threaten workers' retirement security and
    are placing an increasing strain on the pension insurance system. These
    underfunded plans also impose an unfair and increasing burden on
    employers who sponsor healthy pension plans.
        The President's Budget for fiscal year 2006 proposes to reform the
    funding rules, increase disclosures to workers, and protect the pension
    insurance system, on which 44 million Americans rely to protect their
    retirement security. The Administration's plan will promote simplicity,
    accuracy, stability, and flexibility. It will encourage employers to
    fully fund their defined-benefit pension plans and ensure that benefit
    promises are kept. It will also expand, and make more timely,
    disclosures to workers and the public.
        The Administration's plan will reform the outdated premium
    structure to reflect more accurately the cost of the insurance program.
    The plan proposes to update flat rate premiums and index them to wage
    growth. We will also propose to shift the emphasis to risk-based
    premiums for all under funded plans in order to provide greater
    incentives for responsible funding.
        The fiscal year 2006 budget reiterates the Administration's support
    for Association Health Plan legislation that will allow small
    businesses and others to pool together through their trade and
    professional associations to provide health benefits for workers and
    their families. By joining together, small businesses and other
    association members would benefit from similar economies of scale,
    uniform regulation and administrative efficiencies enjoyed by large
    employers and labor unions. Association Health Plan legislation is a
    key component of the President's plan to improve access to quality,
    affordable health coverage for all Americans.

                     PROTECTING VETERANS' EMPLOYMENT RIGHTS

        This Nation's commitment to our veterans must be honored. No
    veteran should return home without the support that is needed to make
    the transition back to private life a smooth and successful one.
    Veterans' Employment and Training Service
        For the Department's Veterans' Employment and Training Service
    (VETS), we are requesting $224.3 million and 250 FTE to maximize
    employment opportunities for veterans and protect their employment
    rights.
        The Department recently issued a notice of proposed rulemaking to
    strengthen and clarify veterans' rights and employers' responsibilities
    under the Uniformed Services Employment and Reemployment Rights Act
    (USERRA). The rule is expected to be finalized during fiscal year 2006.
    Our budget request also includes $22 million for the Homeless Veterans
    Reintegration Program, an increase of $1.2 million. This program will
    provide employment and training assistance to homeless veterans, with
    expected job placements and retention of approximately 10,600 veterans.

                    PREPARING WORKERS FOR NEW OPPORTUNITIES

    Reforming the Workforce Investment System
        Overall, the fiscal year 2006 budget request for the Department's
    Employment and Training Administration is $9.2 billion in discretionary
    funds and 1,216 FTE. Our budget request will allow the Department to
    fulfill the President's call to improve job training and prepare more
    Americans for the growing and changing economy, ensuring that no worker
    is left behind. In 2006, we want to double the number of individuals
    trained under the Workforce Investment Act's major grant programs--
    including State formula grants and the new Community College
    Initiative--from 200,000 to 400,000. Just as important, we want to help
    provide workers with training that prepares them for the jobs of the
    21st century.
        Under the President's job training reform proposal, we seek
    legislation to reform the Workforce Investment Act (WIA) that would
    consolidate four compartmentalized programs into a single funding
    stream so that Governors and local officials will be able to utilize
    resources in a way that best meets their communities' specific needs.
    This proposal, called ``WIA Plus,'' would provide Governors the option
    of adding resources from up to five additional federally-funded
    employment and training programs to this consolidated State grant. The
    major goals include providing flexibility to States and localities and
    reducing overhead so that more workers can receive training.
        In return for this increased flexibility, States will be required
    to develop strategies to meet increasingly rigorous performance
    standards each year, leading to a goal in the 10th year of placing in
    employment 100 percent of the workers trained with Federal funds.
        The President's WIA reform proposal would also establish Innovation
    Training Accounts to provide workers ownership over the education and
    training they pursue by:
      --Allowing individuals to access a broad range of public and private
            training resources through a single, self-managed account;
      --Authorizing longer-term training opportunities, since many skills
            needed for today's jobs require more than just short-term
            attention and exposure;
      --Providing access to improved labor market information to help
            individuals make training decisions based on the jobs available
            in their local area;
      --Holding training institutions accountable for results;
      --Acknowledging the need for incumbent worker training so workers can
            update their skills and advance their careers; and,
      --Promoting the attainment of industry-recognized credentials and
            certifications.

    High Growth Job Training Initiative
        The President's High Growth Job Training Initiative is designed to
    develop a demand-driven workforce training system. This initiative,
    which began in 2002, prepares workers to take advantage of new job
    opportunities in growing industries and sectors of the American
    economy. The approach is based on grants to partnerships that include
    the workforce investment system, business and industry, education and
    training providers, and economic development entities working
    collaboratively to develop industry-specific workforce solutions. Under
    this initiative, the Department has awarded $164.8 million in 88 grants
    for innovative training programs in high growth industries, such as
    health-care, biotechnology and advanced manufacturing. By training
    workers with skills that are in demand, more workers will be able to
    obtain quality jobs with higher wages and enhanced career
    opportunities. At the same time, employers will be able to fill
    critical workforce needs.

    Community College Initiative
        The budget also provides $250 million to continue the President's
    Community College Initiative, which provides for Community Based Job
    Training Grants. For 2005, the Congress approved and financed this new
    initiative, and the first grants will be awarded beginning in the
    summer of 2005. Eighty percent of the jobs in the fastest growing
    fields require education and training beyond high school. The Community
    College Initiative will help fully utilize the expertise of America's
    community colleges as part of our job training programs and better
    train workers for jobs in high growth sectors. These competitive grants
    will build on the High Growth Job Training Initiative and strengthen
    the role of community and technical colleges as partners of the
    workforce investment system.

    Youthbuild
        The President's Budget includes a legislative proposal to transfer
    the Youthbuild program from the Department of Housing and Urban
    Development to DOL. This change was recommended by the White House Task
    Force on Disadvantaged Youth. The Youthbuild program targets
    disadvantaged youth ages 16-24. The program provides grants to local
    organizations that train participants for well-paying construction
    jobs. Their training also results in the building of affordable housing
    units. Transferring Youthbuild to DOL would provide the program with
    better contacts with One Stop Career Centers, stronger ties to DOL's
    Job Corps and apprenticeship programs, new links to the President's
    High Growth Job Training Initiative, improved access to the post
    secondary and community college system, and stronger connections to
    employers and local labor markets. It also promises to offer greater
    placement opportunities for the youths involved.

    Prisoner Re-Entry Initiative
        In fiscal year 2006, $75 million is provided for the second year of
    the President's 4 year, multi-departmental Prisoner Re-Entry
    Initiative. Of this total, $35 million is for the Department of Labor,
    $25 million is for the Department of Housing and Urban Development, and
    $15 million is for the Department of Justice. This initiative is
    designed to strengthen urban communities through an employment-centered
    program that incorporates job training, short-term housing, mentoring,
    and other transitional services to help recently released prisoners
    make a successful transition back to society and long-term employment.
    It taps the unique contributions and capacities of America's faith-
    based and community organizations.

    Strengthening the Integrity of the Unemployment Insurance System
        Building on previous proposals to strengthen the Unemployment
    Insurance (UI) system and reduce erroneous UI payments, the fiscal year
    2006 budget proposes a $10 million increase in beneficiary eligibility
    reviews in One-Stop Career Centers. This is projected to save up to
    $225 million annually. In addition, a $30 million increase is requested
    to prevent and detect fraudulent unemployment benefit claims using
    stolen personal information--otherwise known as identity theft--that
    would result in annual trust fund savings of as much as $105 million.
    These two discretionary proposals are part of the Administration's
    proposal to fund efforts to reduce improper payments across several
    agencies using a new budget enforcement mechanism of spending cap
    adjustments. In addition, the Budget includes a package of legislative
    changes to prevent and recover overpayments of Unemployment Insurance
    benefits, saving an estimated $4.7 billion over 10 years. These budget
    and legislative proposals are not only an important protection for
    American workers, but are also a responsible use of public funds.

                                 OTHER PROGRAMS

    Bureau of Labor Statistics
        In order to maintain the development of timely and accurate
    statistics on major labor market indicators, the fiscal year 2006
    budget provides the Bureau of Labor Statistics with $542.5 million and
    2,475 FTE, which is an increase of $13.5 million over fiscal year 2005.
    This funding level provides the BLS with the necessary resources to
    continue producing sensitive and important economic data, including the
    Consumer Price Index, the Producer Price Index, and the Quarterly
    Census of Employment and Wages.

    Office of Disability Employment Policy
        The 2006 budget request provides the Office of Disability
    Employment Policy (ODEP) with a total of $27.9 million and 59 FTE. In
    past years, the request for ODEP included a large research and grant
    making function. ODEP has invested these funds in testing a variety of
    pilot projects, and we now have several years of results to determine
    which of these pilots work, and which ones don't. ODEP will now focus
    on improving access by disabled Americans to DOL's programs, and on
    developing proven approaches to helping Americans with disabilities
    find meaningful employment opportunities.

    Women's Bureau
        To continue its outreach to working women, the fiscal year 2006
    budget includes $9.7 million and 60 FTE for the Women's Bureau, an
    increase of $0.3 million above fiscal year 2005.

    International Labor Affairs Bureau
        The request for the International Labor Affairs Bureau (ILAB) in
    fiscal year 2006 is $12.4 million and 95 FTE. The budget returns ILAB
    to its core mission of developing international labor policy, and
    performing research, analysis, and advocacy.
        The requested funding levels would allow ILAB to implement the
    labor supplementary agreement to NAFTA and the labor provisions of
    trade agreements negotiated under the Trade Act of 2002, participate in
    the formulation of U.S. trade policy and negotiation of trade
    agreements, conduct research and report on global working conditions,
    assess the impact on U.S. employment of trade agreements, and represent
    the U.S. Government before international labor organizations, including
    the International Labor Organization.
        ILAB will continue to implement ongoing efforts in more than 70
    countries funded in previous years to eliminate the worst forms of
    child labor and promote the application of core labor standards, and
    reduce employment discrimination against persons living with HIV/AIDS.

    President's Management Agenda and Department-wide Management
            Initiatives
        Before I close today, Mr. Chairman, I also want to highlight the
    Department's ongoing efforts to implement the President's Management
    Agenda. In August 2001, President Bush sent to Congress his President's
    Management Agenda (PMA), a strategy for improving the management and
    performance of the Federal Government. The agenda called for focused
    efforts in the following five government-wide initiatives aimed at
    improving results to citizens: Strategic Management of Human Capital,
    Competitive Sourcing, Improved Financial Performance, Expanded
    Electronic Government, and Budget and Performance Integration. DOL is
    also responsible for three of the PMA initiatives that are found only
    in selected departments. The first of these three is Faith-Based and
    Community Initiatives. In the fourth quarter of 2004, DOL began working
    in earnest on another selected PMA component, Real Property. Also, in
    the first quarter of 2005, DOL began tracking its status and progress
    on a new PMA initiative to Eliminate Improper Payments.
        The Department is one of only three cabinet departments that earned
    ``green'' status ratings on four of the five government-wide scorecards
    for the first quarter of 2005, without a single red score. For progress
    during this period, DOL achieved five of five green scores. On the
    basis of its favorable ratings for status and progress in
    implementation of these initiatives, DOL was honored with two
    Presidential Quality Awards and is recognized as one of the best
    managed Cabinet agencies.

                                   CONCLUSION

        With the resources we have requested for fiscal year 2006, the
    Department will continue to improve its protection of workers' safety
    and health, protect workers' pay, benefits, and union dues, secure the
    employment rights of America's veterans, and prepare workers for the
    jobs of the 21st Century.
        Mr. Chairman, this is an overview of the programs we have planned
    at the Department of Labor for fiscal year 2006.
        I would be happy to respond to any questions members of the
    subcommittee may have.
        Thank you.

                             MEDICAL LEAVE PROGRAM

        Senator Specter. Okay. Well, thank you, Madam Secretary.
    The medical leave program has been challenged with some 68
    Federal lawsuits raising issues on the interpretation of when
    employees are eligible for leave under the 1993 Family and
    Medical Leave Act. Last December, your Department announced its
    intention to publish a rule to revise the Act's regulations.
        There are many in the labor area who like the way the
    program is being administered and there are some in the
    business area who would like to see their restrictions
    tightened. We have been studying the issue, but we would be
    very interested in your view as to how the regulations are
    being administered, whether you intend to put up new
    regulations, and what your evaluation is as to the equitable
    balance as you see it.
        Secretary Chao. First of all, let me say that the Family
    and Medical Leave Act is an important law that basically
    benefits a lot of workers and their families, and we take our
    responsibilities under this law very seriously. Let me also say
    that in the last 10 years that the regulations have been in
    effect, there have been numerous lawsuits challenging various
    provisions of the regulations. And some of these provisions in
    the regulations that were set out have in fact been struck
    down, including one by the Supreme Court in a decision in 2002,
    Ragsdale v. Wolverine.
        So we are mandated by the Court to revisit certain aspects
    of the Family and Medical Leave Act, and we've, in response to
    the Supreme Court decision and other case law developments, we
    have held a number of stakeholder meetings throughout the last
    2 years with both employees and employers, with the unions,
    with non-profit groups. And we have been considering a number
    of informal comments and the feedback that we have received
    from these shareholder meetings. We've been reviewing the
    development in case law and we are looking at a number of areas
    where we could possibly provide better guidance.
        But let me say that no final decision has been made on this
    issue. We do have outstanding the 2002 Supreme Court decision
    on Ragsdale, and so something needs to be done on that.
        Senator Specter. Well, let us work together and stay in
    touch to see how--what you're thinking about, have an equitable
    balance so that we do our best to strike a balance between what
    the workers have in mind on leave and what the employers are
    concerned with.

                           YOUTHFUL OFFENDER PROGRAM

        You are again proposing to eliminate the responsible
    reintegration of youthful offender program, replacing it with a
    prisoner re-entry initiative. I was with the President and the
    First Lady in Pittsburgh 1 week ago yesterday, and she has a
    program to help troubled youth, and we have these programs
    sprinkled all over the map, Secretary Chao.
        This prisoner re-entry initiative, you really need a score
    card to keep track of what's going on. It's going to be funded
    through three Departments, $35 million from the Department of
    Labor, $25 million from HUD, and $15 million from the
    Department of Justice. Does all this alphabet soup make sense?
        Secretary Chao. I know that the youth offender program is
    very near and dear to your heart and it's one of your----
        Senator Specter. Well, it has been near and dear to my
    heart since I worked with youthful offenders many years ago as
    district attorney, and it continues to be an atrocious problem.
    There were 11 murders in Philadelphia over the weekend. The
    chief of police decried the situation yesterday, noting that
    there were more murder--more people killed in Philadelphia over
    the weekend than in Iraq. So there really needs to--we really
    need to do something. It is a bottomless pit. What do you
    think?
        Secretary Chao. We know that this is a program that you
    place a great deal of emphasis on, and in fact we share your
    concern that there seems to be a great many different venues
    through which focus on this issue was taken, which was why we
    took the impetus--we took the initiative initially to try to
    work the young offenders program into a larger program. And so
    we have tried to integrate the funding. We have tried to work
    this program into the prison re-entry initiative.
        Our concerns are the same as yours. It's too fragmented.
    And so we thought that, again, with the young offenders
    program, if we work together through the prisoners re-entry,
    along with a more coordinated and coherent approach with other
    Departments that are also involved in facing this--addressing
    this challenge, that we would do a better job.
        Senator Specter. My red light is on, and I like to observe
    the time, but it would lose continuity if I didn't ask you one
    more question. We could solve this fragmentation by simply
    moving the Department of HUD and Urban Development and the
    Department of Justice under your Department of Labor, under
    your overall Secretaryship. Would you think that would
    eliminate the confusion and duplication and overlapping?
        Secretary Chao. I never refuse an offer to expand my
    empire.
        I'm only joking, of course.
        Senator Specter. Madam Secretary----
        Secretary Chao. I think there's a larger issue here: This
    is very much geared toward training and getting young people
    together with community and faith-based organizations who
    support, in a holistic way, the full integration of young
    people back into the community. And so we thought that a more
    holistic, coordinated, and comprehensive approach with other
    Departments that are also doing the same thing would yield
    actually a better result for these young people.
        Senator Specter. I want to now yield to the distinguished
    chairman of the full committee who may be able to solve all of
    our problems when he makes the allocations.
        Senator Cochran. Mr. Chairman, thank you very much for your
    confidence in our decision-making capabilities. I hope that we
    are able to reach a decision that enables the Department of
    Labor to carry out its important responsibilities, particularly
    in job training and their programs in my State.

                               JOB CORPS PROGRAM

        I had the pleasure of visiting last year a Job Corps site
    where they're doing very commendable work in preparing students
    for real jobs that exist in our State. I noticed there's a
    decrease in the budget request for the Job Corps program, a
    decrease of $29 million below last year, and also a suggestion
    for recission of funds in the construction area for the
    renovation and repair of buildings. I think my State has a
    backlog of that kind of work as well.
        I hope we will be able to work with the Department to
    identify some changes that we can make in the budget without
    disrupting the overall goal of holding the line on unnecessary
    spending. But I mention that program, and I wonder what your
    impression has been of the Job Corps program, specifically its
    efforts to train those who don't come to the program with a
    high level of education, some of them don't, and so this job-
    training activity may be their only hope for having a good-
    paying job.
        Secretary Chao. The Job Corps is a very popular program. It
    is liked by Members across--on both sides of the aisle. It's a
    very popular program. The specific line item that you're
    referring to impacts only the construction, the rehabilitation,
    and acquisition account for buildings. So we do not anticipate
    any service reductions at all.
        We will continue to pursue the acquisition of the new sites
    in Pinellas Park, Florida, and Milwaukee, Wisconsin. I think
    what we're talking about here is again, we do not expect that
    current funding requests will impact the current service level
    at all.

                                 LOAN GUARANTEE

        Senator Cochran. There is one request I called in the other
    day by telephone to your office. It has to do with an
    application for a Department of Agriculture loan guarantee
    submitted by a company that is planning to build a steel
    manufacturing plant in Columbus, Mississippi. They've applied
    for a loan guarantee from the Department of Agriculture under a
    program that I'm familiar with.
        But before the Department can approve that, they're
    required to submit the application or notice of the application
    to the Department of Labor. And the Labor Department's role is
    limited to making two findings: That the approval of the loan
    guarantee does not involve the relocation of jobs; and there
    will be no adverse impact on competitors in the immediate area.
        In the immediate area of Columbus, there is no other steel
    manufacturing plant. There is no other steel manufacturing
    plant that will provide the material that this company will
    provide in the entire Southeastern United States. To my
    knowledge, and I'm assured that this is the case, there is no
    question about relocating jobs from some other area.
        I had a very difficult time getting information from your
    office as to what the status of the matter was. I asked for
    additional information. I was assured that my call would be
    returned by somebody who could provide me with that
    information. I haven't received a call yet. Somebody on my
    staff may have gotten a call, but I haven't been advised about
    it until now.
        I hope that you will look at this request. The company's
    name is Steelcorr Corporation. It would manufacture steel
    plates for automobile construction. We have several new
    automobile construction facilities that have been located in
    our State, in the State of Alabama, and in that region, but
    this would be the first plant that would be actually making
    steel plates to be used in the construction of these
    automobiles.
        If this company is able to get the loan guarantee, they'll
    build that plant and it will provide a lot of new jobs and a
    lot of new industries that are compatible with it. Suppliers
    and the like would also likely move into our area.
        So we have a great deal of interest in this, and we hope
    that the Department of Labor won't just continue to hold this
    application. It's a matter of some urgency, I'm told, so that
    they can move forward with the construction of this facility.
    I'm sorry to have to spend so much of my time talking about the
    importance of that. It sounds like it's something that the
    Department could handle very quickly.
        Senator Specter. Senator Cochran, if you'd like more time,
    you're welcome to it.
        Senator Cochran. Thank you, Mr. Chairman. I don't think I
    need it.
        Secretary Chao. May I answer that? May I just make a few
    comments about that if I could? First of all, I'm sorry that
    you have the impression that our Department is not responsive
    in answering, because when the chairman calls, both chairmen,
    we answer the calls right away, so again, I don't know what
    happened. I will check into that.
        Second issue, we understand that this is a--we know that
    you are concerned about this issue, and we're very focused on
    it. We play only a very small part as you mentioned in the
    whole process. The Department of Labor is required by law to
    evaluate the impact of this financial assistance. We have about
    30 days. The application was submitted on February 24 with
    USDA, and it was forwarded to the Department of Labor for
    consideration--I'm sorry--on February 24. So the Department has
    about 30 days and we're still in the evaluation process.
        Please be assured that your interest in this is noted, and
    again, we are just responsible for the assessment, and then we
    go back to USDA and then they, of course, make the final
    decision.
        Senator Cochran. I thank you for your response and hope
    that we will see the timely handling of the Department of
    Labor's responsibility for this application. Thank you, Mr.
    Chairman.

                        PERSONAL RE-EMPLOYMENT ACCOUNTS

        Senator Specter. Thank you very much, Senator Cochran.
    Madam Secretary, in fiscal year 2004, Congress did not approve
    your request for $50 million to initiate a new personal re-
    employment account program, but you used transfer authority to
    spend $9 million on this program anyway. I think it is very
    important that when there is a refusal by the Congress on the
    appropriations process under the Constitution that the funding
    not be used in any collateral way, and I would be interested in
    your comments on the matter and your assurances that the
    Department does not intend to use the collateral way with
    transfer authority, where there has been an expressed
    declination by the Congress.
        Secretary Chao. As you know, the administration strongly
    supports the personal re-employment accounts, and the House
    passed one version and the Senate did not. Because the original
    larger scale personal re-employment accounts were not funded,
    it was decided to test the approach on a smaller pilot basis,
    through some demonstration projects, and I believe we notified
    the Appropriations Committee that we were intending to do so.
    And I think, as you mentioned, there's about $7.9 million out
    of a huge project that was the original intended amount.
        So we hope that we at least--we will get better information
    and test this approach on a--with some communities have
    voluntarily wanted to participate. And we hope that again that
    will yield better information on whether this works or not.
        Senator Specter. Well, Secretary Chao, even though it's a
    relatively small sum of money, although we might discuss
    whether $7.9 million is a relatively small sum of money, and
    even though it's a pilot project, and even though the
    administration very much wants it, and even though some
    communities would like to do it, it's really, really beyond the
    separation of powers.
        Listen, you've done such a good job that I'm not going to
    dwell on the point. But I just want to drop a big red flag.
        Secretary Chao. Okay.
        Senator Specter. Okay? It doesn't have any stars and
    stripes on it.
        Secretary Chao. I understand.

           APPALACHIAN COUNCIL AND THE WORKING FOR AMERICA INSTITUTE

        Senator Specter. Big red flag. I appreciate the work of the
    Department in working through the statutory deadline of January
    31 to put grants into effect for several projects, including
    the Appalachian Council and the Working for America Institute.
    There have been some differences of opinion as between--these
    occur inevitably between the executive and the legislative
    branches, and that's why we have separation of powers.
        But I would like you to take a look at those programs, a
    personal look, and let me know what you think of them, because
    if there are any problems there, I would like to be personally
    informed.
        Secretary Chao. Okay.
        Senator Specter. An effort made to work them out. Those
    projects have been in effect for a long time, and they provide
    sort of a classic confrontation in the political field. You and
    I are both dedicated to service and doing what is good, so
    that's something that I would like something between Elaine
    Chao and Arlen Specter. If you would take a look at them, we
    can see what they're doing and try to work out any problems.
        Secretary Chao. So it's Working for America and the NCEE?
        Senator Specter. Yes, and the Appalachian Council.
        Secretary Chao. The Appalachian Council, okay.
        Senator Specter. And the Working for America Institute.
        Secretary Chao. These are sole-source contracts. We can
    talk more about them, but the main problems are sole source
    criteria.
        Senator Specter. Well, we do still use them to some extent.
        Secretary Chao. But we did fund--the committee earmarked
    and it went out on time.
        Senator Specter. No, no, I know you've done it, and I
    started off by thanking you for doing that. This initiative for
    the black clergy, which Senator Santorum and I were so
    enthusiastic about, looked like it was all going through until
    late in October, and we had a problem, which could have had
    some very serious repercussions. We were able to work it out.
    And I'd like you to take a look at that one too as to how they
    are doing.

                             FAITH-BASED INITIATIVE

        This goes back to the problem we talked about, juvenile
    delinquency, and this is a faith-based initiative. These are
    churches and they've set up six job training programs. And here
    again is something which reaches the level where I would like
    the Secretary and the chairman to work together.
        Secretary Chao. I'd be pleased to do so.

                              ASBESTOS VIOLATIONS

        Senator Specter. Madam Secretary, the issue has arisen on
    increasing the penalties for a willful violation of the
    Occupational Safety and Health Act on asbestos violations. And
    I would be interested--I'm considering legislation on that
    field. Asbestos is a terrible problem which we all know about,
    and I'd be interested in your views as to whether you think
    enhanced penalties would be a good idea there.
        Secretary Chao. I think the current discussions about the
    asbestos bill, which you have taken quite a leadership position
    on, is evolving, and we want to thank you for your leadership.
    It's a difficult issue. There are obviously a great array of
    different stakeholders. And the administration has not really
    taken a position on a number of these issues pending these
    working groups and outside stakeholder groups to come to some
    kind of an agreement.
        Senator Specter. Well, we are working very hard on the
    asbestos bill. I had a chance to talk to the President about it
    when I traveled with him to Pittsburgh a week ago yesterday,
    and he's looking for a bill which he can sign, and we're trying
    to get bipartisan activity. And your Department has had
    phenomenal success in administering matters.
        The way it works is, if you do a good job, people come back
    to you and say, you've done such a good job and we'd like you
    to do more. We find that with this subcommittee and I find that
    on the Judiciary Committee. And on the legislation which we are
    working on to create a trust fund, there's not going to be any
    Federal money going into the fund.
        The insurance and manufacturing industries have agreed to
    put up $140 billion, which we're projecting will be sufficient.
    And we're working very carefully on directing it only to the
    sick people, so that we're not going to have any expanded
    coverage. It's going to people who really are sick.
        The Supreme Court handed down a decision that--5 to 4--that
    if you were exposed to asbestos you would collect money whether
    you were sick or not. And thousands of people are dying of
    mesothelioma and asbestosis. Companies are going bankrupt,
    can't pay them. Seventy-four companies are going bankrupt. But
    there's not going to be any extended coverage, and the
    Department will not be called upon to be a tax collector or
    banker.
        I'm meeting with the Attorney General later today and we're
    giving him a lot of new jobs too on enforcement. And it is sort
    of axiomatic that everybody is overworked, but this is a
    problem which is overwhelming the economy, and we are searching
    very, very hard for remedies.
        I'm delighted to be joined by my distinguished ranking
    member, also delighted to be joined by Senator Inouye, who beat
    the ranking member here by 30 seconds. Senator Inouye, with his
    customary grace and aplomb, has gestured to take Senator Harkin
    first. Senator Harkin has just acceded.
        As I said at the beginning of the hearing, I'm due on the
    floor to offer an amendment to increase the funding for our
    subcommittee, so I'm going to--well, we were--we've been cut
    everywhere, and I want to bring the funding back up to level
    for education, which would be a little over $500 million and
    NIH $1.5 billion. So I'm going to leave the seamless gavel in
    the hands of Senator Harkin.
        Senator Harkin. Thank you very much, Mr. Chairman.
        Senator Specter. Thank you for the very good work you're
    doing, Madam Secretary.
        Secretary Chao. Thank you.
        Senator Specter. We'll be working with you to tackle the
    tough issues which we talked about, and we will have some more
    questions for the record. Thank you.
        Secretary Chao. Thank you.

                    OPENING STATEMENT OF SENATOR TOM HARKIN

        Senator Harkin [presiding]. Madam Secretary, again, welcome
    and I appreciate your work at the Department of Labor and your
    continuing efforts in that regard. I just want to join our
    distinguished chairman in welcome you again to this committee.
        Madam Secretary, I'm just going to make a short opening
    statement and then we'll get to some questions and I'll yield
    to Senator Inouye. Madam Secretary, I know you appreciate frank
    exchanges. We've had many in the past. So I must tell you up
    front that I am very disappointed in the administration's 2006
    budget request for your Department. I appreciate that you're
    being a good soldier and going along with the OMB's marching
    orders, but I must for the record say that the proposed 2006
    budget from the Department of Labor is seriously out of synch
    with the needs of our labor force.

                                   UNEMPLOYED

        Right now, 7.7 million workers are officially unemployed.
    Another 1.8 million are too discouraged to look for jobs, so
    they aren't even included in the official unemployment rate.
    Long-term joblessness is at record levels. Yet despite these
    challenges, the administration proposes to cut DOL's budget by
    $400 million.
        Let me mention some specifics. A 2003 General Accounting
    Office report found that the employment services, the principal
    source of employment and training programs for American
    workers. But the White House proposes to eliminate this proven
    agency and replace it with a generic block grant to the States.

                              MIGRANT FARM WORKERS

        Second, the number of migrant farm workers with immigration
    issues has increased from 7 percent to 52 percent in the last
    decade. Yet the White House proposes to eliminate not only the
    migrant and seasonal farm worker program, but also the source
    of the information, the national agricultural workers study,
    where we get the data and the information.

                                    VETERANS

        Third, our soldiers are coming back from Iraq wounded in
    record numbers, many with amputations that will affect their
    employment options for the rest of their lives. Yet the White
    House has proposed an insignificant increase in the veterans
    employment and training service, and proposes to cut the Office
    of Disability Employment Policy by almost half.
        Next, the President is promoting both the Central American
    Free Trade Agreement and the Andean Trade Agreement, both of
    which will require technical assistance on core labor
    standards. But this budget proposes to essentially gut the
    International Labor Affairs Bureau, ILAB, which provides that
    technical assistance.

                              WORKFORCE CHALLENGES

        So as I said, Madam Secretary, these budget proposals, I
    believe, are out of synch with the needs of our workforce. In
    some cases, the budget is out of synch with the
    administration's own professed priorities. Our workforce today
    faces more challenges than at any time since the Great
    Depression--globalization, outsourcing, the continuing shift
    from manufacturing to services. I would argue the Department of
    Labor needs more resources, not less. Rather than downsizing,
    the Department should be playing a much more robust role in
    guiding the American workforce through this period of change.
        So I am disappointed with this proposed budget and
    hopefully through the efforts of Senator Specter on the floor
    and as we move ahead with the appropriations, I am hopeful that
    we can provide a more appropriate funding for the priorities in
    the Department's budget, Madam Secretary.

                                  HALLIBURTON

        Now, I had some questions, but I would certainly--first,
    Madam Secretary, Dresser-Rand employees from Olean, New York,
    called the Department of Labor 2 years ago with questions about
    the legality of Halliburton confiscating the early retirement
    subsidy to their pension when Halliburton sold the Olean plant.
    To date, these employees have received no response from your
    Department. So I'd like to ask if you could please submit for
    the record a timeline of what your Department has done in the
    past 2 years to respond to these calls and when you anticipate
    being able to respond definitively. I'm particularly interested
    in the activities of DOL investigators located in Texas.
        Now, the reason I mention this, Madam Secretary, is that I,
    along with others, have sponsored legislation since 1999 to
    create an office in your Department to respond to pension
    participants to be an advocate for them within the Government.
    Yet your Department keeps saying it's not necessary, that we
    already respond adequately to pension participants.
        Again, Madam Secretary, if that's your position, can you
    please comment on the experience of the Olean workers in New
    York?
        Secretary Chao. Actually, EBSA, that's the Employee
    Benefits Security Administration----
        Senator Harkin. Is that mike on? Okay, now I hear it.
        Secretary Chao. My opening statement, which I submitted for
    the record, talked about the great--the very strong enforcement
    record we've had ensuring worker safety and health and also
    retirement security. In fact in 2004, EBSA has achieved more
    than $3 billion in monetary results for workers' retirements
    and also pension funds. This is a 121 percent increase over the
    previous year.
        I'm not familiar with the case that you mentioned and I
    will certainly take a look at it. But we have also about 108 of
    these participants' advocates, benefit advisors, within EBSA,
    and that's what these people's jobs should be, and that is
    they're case workers. They're supposed to be helping
    individuals who call in. And so we don't really think that the
    advocacy office is necessary, and I think the results speak for
    themselves. But I'd be very open to showing you what we've been
    doing, and I certainly will get back to you on the information
    concerning the case that you mentioned.
        Senator Harkin. Please do so, because evidently it's been 2
    years, and according to my information--that's all I can go
    on--nothing has been done and they have received no response
    from your Department after 2 years on this issue.
        Secretary Chao. We'll look into it.
        Senator Harkin. So I'd just like to know----
        Secretary Chao. We actually have a good record----
        Senator Harkin. Pardon?
        Secretary Chao. We actually have a good record in
    recoveries and----
        Senator Harkin. But do you have a record on what's happened
    with Olean?
        Secretary Chao. We will look into it.
        Senator Harkin. And you will submit that to us then?
        Secretary Chao. Yes.

                             CHILD LABOR VIOLATIONS

        Senator Harkin. Okay, I appreciate that. Next I'm--Madam
    Secretary, I'm disturbed by reports of an unprecedented
    agreement, really unprecedented, between the Department of
    Labor and Wal-Mart in a settlement on child labor violations.
        On January 11 of this year, the Department of Labor signed
    an agreement with Wal-Mart settling a case against the company
    on violations of child labor laws, in which 85 minors operated
    hazardous equipment. As part of the settlement, Wal-Mart was
    granted an unprecedented concession, 15 days advance notice of
    any future audit or investigation into the company's labor
    practices.
        Well, there's been a lot of stories about this in the
    press. There was a story printed in the American Progress that
    DOL had retracted their initial press release on the settlement
    and re-issued the release with changes that Wal-Mart insisted
    on. Now these are all in the popular press out there. But
    again, I must say I'm disappointed the administration is
    sending the wrong signal on child labor laws, eroding
    protections by providing advance notification of inspections
    domestically, while eliminating support for programs to
    eradicate child labor internationally.
        Madam Secretary, are you aware of this agreement with Wal-
    Mart?
        Secretary Chao. Not initially. This is actually done by----
        Senator Harkin. Are you telling me right now you're not
    aware of it?
        Secretary Chao. No, I am aware of it.
        Senator Harkin. Oh, you are--you said not initially.
        Secretary Chao. Not initially. This is a--this is
    consistent with past practices in different regions of Wage and
    Hour division to enter upon these settlement agreements. In
    fact, during the previous administration they were called
    partnership agreements. So claims that this agreement is
    lenient are totally false. This agreement is consistent with
    other settlements of other enforcement actions. It is a good
    settlement. The terms apply company-wide, not just the stores
    where the violations occur.
        Wal-Mart was assessed a higher fine than the average
    penalty. There was no coordination of any press agreements. The
    15 day was actually quite normal and usual. In fact, in the
    previous administration there have been cases where the
    previous administration gave up to 90 days of notice. The
    purpose of the notice is not to allow the company to not
    comply. The purpose of the period is--of this time period is to
    allow the--is to remove whatever is the harmful action to occur
    quickly and then it also benefits the Government to be able to
    go in and have the company or the employer be prepared to
    answer questions.
        So again, this particular agreement, while I admit is not
    well written, is consistent with past practices, and the time
    period, 15 days or whatever given, is quite consistent, in fact
    is on the lower end of some of the other agreements which we
    have seen executed under the previous administration. Labor
    union organizations are also given a period of time in which
    they are required to compile the necessary documentation so
    that they can come speak in a more--they can have the documents
    that they need to be able to speak to the Government. So this
    is not--this is again----
        Senator Harkin. I'm told----
        Secretary Chao [continuing]. Consistent case. This is
    consistent with past cases, and it's how it's handled.
        Senator Harkin. I'm told that advance notification has only
    been given for voluntary enforcements in past agreements, but
    never in mandatory type of settlements, that this is the first
    time that this has been done.
        Secretary Chao. This is different from OSHA. This is Wage
    and Hour. This is not OSHA. This is Wage and Hour and
    particular--these apply to Wage and Hour infractions. They're
    very different from OSHA.
        And second----
        Senator Harkin. Well, I thought these kids were involved in
    operating hazardous equipment.
        Secretary Chao. This is not an OSHA issue. This is a Wage
    and Hour issue, so it's not OSHA.
        Senator Harkin. Well, it was a violation of child labor
    laws. Eighty-five minors were operating hazardous equipment.
        Secretary Chao. No, the equipment itself is not hazardous.
        Senator Harkin. Oh.
        Secretary Chao. People can--people can operate them, but it
    was just that these young people operated the--they were bale
    machines.
        Senator Harkin. Yeah, and kids are not supposed to operate
    them.
        Secretary Chao. Kids are not supposed to operate that.
        Senator Harkin. I've been through this before with grocery
    stores.
        Secretary Chao. But this was a--this is not a consistent
    basis. It was a once--it was an infrequent occurrence which is
    documented. So when the Government goes in, we need
    documentation, because it's not as if the child--the young
    person is standing there at the machine the whole time. It was
    an infraction at a particular time and a particular day. It was
    not a consistent pattern of behavior.
        But nevertheless, the 15-day notice, or the advance notice,
    is not unusual. As I mentioned, there were past settlements, in
    fact----
        Senator Harkin. That involved violations of child labor
    laws?
        Secretary Chao. Yes. And they also gave much longer periods
    of----
        Senator Harkin. So there have been past violations of child
    labor laws in which the Department has agreed to an advance
    notice of 15 days----
        Secretary Chao. More than that. Under Wendy's and there's
    another one called Genesis, those are two that come to mind
    immediately, they were in the previous administration and they
    gave up to 90 days. This is different from an OSHA violation,
    because when you have an OSHA violation, there is consistent
    hazardous behavior. This is--Wage and Hour infractions are
    intermittent and they're documented much more by paperwork, so
    it's different. But again, the advance notice has been terribly
    portrayed in the press. It is not unusual.
        Senator Harkin. So you're saying that Wal-Mart was not
    given preferential treatment?
        Secretary Chao. No, it was not, and there was no press
    coordination.

                       INTERNATIONAL LABOR AFFAIRS BUREAU

        Senator Harkin. Okay. When you came before our subcommittee
    to discuss the 2004 budget, we discussed funding for the
    elimination of the worst forms of child labor, as you and I
    often do. This has been a constant communication between us. At
    that time, you were requesting $54.6 million in funding for
    ILAB, the International Labor Affairs Bureau, because you said
    that more than that amount was then beyond the capacity of one
    office to absorb. You assured me at the time that we had the
    same goal, that you wanted to work towards increasing the
    capacity of the office to administer these programs. I quote,
    you said, ``please be assured that we are not differing at all
    in the terms of the goal.'' Further on the record you said,
    ``if you want to build the infrastructure internally, it will
    take some time. The commitment I assure you is absolutely
    there.'' These were your words, Madam Secretary.
        Well, what am I to make of the 2006 budget, which proposes
    a measly $12 million for these activities? This is an 86
    percent reduction from $54.6 million down to $12 million. I
    mean, help me understand this.
        Secretary Chao. We're very concerned obviously with child
    labor, and I went to Africa, as you know, in December 2003 to
    review some of the projects which we are in coordination and
    partnership with the ILO. I have to say, Mr. Chairman, the
    results of those visits were not very positive.
        But nevertheless, the current budget in ILAB does not
    reflect our reduced commitment to child labor, but perhaps the
    increasing awareness that we are not the best place to
    administer these programs, and that the best place for--the
    best thing for ILAB is to return to its core mission of working
    on core labor standards and on advocacy, and that's something
    that this budget reflects.
        Senator Harkin. But I don't see it being picked up anywhere
    else. I don't see any--you know, it would be one thing if it
    was cut here but was added some other place and the
    responsibility was shifted, but I don't see that happening
    anywhere in the budget.
        Secretary Chao. Well, I think the State Department, AID,
    and the Peace Corps also does some of these and there are other
    areas we are told that do have an emphasis on this population
    as well.
        Senator Harkin. Well, I don't know about that. AID has been
    focused a lot on disability issues, that's for sure. Mr.
    Natsios has done a very good job in moving AID towards making
    sure that U.S. tax dollars are not used to build facilities
    that are inaccessible. He's done a great job and also the
    Secretary--I should--also did that, Secretary Powell, and
    implemented procedures for disability issues on AID. But I--
    this is one area though in terms of core labor standards, child
    labor, worst forms of child labor, where the Department of
    Labor has had, well, I think some pretty long experience in
    this area for some time. The State Department hasn't. AID, I
    think, yeah, in terms of what they're doing for development
    purposes and responding to issues of disability rights, that's
    fine.
        But in terms of child labor, this is the Department of
    Labor, not the State Department. And so--I mean, I might argue
    with you about where it ought to be located, but if the
    administration wanted to shift it, again, I don't see the money
    anywhere for it. I don't see any line item authority in the
    State Department or anywhere else for this to take place. I do
    see in AID for disability, like I said, but not for these child
    labor issues.
        Secretary Chao. The other issue is a lot of the monies that
    were supplemented in the last few years were grant-making, and
    so I think there was an effort to perhaps bring back ILAB to
    its original mission of international labor policy, our
    research, advocacy, and analysis.
        Senator Harkin. Well, I guess that's just a policy
    difference we have. I mean, I think this Congress, Senate,
    House, in the past few years, and I think pretty
    bipartisanally, has spoken strongly both in the previous
    administration and in this one that we want the Department of
    Labor to be actively involved in the issue of child labor.
        There have been a number of reports from your Department on
    that that have gone back a number of years. I think it's been
    recognized in many places that DOL has really moved
    aggressively on this. Now if you want to say you want to go
    back to the start, gee, we've come a long way and we still see
    instances of gross violations, basic decent child labor
    standards around the globe. And this is leadership. This is the
    United States of America talking about our role, our moral
    leadership, our ethical leadership in talking about child
    labor. And I just hope that it would continue on rather than
    trying to go back to where we were 10 years ago or 12 or 15
    years ago on this.
        Secretary Chao. I think we can still do a great deal. We do
    take the leadership, for example, we hosted the first worldwide
    convention of child labor delegates, and through promoting a
    greater awareness of the problem, through convening the right
    mix of stakeholders, I think we can do a lot. I'm just not sure
    that the grant-making part of the resources is something that
    we can--that we're going to place very much emphasis on as we
    go forward.
        Senator Inouye. Madam Secretary, I'm here to greet you and
    to welcome you to the committee. I'm trying to save my voice. I
    just got out of bed with the flu, so I've been advised to
    maintain a low profile.
        If I may, I'd like to submit my questions to you in writing
    and request some written response.
        Secretary Chao. Of course.
        Senator Inouye. Your assignment is a very difficult one,
    because the policies that you have to work under are oftentimes
    generated by other Departments, Department of Defense,
    Department of State, over which your influence may be at best
    limited. And so, having served on subcommittees that deal with
    these two Departments, I'm well aware that oftentimes decisions
    that you render may have to be determined by our relationship
    with certain countries. I know that it may not be to your
    liking, but such are the facts of life, and for that I thank
    you for your patience and your understanding.
        I will be submitting my questions, but I have to save my
    voice. Thank you very much.
        Secretary Chao. Thank you for coming.
        Senator Harkin. Thank you, Senator. Senator Craig.
        Senator Craig. Thank you very much, Mr. Chairman. I
    apologize to the committee and to the Secretary for trafficking
    late this morning, but there was a bigger billing in a
    different committee, Elaine. Alan Greenspan was here and we're
    talking about retiring and the demographics of a workforce. And
    it's certainly part of your charge and your responsibility, and
    I understand that.
        I think one of the things most significant said, and it
    will be my only question, I'll review your testimony, and I
    must tell you I applaud the work you have been doing and the
    successes you've had in relation to America's workers and the
    enforcement of law in a clear and transparent way that I think
    all of us recognize is tremendously important for the
    credibility of government and for your agency, and you're to be
    recognized and applauded for that.
        I think one of the things the chairman said a few moments
    ago that I found interesting was really no way to fix the
    system, and we were discussing Social Security, and look at
    older Americans' financial security than to keep them a little
    longer in the workforce. The reality is out there no matter
    what we do that the demographics are so overpowering as it
    relates to where we are traveling as a culture. We're going to
    live longer. We're going to be much healthier living longer.
    Americans feel much more productive usually if they're in the
    workforce. And that early retirement is a relatively new
    phenomenon, that the numbers we're seeing and have seen for the
    last good number of decades are really products of a difference
    that 30, 40, 50 years ago was simply not the case.
        I found that quite fascinating. He had, as is quite typical
    of Chairman Greenspan, all the facts, figures, and statistics
    to back that up. But having said that, in the programs that you
    look at today in your charge and responsibility, what areas do
    you believe most effective for those who find the need to stay
    in the workforce, those that might need some additional
    training? We may be looking at some, if you will, bumping up,
    if the skills of 55, 60, 65-year-old people who might choose to
    stay in the workforce another 5 or 6 years or more, that will
    be beneficial to them. Is it possible for you to address those
    programs and what you see in the future?
        Secretary Chao. It's interesting that you mention this
    topic, because I just--because it's very timely and very
    relevant. I just got back from the G-8 labor ministers meeting
    where the theme, interestingly enough, was aging populations.
    Among the industrialized nations of the world, the graying of
    the workforce is a huge concern for policy makers.
        You are right. Workers these days are living longer,
    they're in better health, and they don't view retirement as the
    ending phase of their life, but rather the beginning of a
    fourth of a fifth phase of their life. And so we want to ensure
    that our policies are open and flexible so that individuals who
    want to remain in the workforce can do so, especially since our
    workforce is going to be facing a shortage of workers after
    the--as the baby boom generation retires.
        We do have training programs that will re-skill a person to
    a field in which he or she has not been familiar with. That's
    all part of the workforce development and training that we are
    focused upon.

                        HIGH GROWTH JOB TRAINING PROGRAM

        Then third, I think with the President's high growth job
    training program, we have matched resources and individuals
    with the opportunities that are coming up. We have a need for,
    you know, 3.4 million health care workers in the next 8 years.
    We have a need for 1.5 million nurses in the next 10 years. So
    there are pockets of disequilibrium in our labor market which
    we've got to address, and older Americans are a very valued
    segment of our population.

                               UNEMPLOYMENT RATE

        By the way, I should mention also the unemployment rate is
    5.4 percent nationally this past month. The unemployment rate
    of seniors is about 3.7 percent. So having said all of that,
    and given the tremendous interest that the G-8 labor
    secretaries have on aging workforces, I think it's very timely
    that our Nation is having this discussion as well on Social
    Security and also on pension security as well.
        Senator Craig. Well, I would have loved to have been your
    travel partner and listened to those discussions, because I've
    spent a good deal of time looking at what has happened in
    Japan, and certainly some of the countries of Europe are really
    well advanced in their aging, if you will, and therefore
    finding tremendous impact on their social programs within their
    governments and how they fund them and do all of those kinds of
    things.
        How much of a bias do we still have built in the system to
    force retirement?
        Secretary Chao. If you're an older American and you want to
    work, our country had made great progress. We've abolished--
    we've fought against age discrimination, so that is illegal,
    and we've done away with mandatory retirement age, and we've
    raised the Social Security earnings limits.

                                   RETIREMENT

        But our workforce is still not as flexible as many older
    Americans would like. Again, retirement is no longer this
    twilight of one's life where one retires to the veranda and
    sits on a rocking chair. It is a very active phase of our
    workforce's life, and people also rebel against--a lot of
    people are also rebelling against the cliff effect, where one
    day they're at work and then the next day they're totally
    disconnected with the only community that they know. So there
    should be greater flexibility and more openness in our
    workforce to be more welcoming of those older Americans who
    still want to--who want to still remain in the workforce.

                                SOCIAL SECURITY

        Senator Craig. Well, I thank you very much for those
    comments. I think they are very real hurdles for us. We're in
    the business of trying to get our hands around, and better
    understand and cause the American people to better understand,
    the problems of Social Security.
        What I think is fascinating about that whole debate that
    we're now engaging in is that it's--it is a piece of a much
    larger issue of workforce and aging and all the dynamics of how
    we keep this country running economically and the security of
    retirement and the reality of so many other things that now
    have to be added to it, and the dynamics of the current and
    future cultures in this country.
        So thank you very much. I appreciate you being here.
        Secretary Chao. Thank you.
        Senator Craig. I guess we're ready to wrap up. Please
    proceed.

                               CHILD LABOR ISSUE

        Senator Harkin. This has been a good discussion listening
    to Senator Craig, but I want to follow up one last time on the
    child labor issue, on the $12 million for all these activities.
    In the Bipartisan Trade Promotion Authority Act of 2002, it is
    the statutory obligation of the U.S. Government to:
    ``strengthen the capacity of U.S. trading partner to promote
    respect for core labor standards.'' This is the obligation by
    law of the International Labor Affairs Bureau. So again it's
    not just research, but this is part of the law, it's an
    obligation.
        So again my question comes back, how do we fulfill this
    obligation with $12 million? And do you feel that you can do
    that with $12 million? I guess that's really what I'm getting
    at. I mean, it's not just something we'd like to do. It's now
    an obligation under law.
        Secretary Chao. We're very concerned about child labor and
    we will continue to work on that. Again around 1996 ILAB's
    budget was about $12 million and then in subsequent years it
    rose to about $149 million in 2001. And these were primarily
    grants, and based on an assessment as to what these grants do
    and whether they are as effective as they should be, there was
    some feeling that ILAB should really return to its core mission
    again of promoting core labor standards, going into research,
    analysis, and advocacy and more of that.
        So there will not be any, for example, any FTE----
        Senator Harkin. I'm sorry?
        Secretary Chao. There will not be large FTE reductions. We
    expect to have people who will carry on continuing work. But
    these are----
        Senator Harkin. If there's going to be that big of a cut--
    --
        Secretary Chao. But the ones--but the additional monies are
    much more grants.
        Senator Harkin. I would think if there was that much of a
    cut, there ought to be some FTE reductions.
        Secretary Chao. There won't--I don't think there will be.
        Senator Harkin. Again, this is a question I don't know the
    answer to, but were there assessments made either by your
    Department or GAO about these grants and the effectiveness of
    them?
        Secretary Chao. I know that IG has made----
        Senator Harkin. The IG?
        Secretary Chao [continuing]. Has made a study.
        Senator Harkin. Well, maybe I'll get my staff to get a hold
    of that and see what they said on it, because I'm just not
    familiar with that. But I just wanted to point out that there
    is a statutory obligation for ILAB now, and I'm not certain it
    can fulfill it with $12 million. If all you were going to do is
    research, maybe so. But if you have to fulfill this, especially
    with CAFTA coming up and Andean Trade, all that coming down the
    pike, I would still think this would be an area where you're
    going to require more than that.
        Secretary Chao. Well, we want--we want to work with you on
    it. But it was kind of the assessment that we'd be able to
    provide this kind of assistance with our in-house Department of
    Labor employees, that we would be able to offer technical
    assistance and also coordinating with other grant-making
    agencies as well.

                         ADDITIONAL COMMITTEE QUESTIONS

        Senator Harkin. Madam Secretary, you've been very gracious
    with your time. I have some questions I will submit for the
    record, especially as it deals with the Office of Disability
    Employment Policy and the veterans employment and training
    programs. I'll just submit those in writing.
        Secretary Chao. We'll be pleased to answer them. Thank you.
        [The following questions were not asked at the hearing, but
    were submitted to the Department for response subsequent to the
    hearing.]
                  Questions Submitted by Senator Arlen Specter

                      SUBSTANCE ABUSE TREATMENT WORKFORCE

        Question. I have heard from my constituents that in Pennsylvania
    and throughout the nation, the substance abuse treatment workforce is
    undergoing turnover rates of 50 percent or higher and there is real
    question whether the remaining workforce can get the training needed to
    implement the most effective treatments. This would be a serious
    problem for any industry but given the alarming public health and
    public safety issues associated with addiction it is a particularly
    serious workforce development issue.
        I know that your department has initiated effective workforce
    development programs in several industries such as agriculture, mining
    and nursing. Do you have any plans to implement such programs for the
    substance abuse treatment industry?
        Answer. Health care has been targeted as one of the high growth
    industries in the President's High Growth Job Training Initiative, and
    through that initiative the Department has funded a broad array of
    occupational workforce solutions. This includes such occupations as
    direct support specialists and paraprofessionals, and we would consider
    the substance abuse treatment workforce to be a component of this
    industry. The Department welcomes the contributions of the substance
    abuse treatment industry as part of the High Growth Job Training
    Initiative.
        Additional opportunities are available to address local workforce
    shortages through the Community-Based Job Training Grants, which target
    high growth industries in local communities. Community colleges, as
    grant applicants, in partnership with industry, the workforce
    investment system, and the continuum of education providers, including
    K-12, can submit applications to meet local workforce challenges like
    the shortage of substance abuse workers under the formal Solicitation
    for Grant Applications.

                            JOB CORPS MANAGEMENT FEE

        Question. The Workforce Investment Act provides for a management
    fee of not less that 1 percent for each Job Corps operator and service
    provider. How much is budgeted for such fees for program year (PY) 2006
    compared to 2005? What is the process for determining management fees,
    and what is the range of percentages currently being provided?
        Answer. We estimate that management fees in Job Corps will cost
    about $44.1 million in PY 2006, which is a very slight increase above
    the PY 2005 estimate of $43.9 million. As a percentage of the
    expenditures under contracts in which management fees are included,
    such fees represent roughly 4 percent of the costs. In the framework of
    total Job Corps operating expenditures, fee payments represent only 3
    percent of costs.
        The fee amounts in individual contracts are determined during the
    procurement process. The greatest share of Job Corps contracts, in
    terms of dollar expenditures, contains performance-based fees. The fees
    in these contracts are structured so that the contractors are
    guaranteed a fee payment of 3.6 percent and then can earn as much as
    2.4 percent above that based on objectively determined performance
    excellence. These types of performance-based fees are used in our
    center operating contracts and contracts for post-center career
    transition services.

                             PROGRAM ADMINISTRATION

        Question. Your budget justification material states that
    consolidated job training programs will save $300 million in
    administrative costs, yet you are not proposing any reduction in
    Federal staffing. Please explain.
        Answer. The $300 million in administrative costs savings created by
    consolidating job training programs relates to savings realized at the
    State and local levels, not at the Federal staffing level. Savings
    realized by States and local areas will enable them to increase
    training enrollments and provide improved services to their
    participants.
        The Program Administration account was reduced by $842,000 to
    reflect program efficiencies created by the consolidation. The
    reduction in FTE associated with these efficiencies was offset by the
    anticipated need for FTE to administer the new H-1B job training grant
    program and the YouthBuild program, which is proposed for transfer from
    the Department of Housing and Urban Development, resulting in an equal
    need for FTE staffing in 2006. If the job training grant consolidation
    were enacted, we would expect further long-term Federal administrative
    savings would be possible.

                            COMMUNITY COLLEGE GRANTS

        Question. According to GAO, the Labor Department plans to obligate
    only $13 million of the $250 million requested for the Community
    College Initiative during fiscal year 2006, because unobligated funds
    from fiscal year 2005 can be used for most of its expected needs
    through September 30, 2006. Even though the funds are available for the
    program which extends through June 2007, how do you justify the need
    for the full $250 million during this funding cycle?
        Answer. The Department of Labor has provided GAO with information
    on the allocation of funds for this program pursuant to the
    Congressional appropriation process that is utilized for the
    Department's ``forward funded'' programs. The $248 million appropriated
    in fiscal year 2005 for the Community College Initiative are program
    year funds and accordingly, none of the funds are available for Federal
    obligation until July 1, 2005, with a large portion of the funds only
    becoming available for obligation on October 1, 2005. In preparation to
    utilize fully these resources during the period of obligational
    authority, the Department is publishing two solicitations for grant
    applications--one in April 2005 and the second later during the 2005
    calendar year. Each of these competitive solicitations will be for $124
    million. The purpose of these solicitations is to promote the
    development of strategic partnerships between business and industry and
    community colleges, and to train workers for the industries creating
    the most new jobs.
        Businesses in high-growth, high demand industries face increased
    difficulty in finding workers with the skills they need as a result of
    globalization, the aging of America's workforce, and the fact that
    technology and innovation are continuously changing the nature of work.
    As a result, community colleges will be increasingly critical providers
    for workers needing to develop, retool, refine, and broaden their
    skills. The initial investment of $248 million will be an important
    first investment and allow community colleges to train at least 100,000
    workers. The fiscal year 2006 Budget proposes another $250 million to
    continue this important new initiative and train at least another
    100,000 workers.
        One of the purposes of these resources is to build the capacity of
    community colleges to train workers. The accelerated pace of innovation
    and technology continuously require new sets of skills in the
    workplace, calling for a continued focus on capacity building. We must
    continue to support community colleges in their effort to ensure that
    workers have and maintain the skills they need to be competitive in a
    21st century innovation economy.

                        ONE-STOP SYSTEM ELECTRONIC TOOLS

        Question. Page ETA-12 of your Budget Justification Material lists a
    request of $48,294,000 for ``One-Stop System Electronic Tools.''
        What exactly is being funded with this request, and how does it
    compare to the fiscal year 2005 funding level?
        Answer. Although there appears to be a significant decrease in this
    line item in the fiscal year 2006 request as compared to the fiscal
    year 2005 enacted level ($48,294,000 compared to $97,974,000), the
    actual decrease is approximately $10 million. Funding for this line
    item reflects the movement of the $39,690,000 in funding to States for
    workforce information activities (Core Products & Services and LMI
    Research & Development) formerly housed in this budget line item into
    the WIA Plus State Consolidated Grants.
        This line item has traditionally been utilized to support national
    electronic tools such as America's Job Bank, America's Career
    Information Network, America's Service Locator, and the Occupational
    Information Network (O*NET). These electronic tools help in the
    preparation of a competitive workforce to keep the United States viable
    in the global economy and support the President's Temporary Worker
    Program. In addition, other funds in this line item were targeted to
    system building activities designed to enhance the delivery of services
    through the nation's One-Stop Career Centers and to provide national
    infrastructure for performance accountability. The approximately $10
    million reduction in the 2006 request is in the system building
    activities.
        DOL has been actively evaluating this line item to ensure that it
    provides the critical workforce information products and tools
    necessary to support the workforce investment system and the
    President's Temporary Worker Program. We have also been actively
    identifying mechanisms to control the costs for the current tools. This
    has resulted in strategic changes to the suite of tools that are
    supported. For example, DOL now supports a new Web site--Career Voyages
    (www.careervoyages.gov)--that is designed to provide young adults and
    transitioning workers with a career exploration tool for careers in
    high growth, high demand industries. We have also developed a new Web
    space to promote the transformation to a demand-driven workforce
    investment system called Workforce One (www.workforce3one.org) where we
    feature new and innovative approaches to workforce development. We are
    currently in the process of developing a clearinghouse for industry
    developed competency models and skills standards.
        Below is a brief description of each of the current electronic
    tools supported by this line item:
      --The CareerOneStop (COS) Electronic Tools--a suite of Internet-based
            tools that consists of:
        --America's Job Bank.--An electronic job board where businesses can
                search for candidates and post job listings and job seekers
                can search for jobs and post their resumes;
        --America's CareerInfoNet.--A site that provides access to
                occupational projections and other workforce information
                for career exploration;
        --America's Service Locator.--A site that provides location
                information for One-Stop Career Centers and other workforce
                services;
        --CareerOneStop Portal.--The home page that provides a central
                access point to all the content of the COS sites, by topic
                and customer group;
        --Workforce Tools of the Trade.--A Web site designed to support the
                professional growth of workforce investment professionals
                that help business and citizens meet their workforce needs;
        --On-Line Coach.--A tool that is integrated into the COS to help
                individuals not as familiar with the COS sites to navigate
                through the numerous resources available based on common
                issues or problems they may be facing--the tool then walks
                them step-by-step through the appropriate resources; and
        --Toll Free Help Line.--The TFHL (1-877-US2-JOBS) provides
                telephone access to job seekers and businesses on a wide-
                range of workforce issues.
      --Occupational Information Network (O*NET).--An occupational
            classification system that provides detailed information on
            occupational characteristics and skill requirements and serves
            as the common occupational language for the COS as well as the
            workforce investment system as a whole.

                              LEGISLATIVE SAVINGS

        Question. The Administration is proposing legislation to save both
    unemployment compensation and workers' compensation funds. Provide an
    estimate of savings from each component of these proposals for each
    year, from fiscal year 2006 through 2015 (10 years). Provide the
    legislative text for these proposals.

    ETA's Response
        Answer. The unemployment insurance (UI) integrity proposal is made
    up of five amendments. Amendment 1 would allow States to use up to 5
    percent of recovered overpayments for benefit payment control.
    Amendment 2 would allow States to permit collection agencies to keep up
    to 25 percent of recovered overpayments and delinquent taxes. Amendment
    3 would require a minimum 15 percent penalty on fraud overpayments, to
    be used for benefit payment control. Amendment 4 would prohibit non-
    charging benefits when an overpayment is the employer's fault.
    Amendment 5 would allow intercept of Federal income tax refunds for
    recovery of overpayments. The savings breakdown, in millions of
    dollars, for this proposal is as follows:

                                                [In millions of dollars]
    ----------------------------------------------------------------------------------------------------------------
                                        2006   2007   2008   2009   2010   2011   2012   2013   2014   2015  2006-15
    ----------------------------------------------------------------------------------------------------------------
    Amendment 1......................  .....     12     23     24     25     26     28     29     30     32      229
    Amendment 2......................  .....      4      9      9     10      9     10     11     12     13       87
    Amendment 3......................  .....     39     80     84     88     93     97    101    105    111      798
    Amendment 4......................  .....     10     22     24     25     26     28     29     31     32      227
    Amendment 5......................    281    282    284    288    288    302    317    331    347    362    3,082
                                      ------------------------------------------------------------------------------
          Total Proposal.............    281    347    418    429    436    456    480    501    525    550    4,423
    ----------------------------------------------------------------------------------------------------------------

        These are our best estimates of the savings and delinquent tax
    collections which would result from this proposal. However, of the
    total 10-year savings, only $3.082 billion is scorable under CBO and
    OMB scoring rules. We also estimate that the proposal would produce tax
    reductions of $2.856 billion over 10 years.
        Draft legislation for these proposals was sent to Congress in June.
    ESA's Response
        Answer. The 2006 Budget includes two reform proposals affecting
    Federal workers' compensation programs: Federal Employees' Compensation
    Act (FECA) reform, and Black Lung Disability Trust Fund debt
    restructuring.
        FECA Reform.--The Budget proposes to reform FECA to improve program
    fairness, speed claims processing, adopt best practices of State
    workers' compensation programs, and implement recommendations of DOL's
    Inspector General. Attached is a spreadsheet that shows the FECA Reform
    savings by provision and fiscal year. Legislation is expected to be
    transmitted to Congress this fall.
        Black Lung Trust Fund Debt Restructuring.--The proposed legislation
    seeks to restore solvency to the Black Lung Disability Trust Fund,
    which currently has a $9 billion debt to Treasury. The Administration's
    legislative proposal would: (1) refinance the debt to take advantage of
    current, low interest rates; (2) extend until the debt is repaid the
    Fund's excise tax levels, which are set to revert to lower levels in
    January 2014; and (3) upon enactment of the bill, provide a one-time
    appropriation for a payment to the U.S. Treasury to cover the forgone
    interest payments. Because this is an intragovernmental transfer, there
    is no net government-wide budgetary effect until the 2014 (when the
    current excise tax rates are extended). The following chart provides
    the year-by-year estimates:

    ------------------------------------------------------------------------
                                                                     Excise
                                               Approp    Advances     tax
                                                                     effect
    ------------------------------------------------------------------------
    2006...................................     $3,808     ($452)  .........
    2007...................................  .........      (443)  .........
    2008...................................  .........      (433)  .........
    2009...................................  .........      (429)  .........
    2010...................................  .........      (430)  .........
    2011...................................  .........      (433)  .........
    2012...................................  .........      (434)  .........
    2013...................................  .........      (436)  .........
    2014...................................  .........      (700)       $261
    2015...................................  .........      (833)        378
    ------------------------------------------------------------------------

        Legislation is expected to be transmitted to Congress this fall.
        For FECA Reform:
        The following chart provides the year-by-year estimates for each
    provision:

    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                 Concurrent
                                                                                      Three-day                      Survivor     schedule     Subrogation   Increase     Increase      Net savings
                                                                     Conversion        waiting        Eliminate     cap at  70    award and    rights for     burial      maximum       to special
                                                                      benefit          period       augmentation     percent     disability   COP (savings   benefit   disfigurement       fund/
                                                                                                                                compensation    to Gov't)                   award       Government
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    2006........................................................  ...............    ($4,909,020)   ($12,015,616)   ($106,496)  ............  ($1,903,104)   $640,000     $345,000     ($17,949,236)
    2007........................................................     ($1,548,747)     (5,026,836)    (31,803,310)    (305,136)   $2,385,956    (1,948,778)    640,000      345,000      (37,261,852)
    2008........................................................      (4,546,223)     (5,147,480)    (39,920,647)    (492,847)    4,759,088    (1,995,549)    640,000      345,000      (46,358,659)
    2009........................................................      (7,431,599)     (5,271,020)    (48,033,265)    (671,802)    7,255,545    (2,043,442)    640,000      345,000      (55,210,584)
    2010........................................................     (10,260,326)     (5,397,524)    (56,146,377)    (841,047)    7,429,678    (2,092,485)    640,000      345,000      (66,323,082)
    2011........................................................     (13,085,659)     (5,527,065)    (64,263,845)  (1,003,042)    7,607,990    (2,142,705)    640,000      345,000      (77,429,325)
    2012........................................................     (15,908,472)     (5,659,715)    (72,392,698)  (1,156,980)    7,790,582    (2,194,130)    640,000      345,000      (88,536,412)
    2013........................................................     (18,731,097)     (5,795,548)    (80,537,429)  (1,304,431)    7,977,556    (2,246,789)    640,000      345,000      (99,652,738)
    2014........................................................     (21,553,774)     (5,934,641)    (88,703,356)  (1,447,152)    8,169,017    (2,300,712)    640,000      345,000     (110,785,617)
    2015........................................................     (24,380,724)     (6,077,072)    (96,895,409)  (1,583,296)    8,365,073    (2,355,929)    640,000      345,000     (121,942,356)
                                                                 -----------------------------------------------------------------------------------------------------------------------------------
          Ten-year Total........................................    (117,446,620)    (54,745,922)   (590,711,951)  (8,912,228)   61,740,483   (21,223,622)  6,400,000    3,450,000     (721,449,860)
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

                    OSHA RESOURCES TARGET ERGONOMIC HAZARDS

        Question. What level of funding has been targeted for worker
    protection from ergonomic hazards for fiscal year 2006 budget request?
        Answer. The resources utilized to address ergonomics in the fiscal
    year 2006 budget request are contained within all of OSHA's budget
    activities and are not separately identified or earmarked to address
    ergonomics or any other specific issue.
        Question. For what activities has funding been requested?
        Answer. OSHA's approach to ergonomics involves focused activity by
    the entire agency in addressing the four prongs of the ergonomics
    policy: industry specific and task-specific guidelines, strong
    enforcement, outreach and assistance, and research.
        Question. How many FTEs have been assigned to work on ergonomics?
        Answer. The agency has not specifically identified the number of
    staff working on ergonomics. The staff necessary to address ergonomic
    concerns is available as needed within the ongoing enforcement,
    outreach, and regulatory activities of the agency.
        Question. How many ergonomists does OSHA employ and what are their
    responsibilities?
        Answer. Although there is no formal Federal job classification
    titled ``ergonomist,'' OSHA currently employ four Certified
    Professional Ergonomists (CPE), one Certified Industrial Ergonomist,
    and one Industrial Engineer whose education and experience is Human
    Factors Engineering. Of these six, two are employed in two different
    Regional Offices and provide enforcement oversight; one works at our
    Salt Lake Technical Center; one works in the National Office on
    guidelines; one is a training and curriculum developer; and one is a
    Compliance Assistance Specialist whose job is to provide assistance on
    a broad range of safety and health topics. All of these positions
    include providing training and assistance to compliance staff and
    outreach and assistance to the regulated community.
        Question. How many enforcement actions has OSHA taken pertaining to
    ergonomic hazards during fiscal year 2004 and fiscal year 2005 to date?
        Answer. OSHA assessed ergonomic conditions in 707 inspections
    opened in fiscal year 2004. Of these 707 inspections, 108 were
    conducted under Regional or Local Emphasis Programs which focus
    inspection resources on industries in which high rates of
    musculoskeletal disorders are known to occur.
        As of March 31, 2005, OSHA has assessed ergonomic conditions in 151
    inspections conducted in fiscal year 2005. Of these, 41 were conducted
    under a Regional or Local Emphasis Program with a focus on evaluating
    musculoskeletal disorders.
        Question. Specifically, how many hazard warning letters have been
    issued on ergonomic hazards, and how many general duty clause 5(a)(1)
    citations have been issued, and the date of their issuance?
        Answer. Since the beginning of the Secretary's four-pronged
    approach to ergonomics in April 2002 through April 2005, OSHA has
    issued 380 ergonomic hazard alert letters. Many ergonomic inspections
    are still ongoing in fiscal year 2005; however, for those that have
    been concluded we have issued 26 ergonomics-related Hazard Alert
    Letters (EHALs). In fiscal year 2004, we issued 107 ergonomic hazard
    alert letters. Each EHAL recommends ways to reduce ergonomic hazards,
    and indicates that OSHA may conduct a follow-up inspection to assess
    the extent to which the employer has taken such action.
        OSHA issued a total of 11 general duty clause citations between
    February 2003 and August 2003, and five citations were issued between
    November 2003 and August 2004.
        Question. How many inspections on ergonomic hazards does OSHA plan
    in fiscal year 2004 and fiscal year 2005?
        Answer. In general, OSHA does not have a pre-determined number of
    inspections under which we target ergonomics. In fiscal year 2004, OSHA
    assessed ergonomic conditions in 707 inspections. For fiscal year 2005,
    we estimate that our compliance staff will evaluate approximately 850
    worksites for ergonomic issues.
        Question. What ergonomic guidelines have OSHA issued to date, and
    what is planned through fiscal year 2006?
        Answer. OSHA has issued ergonomics guidelines on nursing homes,
    retail grocery stores and poultry processing. A draft of the shipyard
    guidelines will be released for public comment shortly. The agency
    plans to finalize the shipyards document after considering the public
    comments. No decisions have been made regarding additional OSHA
    guidelines.

                       FAITH BASED COMMUNITY INITIATIVES

        Question. You are requesting a $2,100,000 increase for a ``Faith
    Based and Community Initiatives,'' for a total of $37,432,000 (pg. DM-
    12). What distinguishes these projects from faith-based initiatives of
    the Employment and Training Administration?
        Answer. The total you refer to is for the entire Program Direction
    and Support budget activity in the Departmental Management
    appropriation. This activity includes funding for the Office of the
    Secretary as well as other Departmental policy organizations such as
    the Center for Faith-Based and Community Initiatives. For fiscal year
    2005, approximately $600,000 of the $26,618,000 appropriated for this
    budget activity is used to fund the Center for Faith-Based and
    Community Initiative. This amount does not even fully cover the
    administrative needs for a staff of seven. Thus the entire amount in
    fiscal year 2005 is used to pay for the staff to implement the
    President's Faith-Based and Community Initiative.
        The Center for Faith-Based and Community Initiatives does not have
    a program budget. The Center works with the Employment and Training
    Administration and other DOL grant-making agencies to improve funding
    opportunities for grassroots faith-based and community organizations.
    This includes implementing new pilot and demonstration programs as well
    as assisting agencies in simplifying grant application and reporting
    procedures.
        DOL's request of $2,100,000 in fiscal year 2006 will be used for
    State and local implementation of the Initiative by providing technical
    assistance to State and local workforce development entities
    undertaking projects that integrate faith-based and community
    organizations in workforce development service delivery.
        Question. How much do you expect will be available for new starts
    and how many new projects in fiscal 2006?
        Answer. Of the amount requested, one third of the funds will be
    used to provide the administrative costs of employing staff. The
    remaining two thirds of the requested increase will be used to provide
    technical assistance to fiscal year 2005 and fiscal year 2006 grantees.
    This funding will be used to ensure the success of ongoing projects.
        New fiscal year 2006 grants will be funded from appropriations
    provided to the Employment and Training Administration for program
    purposes. The Center for Faith-Based and Community Initiatives is
    working with the Employment and Training Administration to determine
    the level of funding to be allocated for this purpose and the number of
    new grantees that these funds will allow.

                            MSHA COST DUST MONITORS

        Question. What is the status of the Personal Dust Monitor being
    tested by the Mine Safety and Health Administration?
        Answer. MSHA is currently participating in a collaborative study
    with the National Institute for Occupational Safety and Health (NIOSH)
    to examine the long-term mechanical, electrical, accuracy, and
    precision performance of the PDM in a variety of underground coal mine
    environments. As of May 26, 2005 MSHA and NIOSH completed all of the 10
    detailed in-mine studies. For the special area sampling portion of the
    study, 47 of the 180 mechanized mining units remain to be sampled. MSHA
    expects the study will be complete by August 2005 and that NIOSH will
    issue a report by October 2005.
        Question. Do you expect to issue new mine safety enforcement
    regulations as the result of this new technology being utilized?
        Answer. On June 24, 2003, MSHA issued a News Release announcing its
    intention to suspend all work in the finalization of the proposed
    Single Sample (SS) and Plan Verification (PV) rules and to pursue
    accelerated research on the PDM. MSHA also declared its commitment to
    ``move forward in a new and positive direction with a final rule'' that
    incorporates new requirements for monitoring dust exposures that
    reduces miners' risk of black lung disease'' upon successful completion
    of in-mine performance verification testing of the PDM units. The
    Department will review the various options, including rulemaking, for
    the eventual application of this novel monitoring technology in our
    Nation's coal mines.

                              OVERTIME REGULATIONS

        Question. You are not asking for any increase in staffing for
    enforcement of Wage and Hour Standards, despite the major overhaul in
    overtime regulations that went into effect August 23, 2004. What is the
    Department doing to enforce compliance with the new overtime
    regulations?
        Answer. The final rule went into effect on August 23, 2004. Since
    the final rules were published in April 2004, ESA staff has
    participated in over 630 compliance assistance seminars reaching some
    63,000 employers, employees and others. ESA also launched the new
    FairPay web site, which provides online training seminars, model salary
    basis policy, numerous fact sheets and frequently asked questions.
    Recently, the agency has updated its interactive on-line elaws advisor
    to include the new overtime rule. The advisor averages 35,000 users a
    month.
        ESA's ongoing Overtime Security Task Force initiative involves 162
    targeted investigations of employers with low-salaried employees. The
    initiative was designed to secure overtime protections for the 1.3
    million salaried workers who are now entitled to overtime because of
    the salary increase. Five planned regional employer forums have already
    been conducted in connection with this initiative.
        Question. What has been the experience to date with complaints and
    litigation?
        Answer. Contrary to the dire predictions of some, the new rule has
    proved to be a catalyst for compliance. Media reports from around the
    country confirm that as employers have reviewed how they classify
    employees, many workers who should have been paid overtime under the
    old rules have gained overtime protection for the first time, in
    addition to the many workers who have gained overtime protection as a
    result of the higher salary level test. The new overtime security rules
    have put in place much needed overtime protections for millions of
    workers, especially lower-wage workers.
        For example, a Wall Street Journal article published April 18,
    2005, notes that more workers gained overtime protections than lost
    them under the new rules, citing recent surveys and consultations with
    employers to suggest that few employers reclassified any employees as
    exempt from overtime while many more employers gave overtime protection
    to some workers who did not have it before.
        The few Federal courts that have considered the new rules have
    concluded that the duties tests are essentially the same as under the
    old rules and that the outcome of the cases would be the same as under
    the old rules.

                CIVIL MONETARY PENALTIES FOR VIOLATIONS OF FLSA

        Question. You are proposing legislation to increase penalties for
    violations of child labor and health and safety laws. How many
    additional resources do you estimate would be collected in fiscal year
    2006 from these higher penalties?
        Answer. The proposal, which would increase civil monetary penalties
    for violations of the Fair Labor Standards Act's youth employment
    provisions that result in the death or serious injury of a young
    worker, would provide ESA with stronger deterrents and more effective
    penalties to address the most serious of the youth employment
    violations.
        The Department estimates it would receive no additional resources
    as a result of the increase in child labor civil monetary penalties.
    The proposal specifies that civil monetary penalties collected for
    youth employment violations are to be deposited in the general fund of
    the Treasury, as they are currently. The funds are not now, and will
    not be, returned to the Department as means to augment its enforcement
    efforts.

                      ASSOCIATION HEALTH PLAN LEGISLATION

        Question. Is the Labor Department's fiscal year 2005 budget
    sufficient to effectively administer Association Health Plan (AHP)
    legislation, or would additional resources be necessary?
        Answer. The Department's fiscal year 2005 budget that has already
    been enacted does not include resources specifically allocated for AHP
    administration. This is due to the fact that the legislation has not
    been finalized, and we do not know the extent of the Department's
    jurisdiction, authority, or workload.
        The Department will make determinations about any additional
    funding and staff requirements when the legislation becomes law.

                          H-1B SKILLS TRAINING GRANTS

        Question. Madame Secretary, while the Department of Labor's budget
    request identifies a number of proposed competitive grant programs,
    such as Prisoner Re-Entry and Community College/Community-based
    Training grant programs. The Department's fiscal year 2006 budget
    request does not identify the H-1B skills training program, which is
    financed through employer paid H-1B fees, as one of those competitive
    grant programs.
        With roughly $125 million available in fiscal year 2006 for these
    H-1B skills training grants, can I have your assurance that these
    grants will continue to be awarded on a competitive basis, as they have
    been in previous iterations of the H-1B grant program, and coordinated
    through the workforce investment boards?
        Answer. The implementation plan for the new H-1B job training grant
    program is currently under development. As you know, the new grant
    program and the fees on employers submitting H-1B applications that
    will be the source of funding for the grants were authorized by
    amendments to the Immigration and Nationality Act that were contained
    in the fiscal year 2005 Consolidated Appropriations Act enacted last
    December. ETA anticipates that the vast majority of investments of new
    H-1B job training grants will be awarded on a competitive basis. The
    competitive investments will be strategic partnerships that develop
    solutions-based approaches to workforce challenges identified by
    industry. ETA will look to fund mature partnerships between the
    workforce investment system, education, and employers to implement
    activities, including job training. These services and activities are
    designed to prepare workers, unemployed and employed, to take advantage
    of new and increasing job opportunities in high-growth/high-demand and
    economically vital industries and sectors in the American economy.

                                    OVERHEAD

        Question. Madame Secretary, the President's budget request states
    that the President's job training reforms would increase the number of
    workers trained in large part by eliminating unnecessary overhead. The
    fiscal year 2006 budget builds on the President's April 2004 proposal
    for job training reform that sought to ``double the number of workers
    trained.'' Please define precisely what the Department means when it
    uses the term ``overhead''.
        Answer. Part of the problem lies in the lack of an appropriate
    statutory definition in WIA of overhead or administrative costs. As a
    result, too many WIA dollars are spent on overhead and non-training
    services, such as management studies, travel, and other infrastructure
    costs. In Program Year 2003, the largest share, or 30 percent of WIA
    funds, was spent on ``Infrastructure.'' Nineteen percent of funds were
    spent on employment placement activities while 23 percent was spent on
    core and intensive services and 28 percent was spent on training. Many
    of the infrastructure activities are necessary and appropriate, but it
    is difficult to justify spending more WIA funds on infrastructure
    activities than on training.
        Part of the solution is to more accurately define administrative
    costs. Through WIA reauthorization, the Administration proposes to
    specifically define administrative costs, while emphasizing the
    relative importance of training. The new definition would clarify that
    administrative cost limits apply to subrecipients and vendors just as
    they do to primary grant recipients.
        More broadly, the consolidation of four separate programs proposed
    by the Administration will reduce overhead costs by eliminating
    duplication in the provision of services, taking advantage of gains in
    economies of scale, and promoting a more effective and efficient use of
    Federal dollars. Continuation of the four programs--the WIA Adult
    program, the WIA Dislocated Worker program, the WIA Youth program, and
    the Wagner-Peyser Employment Service program--promotes ``silos'' of
    duplicative government systems providing identical services such as job
    search assistance and career counseling. By continuing duplicative
    service delivery systems, taxpayers pay more for administrative costs,
    overhead, and government bureaucracy, and receive fewer services.
    Furthermore, States that opt for WIA Plus State Consolidated Grants
    will be able to eliminate even more duplication.

                        NATIONAL FARMWORKER JOBS PROGRAM

        Question. Madame Secretary, the Department has once again proposed
    to eliminate the Migrant and Seasonal Farmworker Program, rating it
    ``ineffective'' in an Office of Management and Budget PART assessment.
    The OMB materials go on to note the program's poor performance
    accountability. However, the Department's own budget materials indicate
    that the Program Year 2003 goal was achieved--84 percent of program
    participants were employed at program exit; 80 percent were still
    employed 6 months after initial entry into unsubsidized employment and
    average earnings gains for those employed was over $4,300. Importantly,
    84 percent of farmworkers who participated in education or training
    under the program received an education or occupational credential or
    certificate, enhancing their ability to compete for better jobs.
        Answer. The performance results for the National Farmworkers Jobs
    Program (NFJP) appear high, but these performance levels only reflect
    how successful the program is for those participants who receive
    employment and training services. The majority of the approximately
    20,000 farmworkers served through the NFJP--about two out of three--
    receives related assistance services only (such as emergency
    assistance, transportation or child care) and do not receive any
    employment and training services. Therefore, NFJP is providing
    employment and training services to a very small proportion of the
    estimated 2 to 3 million farmworkers, and it is difficult to justify
    the program's overall impact on improving the economic opportunities of
    farmworkers.
        In addition, the PART review found that the NFJP was duplicative of
    other programs and services available through the WIA Title I programs
    and that farmworkers would be served better by accessing those services
    through the One-Stop system. Many NFJP grantees are already partners in
    the One-Stop delivery system at the State level. Yet, many localities
    rely on NFJP grantees almost exclusively to serve farmworkers outside
    the better-suited One-Stop delivery system.
                                     ______

                   Questions Submitted by Senator Tom Harkin

                               ODEP MOU WITH SBA

        Question. I was very pleased to see that the Department of Labor
    (DOL) recently signed a Memorandum of Understanding (MOU) with the
    Small Business Administration on the development of programs and
    policies to encourage self-employment for people with disabilities.
    Unfortunately, no DOL funds have yet been committed to this MOU, and
    the 2006 budget proposes to drastically reduce funding for the Office
    of the Disability Employment Policy (ODEP). Part of this proposed
    savings is to come from the elimination of $16 million worth of grants
    to enhance employment opportunities for Americans with disabilities.
    Please provide a list of the $16 million worth of grants and a
    justification for why you believe they have outlived their usefulness.
    In addition, I'd like to know how much of the proposed million in the
    budget will be allocated toward programs associated with this MOU.
        Answer. In fiscal year 2006, ODEP will continue, with the Small
    Business Administration (SBA), to implement the Memorandum of
    Understanding through the allocation of staff resources (Full Time
    Equivalents) in order to develop specific activities related to Small
    Business Development. This includes providing information, technical
    assistance, and policy guidance to the workforce development and small
    business development systems, to increase participation of people with
    disabilities in entrepreneurship training, financing, accessing needed
    capital, and increasing capital for individuals with disabilities who
    desire to start their own businesses. ODEP is working with SBA, DOL
    agencies, and business associations to develop the capacity of small
    businesses to recruit, hire, retain, and promote people with
    disabilities by documenting and disseminating effective practices to
    the small business community.
        In addition, the fiscal year 2006 Budget will enable ODEP to
    continue its core mission of policy analysis, technical assistance and
    dissemination of effective practices to increase the employment
    opportunities for people with disabilities. ODEP plans to refocus its
    research emphasis from a reliance on using externally-grant funded
    public and private organizations, to a stronger internal emphasis on
    policy development, analysis, and dissemination.

                   NATIONAL AGRICULTURAL WORKERS STUDY (NAWS)

        Question. The President's budget for 2006 proposes a $13 million
    increase in the Bureau of Labor Statistics and yet a stop work order
    went out in January on the $2 million National Agricultural Workers
    Study (NAWS). This study determines the distribution of more than $1.3
    billion in government spending. Departmental statements in the past
    have been that the study was cancelled in an effort to get other
    Federal agencies to fund the contract. Can you provide a record of DOL
    attempts to ask other agencies to fund the contract prior to
    terminating it? What is the status of the contract right now? Have
    other agencies stepped forward and if not, what are DOL plans with
    respect to this study?
        Answer. Let me begin by clarifying that the Department of Labor has
    not cancelled the NAWS. The Department and this Administration
    recognize that, although the wages, income, and working conditions for
    migrant and seasonal farm workers have improved in recent years, these
    important workers face unique challenges as they continue contributing
    to the success of the agricultural industry.
        As part of the Department's ongoing effort to improve programs that
    benefit both workers and employers, we have been consulting with other
    Federal agencies that use the data collected by the NAWS to determine
    the most suitable host agency for this survey. The Department issued a
    partial stop-work order to the NAWS contractor on January 12, 2005, but
    that stop-work order has been lifted and the NAWS contractor is again
    collecting data and will continue to do so periodically in the future.
    During the stop-work order, the contractor was instructed to cease
    survey work but to continue three NAWS-related task orders, one each
    for the Department's Employment and Training Administration (ETA), the
    Environmental Protection Agency (EPA), and the Centers for Disease
    Control and Prevention, National Institute for Occupational Safety and
    Health (CDC NIOSH). Under these task orders, the contractor is
    analyzing data, writing reports, testing new questions, and providing
    special data sets.
        The Department continues to evaluate survey options for the future.
    We recently produced the ninth NAWS Report, which is based on
    information collected in fiscal years 2001-2002. We are in the process
    of analyzing NAWS data from fiscal years 2003-2004, which will be
    presented in a future report.

                    SANITARY FACILITIES AND FEMALE EDUCATION

        Question. Madam Secretary, research has repeatedly shown that the
    health and survival of children improve in direct proportion to the
    mother's level of education. The education of girls leads to major
    benefits: higher incomes and smaller families for the girls themselves
    and more productive economies in the countries that support the
    education of girls. Despite these statistics, UNICEF has found that
    girls represent 70 percent of children ages 6-11 who are not attending
    school worldwide. There are many reasons for this but one simple
    intervention is making a big difference--girls are more likely to be
    kept out of school if there are no sanitation facilities. When we put
    girls' bathrooms in schools, parents are more likely to send their
    daughters to school rather than to work.
        This is why grants have been made from the Basic Education program
    in the International Labor Affairs Bureau to organizations that build
    girls bathrooms in schools, primarily in Africa. However, I have
    recently become aware of reports that the Department of Labor is
    warning these organizations that for some administrative reason, they
    cannot leave the toilets in the school after the grants have expired.
        If this is true, it is just ridiculous. The whole purpose of the
    funding was to put the bathrooms in the schools so that generations of
    girls would get educated and improve their families and their
    countries--why would we spend additional dollars to take them out after
    3 years or 5 years, or whatever the length of the grant?
        If the Department is indeed requiring the organizations to remove
    the equipment, can you please provide the rationale behind this
    requirement to the committee along with your plan for how you intend to
    fix this situation?
        Answer. The Department of Labor (DOL) believes that projects which
    expand access to quality educational opportunities are a vital tool in
    combating child labor. Moreover, we strongly agree that the
    construction of latrines and other sanitary facilities as part of such
    projects is an effective means of encouraging parents to send their
    children, especially girls, to school, rather than to work in often
    exploitive forms of labor. To date, DOL has not directed any grantee to
    remove latrines from schools, and it is not our intention or desire to
    do so. However, Federal grant regulations governing the acquisition and
    use of items of property may require the removal of these sanitary
    facilities upon the conclusion of the grant, in such cases we are
    obligated to advise the Bureau of International Labor Affairs (ILAB)
    grantees of their responsibilities regarding property acquired with
    Federal grant funds.
        You can be confident that the Department will work very closely
    with its grantees to assist them in retaining any sanitary facilities
    even after direct grant funding ends, by encouraging them to continue
    to use the property to support the grant's goals of improving
    educational opportunities and decreasing exploitive child labor. We
    believe that such uses of the property will allow indefinite retention
    of the sanitary facilities under the Federal grant regulations, and we
    are committed to ensuring the sustainability of these critical
    projects. Given the nature and value of latrines being funded by ILAB,
    we believe Federal property regulations would require removal of the
    facilities or compensation to the United States for the facilities'
    value only in the rare circumstance that the educational project closes
    down, or the project seeks to sell or dispose of the facilities.

                           NATIONAL EMERGENCY GRANTS

        Question. Secretary Chao, at your last appearance before us, you
    and I spoke about the National Emergency Grant program. I am very
    concerned that this remains a problem. A majority of States in a recent
    GAO report stated that they had to delay or deny services to workers as
    a direct result of the backlog in NEG applications at the Department of
    Labor. Is it as a direct result of the backlog in NEG applications at
    the Department of Labor? Is it true that your Department now plans to
    stop counting the number of days elapsed if there is a problem with an
    application? If so, will that include routine clerical errors or must
    there be a significant lack of information for the application to stop
    being counted?
        Answer. The Department of Labor is committed to reviewing National
    Emergency Grant (NEG) applications as quickly as possible, and we have
    made significant progress in resolving any backlog. When the issue was
    raised initially, we imposed a goal on ourselves of making award
    decisions within 30 working days of receiving a completed application.
    Further, we have taken steps to simplify and automate the application
    process through an electronic application system. The GAO study you
    refer to was based on data from a couple of years ago, prior to these
    actions.
        Phase 1 of the e-application system was operational on July 1,
    2004. We are already enhancing this system for State use with a Phase 2
    system that will be fully implemented on July 1, 2005. Preliminary
    testing of Phase 2 with State users received a uniformly positive
    reception. Additional design enhancements will be developed and
    implemented next year.
        The new NEG e-application system ensures that all necessary
    information is provided and eliminates the possibility that
    applications could be rejected purely for clerical errors.
        Since the introduction of the e-application system, the Department
    has seen a reduction in the amount of time required for review and
    approval of NEG applications, and we expect to improve upon this
    response time in the future. We have been within our self-imposed
    timeframe of 30 working days. Further, we will continue to track the
    application award period. States have not been complaining about NEG
    timeliness in the past year due to our proactive reform of the program.
        Finally, the Department believes that States and localities have
    sufficient funds to initiate services to workers who may subsequently
    be served under a National Emergency Grant. Services should not be
    denied or delayed while awaiting a decision on a NEG award. States
    carried in almost $550 million in unexpended Dislocated Worker formula
    funds--roughly two times the amount available for NEGs.

                       NATIONAL LABOR MARKET INFORMATION

        Question. The National Labor Market Information programs provide
    State-by-State information on employment, unemployment, earnings,
    occupational information, skills trends by industry, worker
    displacement, and job openings. Policy makers, including those of us in
    Congress, utilize this information to make decisions on allocation of
    Federal funds, program planning and evaluation as well as labor market
    dynamics. Why does the President's budget propose to eliminate the
    national labor market information programs? What measures will you put
    in place to ensure that State information is reported in a consistent,
    timely, and accurate manner?
        Answer. It is important to clarify that the funding for workforce
    and labor market information within DOL occurs in two different
    agencies. The Bureau of Labor Statistics (BLS) funds States to collect
    a wide array of information, including the information mentioned in the
    question. That information is available on a State by State basis and
    is also used as the foundation for national labor market statistics.
        The Employment and Training Administration (ETA) provides funding
    to States to develop workforce information as a service to businesses
    and job seekers. The data and statistical information that States
    collect on behalf of BLS is an important foundation for the workforce
    information funded by ETA. However, supplemental workforce information
    may come from many other sources including census data, State economic
    development data, educational data, data collected by industry trade
    associations, and information received from direct contact with the
    business community. The goal of ETA's investments is to transform these
    BLS and supplemental data sources into workforce intelligence through
    analysis and the development of user-friendly tools and products.
        The U.S. Department of Labor fiscal year 2006 budget proposal for
    ETA does not eliminate the national labor market information programs.
    As part of the proposed WIA Plus State Consolidated Grants,
    $39,680,000, which was previously provided to States in a stand alone
    grant, would be moved from the One-Stop Career Center/Labor Market
    Information line item into the consolidated grants to support State
    development and dissemination of workforce information. The
    consolidation of the workforce information funding into the WIA Plus
    Consolidated Grants will serve as an additional catalyst for
    transforming the silo system of the past into a demand-driven workforce
    information system that provides more and better information products
    and services that consumers will need in making strategic and tactical
    workforce investment and critical career decisions.
        The consolidation proposal does not affect funding for BLS or the
    Census Bureau, where much of the information used in the national
    allocation of Federal funds, program planning, and evaluation, as well
    as labor market dynamics information is provided.

                                   JOB CORPS

        Question. Madam Secretary, this Subcommittee has demonstrated a
    long-standing support for the Job Corps program. That support has been
    based on proven results working with disadvantaged youth. Despite the
    fact that 74 percent of Job Corps enrollees are high school drop outs
    and 32 percent come from families on public assistance, 90 percent of
    Job Corps graduates are placed in full-time employment. The average
    hourly wage for Job Corps graduates at 6 months after initial placement
    is $8.95 per hour. This is a real opportunity for kids who are headed
    down a tough road.
        In the current economy, however, this figure does not adequately
    reflect the benefit of Job Corps to graduates because it does not
    address the health and pension benefits. Please submit data to the
    Committee on the availability of health and pension benefits to Job
    Corps graduates 6 months after initial placement, the estimated value
    of those benefits, and other significant benefits such as the
    opportunity for continuing education or ongoing training. Madam
    Secretary, these benefits are getting more valuable by the day and I
    strongly urge you to incorporate this question in your 6 and 12 month
    follow-up surveys.
        Answer. Both the 6-month and 12-month follow-up surveys ask
    initially-placed graduates (who indicate that they were employed during
    the week prior to the survey) whether any benefits are available to
    them through their job. Specifically, the survey asks whether the
    employer offers a health insurance plan, paid sick leave, paid
    vacation, childcare assistance, or a retirement or pension plan. The 6-
    month and 12-month surveys do not collect information in regard to the
    value of these benefits.
        The table below depicts the percentage of graduates, employed at 6
    months and/or 12 months during PY 2003, who responded to the survey
    that their employer offers one or more of the listed benefits.

    ------------------------------------------------------------------------
                                                              Percent of
                                                          employed graduates
                                                           offered  benefits
                Benefits offered by employer             -------------------
                                                            at 6      at 12
                                                           Months    Months
    ------------------------------------------------------------------------
    Health Insurance Plan...............................      62.0      61.7
    Paid Sick Leave.....................................      49.2      51.2
    Paid Vacation.......................................      61.0      61.0
    Childcare Assistance................................      15.5      17.2
    Retirement or Pension Plan..........................      42.2      45.6
    ------------------------------------------------------------------------

        Not included in these data are the over 1,581 Job Corps students
    placed in the military during PY 2003, all of whom, as service members,
    receive benefits such as medical, dental, 30 days paid vacation, an
    automatic $32,000 Montgomery GI Bill, and 100 percent tuition
    assistance for college education.
        Question. In addition, while I am a strong supporter of the
    benefits of online learning for rural areas and I am certainly always
    appreciative of budget savings, I am concerned about the suggestion in
    your budget documents that you want to move toward relying more heavily
    on online learning in Job Corps Centers. The kids in these programs are
    difficult to reach and Job Corps does a fantastic job of turning them
    around. At the heart of the program is the personal connection that
    highly qualified instructors make with these kids, cheering them on and
    giving them a real sense of accomplishment. Can you provide a 5 year
    plan for Job Corps curriculum? Please include information on the manner
    in which online learning will be utilized to deliver services to Job
    Corps participants.
        Answer. Since 2002, Job Corps centers have increasingly provided
    online and server-based courses to students to enable them to complete
    their high school programs and receive diplomas. These programs are
    particularly beneficial in situations where the Job Corps centers are
    in rural locations and/or cannot make arrangements with local high
    schools to allow students to attend classes.
        In Job Corps classrooms with online learning opportunities, an
    instructor circulates among the students to answer questions and
    provide one-on-one assistance. Group instruction and written materials
    are often incorporated with the delivery of online courses. Currently
    Job Corps centers do not use a single online curriculum. Operators of
    multiple centers tend to have contracts with online course and software
    providers to enable cost-effective delivery to several centers.
        In PY 2005, however, the Job Corps National Office plans to
    undertake a major effort to establish standards and curriculum for
    foundation courses in reading, math, and writing and to establish core
    standards for high school programs with recommended curricula. These
    efforts will follow the development of strategic education and
    instructional technology plans. Therefore, Job Corps does not currently
    have a 5-year curriculum plan in place. While the specific approaches
    to incorporating online and other curricula will be based on the
    planning process, Job Corps intends to build on best instructional
    practices and courses to create a ``blended learning'' approach
    involving a mix of face-to-face and online instruction. This approach
    has been proven effective in engaging students with diverse learning
    styles and abilities and enabling them to work closely with qualified
    instructors. The use of online learning will also allow students to
    have equal access to Job Corps' newly developed core curricula, based
    on rigorous standards in both academic foundation skills and high
    school programs.

                      HIGH GROWTH JOB TRAINING INITIATIVE

        Question. As a Member of both your Appropriations and Authorizing
    Committees, I was very interested to read in your testimony about a new
    program that is not authorized under the Workforce Investment Act (WIA)
    called the High Growth Job Training Initiative. You cite the fact that
    you have spent $164.8 million for 88 grants since 2002. I have a series
    of questions related to the expenditure of these dollars.
        How many of these grants were awarded on a competitive basis?
        Answer. The High Growth Job Training Initiative was initiated to
    model new and innovative strategies to create a demand-driven workforce
    investment system. In carrying out this mission, the Department awarded
    grants to model programs using discretionary funding for this activity
    as is authorized under title I of the Workforce Investment Act. Through
    unsolicited grants, which are not awarded on a competitive basis, the
    Department has been able to strategically invest in innovative models
    that address the key issues industry identified and to do so in the
    context of different sectors for each industry. Unsolicited grants also
    have allowed the Department to spark transformation of the workforce
    investment system to a system that is more demand-driven--that is, more
    responsive to the skill needs of businesses and industry. This
    innovative approach to workforce investment features partnerships that
    include the workforce investment system, business and industry,
    education and training providers, and economic development working
    collaboratively to develop solutions to workforce challenges. The 88
    grants cited, and a subsequent grant awarded on June 3 to the
    Pennsylvania Workforce Investment Board for a comprehensive statewide
    strategy for addressing the workforce needs of Pennsylvania's plastics
    manufacturing sector, were awarded as non-competitive grants. All of
    these grants were subject to review and approval by the Department's
    Procurement Review Board.
        It has been the Department's intent from the beginning to move to
    competitive opportunities following the first round of strategic
    investments by industry. In June 2005, the Department announced 12
    grants, in the health care and biotechnology industries, which were
    competitively awarded in accordance with a Solicitation for Grant
    Applications. Moving forward, the majority of future investments will
    be made on a competitive basis.
        Question. How many of these grants were awarded directly to private
    sector companies?
        Answer. Of the 88 grants cited, three were awarded to private
    sector companies in partnership with non-profit associations, workforce
    investment boards, and other public sector entities, which was a
    requirement. These grants were awarded to:
      --Catalyst Learning, in partnership with Anne Arundel Community
            College
      --Hospital Corporation of America (HCA), in partnership with Broward
            County Community College, Dade County Community College, and
            Palm Beach County Community College
      --Management & Training Corporation, in partnership with City
            Colleges of Chicago, Cincinnati State Technical and Community
            College, Sinclair Community College, Luzerne County Community
            College, Lehigh/Carbon County Community College, the
            Metropolitan Chicago Healthcare Council, the Paul Simon Chicago
            Job Corps Center, the Cincinnati Job Corps Center, the Dayton
            Job Corps Center, and the Keystone Job Corps Center
        Two subsequent grants were competitively awarded in accordance with
    a Solicitation for Grant Applications to private sector companies. They
    are:
      --CVS Regional Learning Center, in partnership with Detroit Workforce
            Development Department, ORC Macro, Wayne County Community
            College District, Goodwill Industries of Greater Detroit, New
            Galilee Missionary Baptist Church, Perfecting Church, and
            Little Rock Baptist Church
      --United Regional Health Care System, in partnership with North
            Central Texas Healthcare Consortium, United Regional Healthcare
            System, Wilbarger General Hospital, Electra Memorial Hospital,
            Seymour Hospital, Vernon College, Midwestern State University,
            Texas Christian University, North Texas Tech Prep Consortium,
            Partners-in-Education, and Region 9 Education Service Center
        Question. Can you provide the Appropriations Committee with a
    complete list of all of the grants awarded under this program and their
    geographic locations?
        Answer. Yes. Through the High Growth Job Training Initiative, the
    Department has made 101 investments in 12 high growth industries. The
    details on each award follows:
        Grant Recipient and Location: Henderson-Henderson County Chamber of
    Commerce/Kentucky
        Partner(s) and Location(s): Henderson, Union, and Webster County
    WIBS; Henderson Community College; the Kentucky Community and Technical
    College System; Employer representatives from targeted industries;
    County economic development councils; city and county municipal
    governments and county high school technology centers/KY
        Funding Amount: $2,991,840
        Purpose of the Award: This pilot will design and deliver demand-
    driven training and placement services in the following industries:
    industrial technology, engineering technology, manufacturing,
    hydraulics, pneumatics and IT. We anticipate that this demonstration
    will train and place 1,265 workers. It is anticipated that at least 63
    percent will be placed within four weeks and 71 percent of dislocated
    workers will be placed.
        Grant Recipient and Location: Automotive Youth Educational Systems/
    Michigan
        Partner(s) and Location(s): Automotive manufacturers and dealers'
    associations; local high schools/national
        Funding Amount: $600,000
        Purpose of the Award: The grantee will demonstrate a demand-driven
    automotive technician curriculum and training process that uses a new
    blended training delivery model (including on-line features). This new
    approach to learning, paired with work-based applications in
    dealerships across the country, will offer access to expanded learning
    opportunities in urban and rural communities. This pilot project is
    projected to train 6,250 new participants in year 1, 7,700 in year 2,
    and 8,600 in year 3.
        Grant Recipient and Location: Council for Adult and Experiential
    Learning/Pennsylvania
        Partner(s) and Location(s): WIBs in local sites; Community colleges
    in local sites; hospitals at local sites; Department of Labor Office of
    Apprenticeship/IL, MD, SD, TX, WA, GA, VA, DE, WI
        Funding Amount: $2,174,450
        Purpose of the Award: This pilot is designed to increase the number
    of CNAs, LPNs, and RNs by building upon a pre-existing career ladder
    model and adding an apprenticeship component for CNAs and LPNs. It is
    anticipated that the demonstration will train approximately 300
    students per site at 5 sites for a total of 1,500 students served
    during the pilot.
        Grant Recipient and Location: Computing Technology Industry
    Association (CompTIA)/Illinois
        Partner(s) and Location(s): Northern Virginia Community College;
    NFL Films; Okidata; Hill International, Keyport Division; Naval
    Undersea Warfare Center; Henkels & McCoy; Exodux IT Services;
    Cosmopolitan Chamber of Commerce/national
        Funding Amount: $2,818,795
        Purpose of the Award: This demonstration will support the
    development and implementation of a National Information Technology
    Apprenticeship System (NITAS), a competency-based apprenticeship
    methodology that supports consistent and flexible credentialing for the
    career development and advancement of IT workers. It is anticipated
    that throught this demonstration approximately 384,000 IT workers will
    become registered apprentices and approximately 6,700 employers will
    register as on-the-job learning providers.The seven-track NITAS career
    matrix allows workers to progress through all or part of the
    apprenticeship program using a combination of classroom instruction and
    on-the-job training. Standardized, industry-recognized certifications
    are earned as each apprenticeship tier is completed and the
    certifications are transferable from employer to employer.
        Grant Recipient and Location: The National Retail Federation
    Foundation (NRFF)/Washington, D.C.
        Partner(s) and Location(s): Local WIBs involved in multiple project
    sites; local community colleges involved in multiple locations; Toys
    ``R'' Us; Saks, Inc.; CVS/pharmacy; the Home Depot; seven major
    shopping center developers; hundreds of large and small retail
    employers and businesses; NRFF's State and Local Affiliate Network;
    State and Government Agencies; Community-based organizations/DC
        Funding Amount: $2,250,000
        Purpose of the Award: Grantee will demonstrate a model for creating
    a comprehensive cross-industry career ladder from sales associate
    through senior level management. For each level in the career ladder, a
    core competency and training curriculum model will be developed for
    distribution throughout the industry and the public workforce system.
    In addition, the demonstration will train a significant number of
    incumbent and new workers in the retail sector in partnership with
    employers and the public workforce system. The curriculum will be
    disseminated broadly to retail employers across the country through the
    public workforce system.
        Grant Recipient and Location: The National Retail Federation
    Foundation/Washington, D.C.
        Partner(s) and Location(s): Local WIBs involved in multiple project
    sites; seven major shopping center developers and hundreds of large and
    small retail employers and businesses; Montgomery College; NRFF's State
    and Local Affiliate Network; State and Local Government Agencies; and
    community-based organizations/national
        Funding Amount: $2,815,000
        Purpose of the Award: This Project will demonstrate the use of
    retail skills centers' at eight sites that provide retail and customer
    service education and training services for mall employees and area job
    seekers. Located in shopping centers, these ``skills centers'' help
    retail employers recruit, retain, and advance workers through a range
    of training options, from language and employability skills classes to
    customized seminars. This pilot project is projected to train and place
    over 3,000 individuals in the retail sector.
        Grant Recipient and Location: National Restaurant Association
    Educational Foundation/Illinois
        Partner(s) and Location(s): State Restaurant Associations in each
    State; International School Licensing Corporation's America's Schools
    Program/national
        Funding Amount: $1,765,000
        Purpose of the Award: NRAEF will demonstrate the value of creating
    a national system of State hospitality partnerships through the HBA/
    ProStart project. These partnerships, in 19 States across the country,
    are dedicated to the establishment of 900 high school hospitality
    School-to-Career programs and industry mentoring programs that lead to
    an industry-recognized national certificate. The goal of the project is
    to offer work-based learning opportunities for 6,700 students at
    approximately 6,000 work sites. By increasing student worksite
    experience and increasing industry involvement in workforce issues
    through this project, NRAEF will have the ability to cultivate new
    sources of talent and thus strengthen the hospitality industry by
    attracting, supporting, guiding, training, and teaching current and
    future workers.
        Grant Recipient and Location: National Institute for Metalworking
    Skills (NIMS)/Virginia
        Partner(s) and Location(s): Employer partners are mentioned but not
    specifically named/national
        Funding Amount: $1,965,700
        Purpose of the Award: This demonstration is designed to create a
    more economical, rational, effective and efficient competency-based
    apprenticeship model that builds on the time-tested NIMS skill
    standards credentialing system. Under this demonstration, NIMS will
    develop a competency web for metalworking occupations consistent with
    NIMS skill standards.
        This includes developing apprenticeship programs and curriculum
    development for the six competency-based apprenticeship programs with
    portable, nationally-recognized credentials for these occupations
    complete with a curriculum guide and implementation guide. It is
    anticipated that this demonstration will train ATELS staff and industry
    partners on the apprenticeship programs to better serve the over 500
    apprenticeships under way at any one time by employers and assocations.
        Grant Recipient and Location: Community Learning Center, Inc.
    (CLC)/Texas (two grants)
        Partner(s) and Location(s): Tarrant County Workforce Development
    Board; Tarrant County College; Lockheed Martin-Aero; Bell Helicopter-
    TEXTRON; Interconnect Wiring and Southwest Airlines/TX
        Funding Amount: $4,028,400
        Purpose of the Award: This demonstration project will continue the
    Aerospace Industry Training Project (AITP) for preparing and placing
    dislocated workers in aircraft assembly and will provide incumbent
    workers with advanced training. It is anticipated that 1,024 dislocated
    workers will receive training and wage increases and that 802 workers
    will be placed in unsubsidized employment.
        Grant Recipient and Location: Downriver Community Conference--
    AutoAlliance International/Michigan
        Partner(s) and Location(s): Michigan Works Association; Monroe
    County Community College; Henry Ford Community College; Wayne County
    Community College; Davenport University; Baker College; AutoAlliance
    International (joint venture of Ford and Mazda); UAW; Downriver Career
    Technical Consortium; Flat Rock secondary schools/MI
        Funding Amount: $5,000,000
        Purpose of the Award: It is anticipated that the grantee will
    demonstrate methods for training and preparing automotive workers for
    new advanced manufacturing production processes. Grantee will map,
    track, and analyze transferable manufacturing skills sets and
    competencies required for the new positions and provide training,
    assessment and employment for 1,400 worker
        Grant Recipient and Location: Alameda County Workforce Investment
    Board/California
        Partner(s) and Location(s): San Mateo County WIB; Skyline Community
    College; Ohlone Community College; Genetech; Alza; Baxter; Chiron;
    Adecco; Gruber and Pereira Associates; Opportunities Industrialization
    Center West/CA
        Funding Amount: $2,000,000
        Purpose of the Award: Under this pilot, it is anticipated that the
    grantee will develop career pathways in bio-tech manufacturing,
    facilities management, quality control, and product engineering.
    Additionally, the program will work with area community-based
    organizations to create a ``bridge'' program to prepare lower skilled
    individuals for entry-level employment. This pilot project is expected
    to train up to 150 workers and place them in employment at wages of
    $35,000-$40,000 per year. In addition the grantee is expected to train
    40 dislocated engineers and place them in employment at wages of
    $50,000-$80,000 per year.
        Grant Recipient and Location: Forsyth Technical Community College/
    North Carolina
        Partner(s) and Location(s): Forsyth Tech has a local JobLink One-
    Stop Career Center on campus; grantee is Community College; Syngenta,
    Targacept, Orthofix and Wake Forest University School of Medicine
    (WFUSM); North Carolina Biotechnology Center; Wake Forest University;
    Winston-Salem State University; University of North Carolina-
    Greensboro; Winston-Salem Chamber of Commerce; Winston-Salem/Forsyth
    County Schools/NC
        Funding Amount: $754,146
        Purpose of the Award: Forsyth Tech will demonstrate a program
    designed to implement a biotechnology associate degree training program
    for the region's dislocated manufacturing workers. Forsyth Tech will
    retrain workers who have been dislocated from declining industries so
    that they are qualified for employment in the emerging biotechnology
    field. The Forsyth Tech curriculum will focus on training laboratory
    technicians in biotechnology and related pharmaceutical occupations and
    can be broadly replicated in community colleges across the country.
        Grant Recipient and Location: Indian Hills Community College/Iowa
        Partner(s) and Location(s): Iowa Workforce Development; Des Moines
    Area Community College; Biotechnology Association; Iowa Renewable Fuels
    Association; Cargill, Inc.; Genencor; Pioneer Hybrid International;
    Garst Seed; Phytodyne; Kemin Industries; Iowa Biotechnology
    Association; Iowa Renewable Fuels Association/IA
        Funding Amount: $996,250
        Purpose of the Award: Under this demonstration project, the grantee
    will establish a comprehensive State-wide approach to growing the
    biotech industry as a part of the Iowa economic base; Create a skilled
    workforce through community colleges and workforce investment system
    partnerships; Educate middle and high-schoolers about biotech career
    options and skills needed. The grantee anticipates they will train 100
    high school teachers and counselors, 100 unemployed and underemployed
    biotech workers, 600 incumbent biotech workers and provide career
    awareness training activities to over 6,000 students during the life of
    the grant.
        Grant Recipient and Location: Lakeland Community College/Ohio
        Partner(s) and Location(s): STERIS Corp.; Athersys, Inc.;
    Lakeland's BioTech Council and its employer members; school systems in
    Mentor, Ashtabula, and Mayfield, Ohio; Tech Prep Consortium; Ricerca
    Biosciences; BioEnterprise; Association for the Advancement of Medial
    Instrumentation; NeoBio; Lakeland Community Learning; Lakeland Center
    for Quality and Productivity/OH
        Funding Amount: $333,485
        Purpose of the Award: The grantee will develop demonstration
    training programs that are designed to recruit new workers, beginning
    at the high-school level and up through a Master's Degree level in
    northeast Ohio. The grantee will partner with industry to create
    training and curriculum; develop a BioCenter and a national
    biotechnology career coaching model. This curriculum will be
    deseminated broadly expanding the availability of industry-based
    curruculum and articulating career cadders and competency models
    designed to industry standards. It is expected that the grantee, as
    part of their activities, will expand internship and training
    opportunities through the pilot Bio Center.
        Grant Recipient and Location: Pittsburgh Life Sciences Greenhouse/
    Pennsylvania
        Partner(s) and Location(s): Three Rivers Workforce Investment
    Board; Community College of Alleghany County; Renal Solutions, Inc. and
    six additional employers in the area; the Pittsburgh Technology
    Council; The Allegheny County Job Link/PA
        Funding Amount: $2,433,160
        Purpose of the Award: In this pilot project, the grantee will match
    trained workers with local area biotechnology companies with the goal
    of rapidly deploying professionals into biotechnology employment
    through customized training programs and biotechnology curriculum. The
    grantee anticipates that they will train and place 200-400 workers in
    biotech business jobs. As a part of its efforts to support the growth
    of greater Pittsburgh life sciences employers, the project will provide
    training for new entrants into biotech as well as retraining for
    workers affected by declining industries.
        Grant Recipient and Location: The Workforce Alliance, Inc./Florida
        Partner(s) and Location(s): the Workforce Alliance; Treasure Coast
    Workforce Development Board; Indian River Community College; Workforce
    Florida, Inc.; Palm Beach County Business Development Board and
    Economic Development Council; Regional Biotechnology Employers; Florida
    Atlantic University; Office of the Governor; Scripps Research
    Institute; Palm Beach County's Government; school boards; the Agency
    for Workforce Innovation; Business Development Board; Economic
    Development Council/FL
        Funding Amount: $2,325,303
        Purpose of the Award: This demonstration project is designed to
    retrain employed and unemployed workers to build careers in biotech in
    the Palm Beach County, Florida area. Through this demonstraion project,
    the grantee anticipates enrolling 110 workers. The grantee estimates
    that 80 percent of employed and 65 percent of unemployed participants
    will complete their training with a certification or degree. FAU's
    Biotech Training Program will establish a biotech career ladder and
    develop curriculum as well as a program for participants to obtain a
    postgraduate level certificate in Biotechnology and Bioinformatics. The
    learning's from this program will be disseminated broadly for
    replication.
        Grant Recipient and Location: American College of the Building
    Arts/South Carolina
        Funding Amount: $2,750,000
        Purpose of the Award: The grantee will demonstrate the development
    and testing of an innovative, industry-driven curriculum that focuses
    on the traditional building arts, such as carpentry, ironwork, masonry,
    timber framing, plasterwork, and stone carving through the first of its
    kind school, the American College of Building Arts (ACBA). ACBA also
    will establish partnerships with industry organizations for future
    internship programs based on this piloted curriculum. The inaugural
    class of 100 students will be recruited from across the nation to
    attend this unique restoration training college and will return to
    local communities for work-based learning opportunities and employment.
        Grant Recipient and Location: SkillsUSA-VICA/Virginia
        Funding Amount: $142,000
        Purpose of the Award: Grantee will demonstrate methods for
    increasing the pipeline of skilled trade workers by building advanced
    competency models and career ladders and provide secondary students
    interested in the skilled trades with more post-secondary training
    alternatives, such as the opportunity to continue their skills
    development in advanced community college programs.
        Grant Recipient and Location: Oklahoma Department of Career and
    Technology Education/High Plains Technology Center/Oklahoma
        Partner(s) and Location(s): Northwest Workforce Development
    Council; Workforce Oklahoma; Marathon Oil Company; Mid-Continental Oil;
    Mid-Continental Oil and Gas Association of Oklahoma; Unit Drilling;
    Patterson-UTI Drilling; BP America Production Company/OK
        Funding Amount: $1,546,463
        Purpose of the Award: In this demonstration project, the grantee
    will develop a bilingual training curriculum in gas and energy based on
    the skills needs of local employers. The grantee estimates they will
    train approximately 500 workers, including 125 workers new and 325
    incumbent workers. As part of the demonstration, the grantee will
    develop and provide training for new and incumbent workers in the oil
    and gas industry and better integrate the industry with existing
    workforce development resources in Northwest OK, Southwest KS and the
    TX Panhandle. This model will be disseminated to the public workforce
    system for replication across the country in areas in need of a skilled
    energy workforce.
        Grant Recipient and Location: San Juan College Regional Training
    Center/New Mexico
        Partner(s) and Location(s): Farmington WIB; local One-Stops in
    other participant recruitment States (CO, NM, UT, WY); Key Energy
    Services; Navajo Nation; Church of Jesus Christ of Latter-Day Saints/NM
        Funding Amount: $2,113,127
        Purpose of the Award: This pilot project is designed to develop a
    regional energy training center with initial recruitment and screening
    conducted at one-stop centers to provide training to three targeted
    groups: minorities, predominately Spanish-speaking and Native
    Americans, underemployed and dislocated worker populations and
    underemployed incumbent workers. The grantee anticipates training 50
    workers to complete applied basic education to attain required literacy
    level and training 400 workers in a certificate-based training program.
    The grantee anticipates that 320 candiated will complete the training,
    with 300 projected placements. In addition, the grantee anticipates
    that 240 will be retained after 30 days and 210 after 180 days of
    employment. In addition, the grantee will design a skills-based,
    competency model curriculum by mapping key occupational skills and
    benchmarking against the skills of current incumbent workers. This
    curriculum will be used as the basis for safety training
    certifications. To support efforts to reach under represented
    popolations, the grantee will also develop video assessment tools,
    training videos with supportive curriculum written in Navajo and
    Spanish language. These recuritment tools will be made available to the
    public workforce system for use in providing career guidance to
    workers.
        Grant Recipient and Location: University of Southern Mississippi
    (USM)--Geospatial Development Center/Mississippi
        Partner(s) and Location(s): Local WIBs and One-Stop Career Centers;
    Mississippi Gulf Coast Community College; Pearl River Community
    College/MS
        Funding Amount: $1,565,227
        Purpose of the Award: In this demonstration project, the grantee
    will develop a registered apprenticeship program in Geospatial
    Technology based on a competency model that will be designed as part of
    the pilot. The grantee anticipates that as part of the project, 30
    apprentices will be trained. In addition, training materials, tests for
    related classroom instruction, and assessments for structured OJT will
    be developed. Some curriculum modules will be made available through
    web-based distance learning tools to allow for easy replication by the
    workforce system in partnership with employers in the Geospatial
    sector.
        Grant Recipient and Location: American Health Care Association
    Foundation/Washington, D.C.
        Partner(s) and Location(s): George Washington University's Center
    for Health Services Research and Policy and Wertlieb Educational
    Institute for Long Term Care Management/DC
        Funding Amount: $113,296
        Purpose of the Award: This research and demonstration project is
    designed to support the workforce challenges faced by the over 16,000
    long-term care facilities across the country. In this project, the
    grantee will develop an infrastructure of ``Best Practice'' models to
    build partnerships for combating the nursing shortage in long-term care
    that can be expanded, evaluated, replicated, and transported to other
    areas of the country. This project is designed to support addressing
    the nursing shortage in long-term care and offer a model designed to be
    replicable by workforce systems across the country, meeting this
    critical workforce shortage.
        Grant Recipient and Location: Berger Health System/Ohio
        Partner(s) and Location(s): Ohio University/OH
        Funding Amount: $200,000
        Purpose of the Award: This demonstraion project is designed to meet
    the needs of the rural community hospital by holding all classes and
    clinical rotations at the Berger Hospital facilities for the 3-year,
    university-based Associate Degree nursing program. The grantee
    anticipates that through this project, 30 incumbent employees and non-
    traditional students will enroll in credentialed programs. This project
    will serve as a model for replication in rural communities across the
    country, offering employee and opportunity to grow in their careers
    while remaining in their rural community.
        Grant Recipient and Location: Capital IDEA/Texas
        Partner(s) and Location(s): Worksource-Greater Austin Area
    Workforce Development Board; Austin Community College; in Austin:
    Seaton Healthcare Network; St. David's Healthcare Partnership; Austin
    Heart; in San Marcos: Central Texas Medical Center/TX
        Funding Amount: $224,088
        Purpose of the Award: This demonstration project is designed to
    enable students and lower-skill hospital employees to advance to career
    training courses by providing tutoring in a key pre-requisite anatomy
    and physiology course. Tutoring begins the first week of class in order
    to: (a) increase the success rate of students, thereby reducing the
    extra expense of tuition, counseling, child care, and time associated
    with students repeating the course; (b) accelerate graduations; and (c)
    increase the success rate of disadvantaged students. Rather than take
    remedial action after students fall behind, the tutoring will raise
    their chances of enrolling in training for and successfully completing
    a nursing or allied health occupation.
        Grant Recipient and Location: Catalyst Learning/Kentucky
        Partner(s) and Location(s): Anne Arundel Community College/FL, IL,
    IN, KT, MD, MI, MO, NC, OH, PA, TN, TX, VA
        Funding Amount: $3,176,000
        Purpose of the Award: Make basic skills and work-related education
    more accessible to adults in low-wage jobs and more feasible for
    employers by combining interactive television broadcasts in the
    workplace with additional coursework through printed materials and
    interactive online exercises.
        Grant Recipient and Location: Columbia Gorge Community College/
    Oregon
        Partner(s) and Location(s): Region 9 Workforce Investment Board;
    Columbia Gorge Community College; eight area hospitals and health care
    providers; K-12 school districts; Oregon Health and Science University;
    and city and county governments/OR, WA
        Funding Amount: $1,250,000
        Purpose of the Award: This pilot project is designed to create a
    Health Occupations Career Ladder Nursing Program to train 200 new
    workers and expand CGCC's offerings and opportunities for an Associate
    Degree in Nursing and a distance learning option for a Bachelor Degree
    of Nursing Program. The grantee anticipates they will train 200 new
    healthcare workers. It is expected that forty nurses of 200 total
    trainees will have the opportunity to earn a BSN through Columbia
    Gorge's dual admission agreement with Oregon Health and Science
    University. In addition, the grantee will expand Certified Nursing
    Assistant/Certified Medication Aide training to fill vacancies created
    from the pilot project. The grantee anticipates they will offer 7-9
    classes per year to train an additional 60 students and to develop
    opportunities for training including 10-20 CMAs per year.
        Grant Recipient and Location: Excelsior College/New York
        Partner(s) and Location(s): Excelsior College; fourteen hospices in
    New York State, along with one each in Montana, North Carolina, Rhode
    Island, South Carolina, and Texas; WINs demonstration project in
    various local areas/MT, NY, NC, RI, SC, TX
        Funding Amount: $516,154
        Purpose of the Award: In this pilot project the grantee is expected
    to expand the number of registered nurses and create a stable, highly
    skilled RN workforce for hospices by developing a Hospice and
    Palliative Care Online Certificate Program (HPCC) that includes a
    period of practical experience and training supervised by an expert or
    specialist. The grantee is expected to development of a recruitment
    strategy designed to attract nurses to end-of-life care. Emphasis will
    be placed on the recruitment of RNs who are no longer employed in
    nursing but are interested in re-entering the field, nurses planning to
    leave the acute care arena, and new graduates. As part of the career
    awareness, the grantee will establish a website that will give hospices
    across the nation free access to discuss best practices, announce job
    openings, and publicize trainings and conferences. The grantee will
    also develop a 12-month end-of-life nursing training program that will
    be disseminated broadly to employers and community colleges for
    replication. The grantee anticipates serving 60 interns and
    approximately 30 preceptors affecting the quality of care of over
    17,000 patients from its 212 hospice partners.
        Grant Recipient and Location: Florida International University
    School of Nursing/Florida
        Partner(s) and Location(s): Florida International University School
    of Nursing; Hospital Corporation of America/FL, TX
        Funding Amount: $1,421,639
        Purpose of the Award: This innovative demonstration is designed to
    train 100 baccalaureate-prepared nurses from a pool of foreign educated
    physicians who are currently unemployed or underemployed, offering a
    new model for addressing the critical shortage of nurses in this
    country. As part of the demonstration, the grantee will pilot test a
    synchronous distance education component utilizing interactive
    television, offering an opportunity and method of replication for other
    areas of the country.
        Grant Recipient and Location: Hospital Corporation of America
    (HCA)/Tennessee
        Partner(s) and Location(s): Broward County Community College; Dade
    County Community College; Palm Beach County Community College/FL, TX
        Funding Amount: $4,000,000
        Purpose of the Award: Under this demonstration, the grantee will
    address the lack of experienced nurses and set standards that can be
    replicated across the country by creating a distance learning model and
    a fellowship program that will create an intensive, hands-on,
    accelerated learning setting similar to a medical residency. The
    grantee anticipates that 100 students will enroll in the critical care
    core program during the first year of the grant. During the second year
    of the grant, these 100 students will specialize in either critical
    care specialties or emergency department specialty and an additional
    100 students will enroll in the critical care core. In addition to this
    training, the grantee anticipates that at least 30 students annually
    will receive sponsored scholarships. This demonstration will also allow
    for the develop a competency based Basic Arrhythmia challenge
    examination for experienced nurses as well as various forms of blended
    e-learning curriculum modules for additional topics in the critical
    care core curriculum. The project is designed to enhance the basic
    critical care core on-line curriculum with e-learning course content
    and didactic and laboratory activities. The model will develop critical
    care clinic courses for new nursing graduates and experienced med-surg
    and telemetry nurses and includes a teaching manual that provides
    course outlines, course syllabi, and clinical assessment instruments.
        Grant Recipient and Location: States of Georgia, Colorado, Texas,
    and Florida
        Partner(s) and Location(s): WIBs in all local areas, HCA, Inc.;
    community colleges in local sites
        Funding Amount: $4,541,205
        Purpose of the Award: Grantee will demonstrate a program designed
    to assist workers dislocated since 9/11 by providing training
    scholarships for employment in high-growth nursing careers, LPN,
    radiology technologists, surgical technicians and certified nursing
    assistants. Over 875 individuals along the healthcare career ladder
    will receive scholarships.
        Grant Recipient and Location: Johns Hopkins Health System/Maryland
        Partner(s) and Location(s): Baltimore City WIB; Baltimore City
    Community College, Community College of Baltimore County (CCBC)/MD
        Funding Amount: $3,000,000
        Purpose of the Award: In this demonstration, the grantee will
    develop and execute an Incumbent Worker Career Acceleration Program,
    including five components: (1) an initiative for addressing retention
    and growth of at-risk workers; (2) a GED and diploma preparation
    program; (3) an initiative for retraining of employees in declining
    jobs for emerging jobs; (4) a high-potential worker assessment and
    skills training program; and (5) an initiative to upgrade training of
    incumbent workers into critical skills shortage positions. The grantee
    anticipated that they will have an 80 percent retention rate for 100-
    150 employees participating in the Retention and Growth of At-Risk
    Workers Initiative as well as a 70 percent retention rate among 50
    incumbent workers receiving a GED or diploma through the initiative;
    they expect that at least 25 of these individuals will go on to further
    skills training and higher-skilled positions. They anticipate that 75
    participants to receive skills assessment, career counseling, and
    skills-based training and that 200 incumbent workers will receive
    assessment and training leading to the staffing of more critical
    skilled positions.
        Grant Recipient and Location: Management & Training Corporation/
    Utah
        Partner(s) and Location(s): In Illinois: City Colleges of Chicago;
    the Metropolitan Chicago Healthcare Council; in Ohio: Cincinnati State
    Technical and Community College and Sinclair Community College; In
    Pennsylvania: Luzerne County Community College and Lehigh/Carbon County
    Community College. Also, the Paul Simon Chicago Job Corps Center, the
    Cincinnati Job Corps Center, the Dayton Job Corps Center, and the
    Keystone Job Corps Center in Drums, Pa./IL, OH, PA
        Funding Amount: $1,500,000
        Purpose of the Award: The focus of the grant is to unite the
    efforts of Job Corps Centers with community colleges to address the
    health care workforce challenges in Illinois, Ohio, and Pennsylvania.
    This demonstration is expected to train 210 youth over a 2-year period
    span at three different Job Corps Centers. The grantee is expected to
    measure retention and completion rates, percent of students who
    complete training in the project and become employed in the healthcare
    industry (job-training match), average wage of students employed, long-
    term attachment to the workforce, and promotions or lateral moves in
    the healthcare fields. As part of their activities, the grantee will
    develop outreach materials that are designed to attract low income, out
    of school youth between the ages of 16-24 targeting out-of-school youth
    and Hispanic worker populations.
        Grant Recipient and Location: Maryland Department of Labor,
    Licensing, and Regulation and Governor's Workforce Investment Board/
    Maryland
        Partner(s) and Location(s): WIB is the grantee; a MOU will be
    developed among the community college system, the university system and
    the health care industry/MD
        Funding Amount: $1,500,000
        Purpose of the Award: This demonstration is designed to address the
    faculty capacity problem by implementing a scholarship program for
    nurses who pursue credentials to teach nursing and allied healthcare
    professions. The grantee anticipates offering forty $10,000
    scholarships to nurses selected to obtain teaching credentials in
    healthcare. In addition, the grantee will offer forty $10,000
    scholarships will be provided to incumbent healthcare workers seeking
    to become Registered Nurses to replace those who have left to teach
    nursing. This model is designed to demonstrate partnerships that help
    backfill RN positions by implementing a scholarship program for
    Licensed Practical Nurses (LPNs) and other incumbent workers that are
    seeking their Registered Nurse (RN) credentials.
        Grant Recipient and Location: North Carolina Department of Commerce
    Commission on Workforce Development/North Carolina
        Partner(s) and Location(s): North Carolina WIBs; North Carolina
    Community College System; NC Hospital Association; University of North
    Carolina System; NC Department of Health and Human Services; NC Area
    Health Education Centers/NC
        Funding Amount: $1,500,000
        Purpose of the Award: This demonstration is designed to address
    North Carolina's critical nursing and direct care worker shortages by
    targeting the State's pool of dislocated workers. The grantee
    anticipated training up to 450 displaced workers to enroll in Human
    Resource Development Plus pilot sites, 300 workers are expected to
    enroll in additional training with 200 placed in jobs including 120 as
    direct care workers. In this model, H.E.A.L.T.H. will work to enhance
    health career development and employability of dislocated workers and
    provide the needed support for an education and training institution
    for nursing. In addition, the grantee is building capacity to meet
    future training needs by training teachers and mentors, including
    adding MSN faculty with Master's Degrees in the Community College
    System, to meet on-going demand for healthcare workers.
        Grant Recipient and Location: Paraprofessional Healthcare
    Institute/New York
        Partner(s) and Location(s): Workforce Investment Board of Lancaster
    County, Pennsylvania; community colleges; Lehman College of New York;
    North Carolina Foundation for Advanced Health Programs/NY, PA, NC
        Funding Amount: $999,902
        Purpose of the Award: The grantee will provide a range of technical
    assistance, training initiatives, and materials for the long-term care
    workforce. Emphasis will be placed on assisting Hispanic caregivers and
    supporting the nation's Workforce Investment Boards and community
    colleges in recruiting and training. As part of their activities, the
    grantee will create a coaching approach to supervision model for front-
    line supervisor with a curriculum designed specifically for employer-
    based community colleges and demonstrate the ``Four Ps'' problem
    solving training curriculum in partnership with Workforce Investment
    Board of Lancaster, PA. As part of this demonstration, the grantee will
    develop an apprenticeship career-lattice model based on work with home
    care agencies employing Hispanic and African-American workers as home
    health aides. To allow for replication of the model, the grantee will
    author a full series of guidebooks, curricula and teaching manuals-
    written in both Spanish and English-on a range of effective
    paraprofessional workforce development practices targeted to the home
    care workforce.
        Grant Recipient and Location: Pueblo Community College/Colorado
        Partner(s) and Location(s): Pueblo Work Link (One-Stop Career
    Center); Pueblo Community College; Trinidad State Junior College;
    Colorado Community College System; Parkview Episcopal Medical Center/CO
        Funding Amount: $715,402
        Purpose of the Award: This demonstration is designed to bring
    healthcare training opportunities to outlying areas, and help volunteer
    medical personnel secure paid employment. As part of the grantee's
    activities they will create a multi-disciplinary curriculum based on
    competency models that is facilitated by Distance Learning modalities.
    As a result of their activities, the grantee expects to increase by 50
    percent the efficiency of preparing under-represented minorities to
    take advantage of health career opportunities by developing a
    partnership between Pueblo Community College and Pueblo Work Link. The
    grantee expects that by the end of the grant, the project will increase
    the number of minority/disadvantaged EMT-I/Respiratory Care training
    enrollees by 35 percent at Trinidad State Jr. College and 20 percent at
    Pueblo Community College.
        Grant Recipient and Location: Rio Grande Valley Allied Health
    Training Alliance/Texas
        Partner(s) and Location(s): Cameron County Workforce Development
    Board; Lower Rio Grande Valley Workforce Development Board; South Texas
    Community College; Texas State Technical College; Tech Prep of the Rio
    Grande Valley; Mission Hospital Harlingen Medical Center; Starr County
    Hospital; Brownsville Medical Center; Dolly V infant Memorial Hospital;
    Knapp Medical Center; Rio Grande Regional Hospital; South Texas Health
    System; Valley Interfaith; Valley Initiative for Development and
    Advancement/TX
        Funding Amount: $4,000,000
        Purpose of the Award: It is expected as part of this demonstration
    that the grantee will assist area businesses and community leaders to
    develop, attract, and retain local talent by enrolling candidates,
    retaining them through tuition assistance, and developing a High School
    Concurrent Enrollment program and comprehensive Faculty Sharing Program
    while drawing from Alliance hospitals' supply of Masters of Science in
    Nursing. The grantee estimates that 135 participants enrolled in Post
    Licensure Specialties with a completion rate of 95 percent; 70 students
    annually prepared in academies; 90 high school juniors and seniors have
    the annual opportunity to take college classes; 360 participants
    receive comprehensive case management with 90 percent student retention
    rates. In this model demonstration, online coursework will be used as
    part of the Faculty Sharing Program for one allied health specialty and
    400 students' clinical rotations coordinated via on-line, regional
    scheduling.
        Grant Recipient and Location: State of Oregon/Oregon
        Funding Amount: $300,000
        Purpose of the Award: This demonstration model will support the use
    of innovative technology to increase the capacity to train students for
    the health care industry by helping to purchase seven SimMan, real-
    time interactive human patient simulators. The simulation technology
    will be integrated into health care curricula for use by well-prepared
    and networked faculty, available over the State's broadband Internet
    network, and affordable for all education and service groups in the
    State, increasing the capacity of the State to meet training needs for
    the industry. At least 90 instructors will receive training in using
    the patient simulators and will provide simulator-based training to at
    least 225 students.
        Grant Recipient and Location: Tacoma/Pierce County Workforce
    Development Council/Washington
        Partner(s) and Location(s): Bates Technical College; Clover Park
    Technical College; Tacoma Community College/WA
        Funding Amount: $762,659
        Purpose of the Award: This demonstration is designed to improve and
    expand the pool of qualified professionals in high-demand health care
    jobs by training invasive cardiovascular technologists, creating a
    Comprehensive Career Coaching Program, establishing connections through
    a Healthcare Educator Network, and reaching out to minorities and
    youth. The grantee anticipates that 10 participants will complete the
    Health Unit Coordinator Pre-Apprenticeship Program and 50 healthcare
    workers will have access to the Comprehensive Career Coaching Program
    to access and complete high demand healthcare training programs. As
    part of the demonstration, the grantee will enroll 8 students in the
    Medical Rotation Program, implement a Health Summer Camp for 15 youths,
    and enter 15 students per year into a 2-year distance learning program.
    This grant will increase minority youth participation in job shadow and
    volunteer programs by 10 percent.
        Grant Recipient and Location: Healthcare Workforce Network/
    Wisconsin
        Partner(s) and Location(s): Northwest Wisconsin Workforce
    Investment Board, Ashland; Burnett Medical Center, Grantsburg; Flambeau
    Hospital, Park Falls; Memorial Health Center, Medford; Memorial Medical
    Center, Ashland/WI
        Funding Amount: $215,600
        Purpose of the Award: This project will demonstrate the use of
    disance learning to train healthcare workers in rural areas and
    establish ongoing, collaborative relationships among rural health care
    providers and the One-Stop Career Center system. The grantee will pool
    financial, material, and human resources of small, remote hospitals and
    clinics for the purposes of increasing the supply and retention of
    health care professionals, and develop distance learning materials,
    including web-absed trainnig modules and satellite broadcasts. At least
    300 incumbent workers will successfully complete at least one skills-
    upgrade module. The project will also increase the local pool of
    interested healthcare workers by 25 percent.
        Grant Recipient and Location: The 1199 SEIU League Grant
    Corporation on behalf of the League 1199 SEIU Training and Upgrading
    Fund/New York
        Partner(s) and Location(s): NYC Department of Education; the
    Consortium for Worker Education/NY
        Funding Amount: $192,500
        Purpose of the Award: As part of this demonstration the grantee
    expects to expand the Contextualized Literacy Pre-LPN Program, which
    combines literacy and job training in preparation for LPN programs.
    This pre-LPN program has been designed for low-level health-care
    workers who have been out of school for a long period of time and have
    had difficulty passing entrance exams. The grantee expects to implement
    10 pre-LPN classes of 25 students each (250 students) who will enroll
    in a 35-week contextualized course of study that will prepare them to
    pass the C-NET exam and lead to enrollment in an accredited LPN
    program. It is expected that 90 percent of the 250 workers pass the C-
    NET test and enroll in an LPN program, supporting meeting this critical
    workforce shortate. As part of the demonstration, the grantee will
    develop an easily replicable demonstration model of contextualized
    literacy for similar programs within the adult education and health
    care industries, allowing for replicaiton throught the workforce system
    in partnership with health care employers across the nation.
        Grant Recipient and Location: The Evangelical Lutheran Good
    Samaritan Society/South Dakota
        Partner(s) and Location(s): In South Dakota: Lake Area Technical
    Institute, Watertown; Sioux Valley Hospitals and Health System;
    University of South Dakota; South Dakota State University, Brookings;
    in Nebraska: Bellevue University, Bellevue; pullUin software/South
    Dakota Health Technology Innovations Inc./MN, SD, ND
        Funding Amount: $1,877,517
        Purpose of the Award: In an effort to increase the pool of
    qualified workers, this demonstration is designed to raise public
    awareness of health care career opportunities by recruiting from high
    schools and non-traditional labor pools such as displaced workers. As
    part of the project, the grantee will produce a video/CD entitled
    ``It's Happening in Healthcare!'' that will be distributed to schools,
    the workforce investment system and other entities to promote
    healthcare careers with a specialized target of nontraditional workers.
    The grantee will also develop an online ``virtual caregiver'' that will
    provide a realistic view of career options in this field. The
    demonstration also is designed to increase healthcare worker retention
    by starting a mentor project to support entry-level workers and
    providing various support services. Finally, the grant will develop and
    pilot methods for providing supervisory and management training by
    delivering nursing programs through the Master's degree level, both
    online and through local community colleges. At least 110 participants
    will receive training under this grant.
        Grant Recipient and Location: Delaware Valley Industrial Resource
    Center/Pennsylvania
        Partner(s) and Location(s): Local WIBS; Delaware County Community
    College; Drexel University; Local Manufacturing Companies: AGF
    Manufacturing Co.; Kingsbury, Inc.; Philadelphia Coca Cola Bottling;
    PA's Industrial Resource Network/PA
        Funding Amount: $3,000,000
        Purpose of the Award: This pilot project is designed as a model for
    helping the advanced manufacturing sector develop and recruit students
    for new technical education programs that will produce a steady and
    predictable supply of skilled and educated individuals for key
    technology-intensive industries. This project will train over 500
    workers, serve over 300 companies and will establish a Regional
    Industrial Leadership Coalition to provide public policy leadership and
    outreach to better serve the manufacturing community. The goal of the
    grantee is to produce an annual pipeline that contains 1,000 skilled
    and educated individuals to support the region's advanced technology
    and manufacturing businesses over 3-5 years and to train 95 incumbent
    workers and 455 entry-level workers (100 percent placement) over the 2-
    year course of the grant.
        Grant Recipient and Location: Greater Peninsula Workforce
    Investment Board/Virginia
        Partner(s) and Location(s): Greater PA WIB; Thomas Nelson Community
    College; Northrop Grumman Newport News (NGNN); PA's regional Advanced
    Manufacturing Consortium; Consortium of Seven Cities and Counties; the
    PA Alliance for Economic Development; Pennsylvania Worklink; Virginia
    Employment Commission/VA
        Funding Amount: $1,965,000
        Purpose of the Award: This demonstration will will implement a 10-
    part program that will deliver a highly skilled workforce for a
    growing, high-performance manufacturing sector. The grantee estimates
    they will train over 5,000 workers for advanced manufacturing jobs
    covering a variety of industries in Southeast Virginia. The services
    are targeted to youth, incumbent workers, and career-transitioning
    individuals. As part of their activities, the grantee will develop or
    adapt education and training curricula to produce required skill sets
    for new, transitional, and incumbent workers. The grantee will offer
    opportunities for work-based experience will be developed as well.
    Instructors will have the option of expanding their skills through
    externships and a regional Advanced Manufacturing Instructor Training
    Institute. As part of the demonstration, the grantee will create
    detailed task analyses and training curriculum for more than 30
    advanced manufacturing jobs and train 30 community college personnel to
    replicate the program and deliver curriculum content statewide. To
    support the recruitment of prospective employees, the grantee will
    develop realistic job action videos on locally-available jobs for
    posting on One-Stop Career Center computers and available.
        Grant Recipient and Location: Illinois State University/NCIST/
    Illinois
        Partner(s) and Location(s): Local WIBS; local community colleges;
    local/regional manufacturers and representatives from NAM/CWS local
    affiliate groups/IL, OH, PA, TX, WY, NC
        Funding Amount: $5,774,420
        Purpose of the Award: The grantee will pilot a program curriculum
    to create an associate's degree in integrated systems technology,
    enhance the highly successful apprenticeship model, develop career
    awareness materials, and create a comprehensive career ladder and
    lattice standardizing the career competencies. This pilot will then be
    replicated in four additional States through the creation of regional
    centers of excellence to train more workers, new and incumbent, for
    careers in the advanced manufacturing sector. Approximately 420 workers
    will receive training under this demonstration grant.
        Grant Recipient and Location: Lancaster County Workforce Investment
    Board/Pennsylvania
        Partner(s) and Location(s): Lancaster County WIB; Stevens College
    of Technology; Viking Cabinetry Group; Lancaster County Career and
    Technology Center/PA
        Funding Amount: $1,354,585
        Purpose of the Award: This demonstration is designed to addresses
    the issue of narrowing skill gaps in manufacturing through incumbent
    training. The Lumber & Wood Consortium, the Food Manufacturing
    Consortium, the Plastics Consortium, and the Powdered Metals Consortium
    want to develop curriculum and provide incumbent training. The grantee
    anticipates conducting 70 train-the-trainer sessions and placing 105-
    170 incumbent workers into training.
        Grant Recipient and Location: Lower Rio Grande Workforce
    Development Board/Texas
        Partner(s) and Location(s): Local WIBS; Texas State Technical
    College; Texas Southmost College; South Texas Community College; Texas
    Manufacturing Association (STMA); Brownsville Area Manufactures
    Association; Harlingen Manufacturers Association; McAllen Economic
    Development Corporation; McAllen Independent School District; Valley
    Initiative for Development and Advancement/TX
        Funding Amount: $2,000,000
        Purpose of the Award: This demonstration project will develop a
    curriculum and a 5-year Apprenticeship Strategic Plan with multiple
    programs for tool and die, industrial maintenance, and plastic process
    technicians. As part of their activities, the grantee expects to train
    225 youth in advanced manufacturing trade skills; train 200 adults
    through the Skill Enhancement, Pre-Apprenticeship and Post Secondary
    Dual Credit Programs; train 213 adult apprentices over 2 years; and
    attain Journeyman Certification for 20 adult apprentices. The
    partnership will attain credentialing from NIMS for apprenticeship
    trainers. It will also develop program study guides and curriculum for
    Industrial Maintenance, Tool and Die and the Youth Apprenticeship
    Career Pathway.
        Grant Recipient and Location: National Association of
    Manufacturers/Washington, D.C.
        Partner(s) and Location(s): Undetermined/MO, TX and four other
    States
        Funding Amount: $498,520
        Purpose of the Award: The grantee will pilot launch the national
    ``Dream It, Do It'' Career Campaign in Kansas City, Missouri, to
    increase career awareness for young people exposing them to high wage
    job opportunities in the manufacturing industry. The program will then
    be replicated throughout the county.
        Grant Recipient and Location: National Center for Integrated
    Systems Technology (IL)/Illinois
        Partner(s) and Location(s): Local WIBs in each of the 8 OH and IL
    sites; IL: Elgin, Moraine Valley, Richard J. Daley, Rock Valley; OH:
    Cuyahoga, North Central State, Owens, Sinclair; Caterpillar, Amatol,
    local manufacturers/IL
        Funding Amount: $9,142,496
        Purpose of the Award: In this demonstration, the grantee will
    provide advanced manufacturing training in integrated systems
    technology for dislocated workers in 8 community colleges in Ohio &
    Illinois. The grantee anticipates training 288 dislocated workers in
    each State and placing 80 percent in full-time employment within six
    weeks of completion of training.
        Grant Recipient and Location: National Institute for Metalworking
    Skills (NIMS)--2/Virginia
        Partner(s) and Location(s): 25 pilot companies/national
        Funding Amount: $939,815
        Purpose of the Award: As part of this pilot project the grantee
    will develop flexible yet structured training delivered ``just-in-
    time'' on the shop floor. Separate training models will be developed
    for, and piloted with, five targeted sub-sectors, including: machine
    tool builders, tool shops, contract stamping and mold making companies,
    Computer Numerical Control (CNC) job shops, and CNC high volume
    machining companies. The grantee anticipates piloting the project by
    training new and incumbent workers at 25 companies.
        Grant Recipient and Location: Nebraska Central Community College/
    Nebraska
        Partner(s) and Location(s): Six State community colleges; three
    Colleges/Universities; 10 core businesses and industry affiliates; 10
    High Schools; Nebraska DOL; NE Department of Economic Development;
    Bureau of Apprenticeship and the NE Department of Education/NE
        Funding Amount: $1,639,403
        Purpose of the Award: The demonstration will train 834 individuals
    with industrial training for high skill, high wage manufacturing jobs.
    The pilot will develop curriculum and competencies for mechatronics
    technicians and will include manufacturing seminars for 145 high school
    and college instructors annually. This curriculum will also be made
    available to community and technical colleges across the country to
    increase the number of workers trained as mechatronics technicians.
        Grant Recipient and Location: Oregon Manufacturing Extension
    Partnership (MEP)/Oregon
        Partner(s) and Location(s): The Northwest Food Processors
    Association; Oregon, Idaho, and Washington MEPs, not-for-profit teams
    of manufacturing professionals who help small-to-medium-sized
    manufacturers transform the way they do business/OR, WA, NV, ID
        Funding Amount: $3,199,709
        Purpose of the Award: This pilot is designed to implement lean
    manufacturing training comprised of classroom and workplace-based
    activities during work hours, with a strong ``English as a Second
    Language'' (ESL) component. The grantee expects to train at least 2,026
    workers at 48 companies in Oregon, Washington, Idaho, and Nevada. This
    model for implementing training for ESL students in a Lean environment
    will be promoted to the public workforce system as an effective model
    to pair ESL with high-growth jobs in the manufacturing sector.
        Grant Recipient and Location: San Bernardino Community College
    District/California
        Partner(s) and Location(s): WIBs; Business Alliance Partnerships;
    Regional Occupational Centers and Programs (ROOP, NACFAM, SMI, SMAC,
    OCBC, RCMIC, and IVMA); Manufacturing Skills Standards Council; and
    Centers for Applied Competitive Technologies (CACTs)/California
        Funding Amount: $1,618,334
        Purpose of the Award: This demonstration will assess and train new
    and incumbent workers to MSSC skill standards, a nationwide industry-
    based skill standard, with assessment and certification system for all
    sectors of manufacturing. Workers' skills will be documented and
    individuals certified for hire and promotion, allowing for new job
    opportunities and/or further training and education. Revised education
    and training for advanced manufacturing will also be incorporated into
    technical programs at high schools, WIBs, and community colleges
    throughout Southern California. The grantee expects to train 180
    currently employed lower skill workers wishing to advance to a
    competency level of manufacturing certified by MSSC assessment. In
    addition, the grantee expects 80 job requisitions will be created and
    100 clients identified who wish to pursue manufacturing careers at a
    certified skill level. To support efforts to reach under-served
    populations, the grantee will develop brochures, literature and CDs
    describing, in English and Spanish, the new jobs and career ladders in
    manufacturing. The grantee will also develop brochures, literature and
    CDs describing the value of manufacturing careers and the process and
    qualifications needed to obtain certification.
        Grant Recipient and Location: St. Louis WIB/Missouri
        Partner(s) and Location(s): St. Louis City WIB; St. Louis Community
    College; Ford Motor Company; Daimler Chrysler Corporation; General
    Motors Corporation; UAW International--Region 5/MO
        Funding Amount: $1,499,998
        Purpose of the Award: As part of this demonstration, automotive
    manufacturing workers will receive state-of-the-art training in: (1)
    integration of automated systems; (2) predictive maintenance for
    advanced manufacturing systems; (3) enhanced mechanical technology; and
    (4) enhanced electrical technology. This training will allow St. Louis
    area auto manufacturers to remain globally competitive while giving
    employees portable skills and job advancement opportunities. The
    grantee expects to train 430 workers.
        Grant Recipient and Location: The Workplace, Inc./Connecticut
        Partner(s) and Location(s): Connecticut WIB; Hurosatonic and
    Norwalk Community Colleges; ASML; Westport Precision; Jurman Metricas;
    Nerjan Development Co.; Nordex, Raym-Co.; Hurosatonic; State of CT
    Department of Education; State of CT Dept. of Economic and Community
    Development (DECD); The CT Employment and Training Commission (CETC)/CT
        Funding Amount: $2,000,000
        Purpose of the Award: This demonstration is designed to addresses
    the training needs of small and medium-sized manufacturers of new and
    incumbent workers (mainly engineers and technicians) in the areas of
    innovation, soft skills and ESL. At a minimum, the grantee anticipates
    assessing and enrolling over 500 workers over the 3 year life of the
    grant. At least 75 percent of those enrolled will complete one or more
    training courses that will result in technical certification and a
    minimum of 90 percent of course completers will acquire technical
    skills that can advance them on a career ladder.
        Grant Recipient and Location: Brevard Community College in
    partnership with American Technical Education Association/Florida
        Partner(s) and Location(s): The Brevard Workforce Development
    Board; National Science Foundation's SpaceTEC, a national center for
    aerospace technical education; the Florida Space Authority; Florida
    Space Institute; and the U.S. Air Force 45th Space Wing/FL
        Funding Amount: $98,560
        Purpose of the Award: The grantee will provide students the
    opportunity to assist in the operation of launch facilities and conduct
    six sub-orbital launches at Cape Canaveral Air Force Station, to
    demonstrate the usefulness of hands-on learning opportunities for
    students in developing technical aerospace skills and improving
    awareness of the skills required for aerospace careers.
        Grant Recipient and Location: Edmonds Community College/Washington
        Partner(s) and Location(s): Snohomish Workforce Development
    Council; Everett Community College; Manufacturing Industries; Boeing;
    Boeing Aerospace Suppliers; the Snohomish County Workforce Development
    Council; the Snohomish County Economic Development Council/WA
        Funding Amount: $1,475,045
        Purpose of the Award: The grantee will train new and incumbent
    workers in a pilot implementation of advanced aerospace technician
    curriculum, develop career ladders, and demonstrate distance learning
    approaches to train workers for aerospace industry. The curriculum
    developed will be broadly disseminated for use by community and
    technical colleges resulting in an increased number of training
    workers, meeting the workforce demands of the aerospace industry.
        Grant Recipient and Location: Florida Space Research Institute/
    Florida
        Partner(s) and Location(s): Workforce Florida; NASA; the Civil Air
    Patrol; Florida School Districts/FL
        Funding Amount: $355,628
        Purpose of the Award: The grantee will demonstrate the benefits to
    providing aerospace-industry training to school teachers as a means of
    improving aerospace career knowledge and awareness among youth.
    Specifically, aerospace mentors will work with 25 teachers in seven
    counties and provide externships for technology teachers to increase
    their industry knowledge and their ability to apply the learning's in
    the classroom. Approximately 5,000 students will be exposed to the
    Aerospace industry as a viable career path.
        Grant Recipient and Location: The Houston-Galveston Area Council
    for the Gulf Coast Workforce Board/Texas
        Partner(s) and Location(s): Gulf Coast Workforce Board and area
    One-Stop Career Centers; San Jacinto College; Aerospace Academy; 23
    area aerospace employers including NASA Johnson Space Center/TX
        Funding Amount: $1,000,000
        Purpose of the Award: This demonstration is designed to address the
    issue of narrowing skill gaps in high-tech manufacturing. This project
    includes piloting a training program in which people will be trained in
    high-tech automotive manufacturing and/or construction and building
    trades in addition to other training/curriculum that will be developed.
    The grantee expects to train an estimated 625 individuals in either
    aerospace (advanced IT) areas or advanced manufacturing. Nearly all
    will be incumbent workers. It is extimated that 90 percent of the
    enrollees will complete training and 90 percent of completers will
    receive a 3-5 percent wage increase. In addition, 90 percent of
    unemployed workers will receive job placements and 5 percent will
    receive a promotion.
        Grant Recipient and Location: Automotive Retailing Today (ART)/
    Virginia
        Partner(s) and Location(s): The National Automobile Dealership
    Association; National Automotive Technicians Education Foundation;
    other industry and business stakeholders; Automotive Youth Educational
    Systems/national
        Funding Amount: $150,000
        Purpose of the Award: As part of this research project, ART and its
    partners will gather, validate, and deliver information and data about
    career opportunities in the automotive industry to career-related
    websites and portals and to workforce development professionals. This
    information will help promote the industry by describing viable and
    exciting career opportunities, connecting job seekers to training
    opportunities and job openings in the field, and dispelling negative
    presumptions that the general public may have about the industry. This
    information will be made available to the public workforce system to
    support their efforts of meeting the needs of local dealers across the
    country by educating job seekers on career opportunities in the
    automotive service sector.
        Grant Recipient and Location: Automotive Youth Education Services/
    Michigan
        Partner(s) and Location(s): Members of AYES' Board, including
    General Motors, DaimlerChrysler, Toyota, Volkswagen, Mercedes, Honda,
    BMW, Audi, Subaru, Nissan, Mitsubishi, Hundai, and Kia Motors; Snap-On
    Tools; SkillsUSA; the National Automotive Technicians Education
    Foundation (NATEF); the National Institute for Automotive Service
    Excellence (ASE); Hudson Institute's Center for Economic
    Competitiveness/national
        Funding Amount: $600,000
        Purpose of the Award: The grantee will demonstrate the expansion of
    a national automotive technician certification program through the use
    of on-line testing, which is linked to professional ASE certifications,
    in high schools. The grantee will also pilot the development of
    registered apprenticeship standards that can be applied across the
    nation in programs targeting high school students entering employment
    in the automotive service sector. The pilot project is expected to test
    5,000 students for the credential, offering an industry-based
    credential to enter employment in the automotive service sector.
        Grant Recipient and Location: Eastfield College/Texas
        Partner(s) and Location(s): Workforce Investment Boards in Dallas,
    Fort Worth & East Texas; Tarrant County College of Fort Worth, TX;
    Toyota Motor Sales USA; Gulf States Toyota; 20 area Toyota and Lexus
    Dealers; Automotive Technology Advisory Committee/TX
        Funding Amount: $837,424
        Purpose of the Award: The grantee will demonstrate methods for
    providing automotive services training to untapped labor pools by
    offering training to individuals, including support services,
    internship experiences, and an English as a Second Language component.
    The demonstration project is expected to train 100 workers to enter
    employment in the automotive service sector.
        Grant Recipient and Location: Gateway Technical College/Wisconsin
        Partner(s) and Location(s): Gateway (a community college); Snap-On
    Tools, Inc.; WI Automobile and Truck Dealers Association (WATDA);
    Melior Institute; National Coalition of Advanced Technology Centers
    (NCATC); Community-based organizations; Automotive Youth Educational
    Systems; the Workforce System/WI
        Funding Amount: $900,000
        Purpose of the Award: The grantee will demonstrate the use of
    blended training delivery systems, including the use of on-line
    features, to provide training toward industry-driven certifications, as
    awarded by the National Automotive Technicians Education Foundation
    (NATEF). The grantee expects to train over 1,500 instructors for ASE
    certification, increasing the capacity of community colleges and career
    and technical education institutions to train more students to industry
    standards for employment in the automotive service sector.
        Grant Recipient and Location: Girl Scouts of the USA/New York
        Partner(s) and Location(s): Automotive Insurance Companies;
    Dealerships; Associations including the Greater NY Automotive
    Dealership Association; Private Auto Repair Operations; Driving
    Schools; Girl Scout Local Councils; AAA Offices; High School Drivers'
    Education Departments/national
        Funding Amount: $200,000
        Purpose of the Award: The grantee will demonstrate methods for
    reaching out to untapped labor pools (such as young women) to consider
    careers in non-traditional occupations, such as automotive services, by
    developing and distributing information geared toward young girls,
    educating them about automotive services as a career option and
    building their skills in car repair and maintenance. Girls will be
    placed in experiential learning programs such as an internship at a
    dealership or a tour of a training facility. This project is designed
    to expand the number of youth overall considering careers in automotive
    services, and particularly young women.
        Grant Recipient and Location: National Institute for Automotive
    Service Excellence/Virginia
        Partner(s) and Location(s): One-Stops; ACT, Inc.; The National
    Automobile Dealership Association; other industry and business
    stakeholders; National Automotive Technicians Education Foundation
    (NATEF); National Automobile Dealers Association/DC
        Funding Amount: $300,000
        Purpose of the Award: The grantee will demonstrate new methods for
    training Spanish-speaking automotive service technicians by translating
    some of the most in-demand certification exams into Spanish and by
    having these exams administered throughout the country. Translation of
    these exams will allow for limited-English technicians to be industry
    certified and to enter in and move up the career ladder offering
    opportunity for greater wage gains in the automotive service sector.
    The grantee expects approximately 2,000 more Spanish-speaking
    technicians will take the test than took it in previous years.
        Grant Recipient and Location: Pennsylvania Automotive Association/
    Pennsylvania
        Partner(s) and Location(s): Harrisburg Area Community College;
    Harrisburg Career and Technology Academy; Snap-On Tools, Inc.;the PA
    Workforce System; Automotive Youth Educational Systems (AYES)/PA
        Funding Amount: $95,000
        Purpose of the Award: This small grant will demonstrate a model for
    improving the capacity of local training institutions to provide
    industry-certified training in automotive services, as a means of
    increasing the industries ability to train a diverse workforce. To test
    this model, the grantee will develop a work-training opportunity, or
    on-the-job mentor/intern program, that strengthens business connections
    and provides career opportunities to five students facing social and
    economic barriers. This model will be made available to the public
    workforce system to partner with State dealer associations across the
    country to replicate, offering new career opportunities to underserved
    urban students.
        Grant Recipient and Location: Shoreline Community College/
    Washington
        Partner(s) and Location(s): Workforce Development Council of
    Seattle, and WorkSource-North Seattle; Toyota Motor Sales USA; General
    Motors Corporation; Daimler/Chrysler; American Honda; Puget Sound Auto
    Dealers Association; Hunter Engineering; Chevron Oil Company;
    Wagonmaster Corporation; Overall Laundry/WA
        Funding Amount: $1,496,680
        Purpose of the Award: The grantee will demonstrate the use of
    curriculum based on a new set of industry-driven competency
    requirements by training hard to serve individuals for careers in the
    automotive service sector. The grant is targeted to train 50 out of
    school youth and dislocated workers. The curriculum developed will be
    broadly disseminated for use by community and technical colleges and
    high schools across the country to train more workers in the automotive
    service industry.
        Grant Recipient and Location: U.S. Hispanic Chamber of Commerce
    Foundation/Washington, D.C.
        Partner(s) and Location(s): BMW of North America; LLC; Snap-On
    Tools, Inc./CA, FL
        Funding Amount: $136,000
        Purpose of the Award: This project will demonstrate successful
    methods for training Spanish-speaking individuals to become skilled
    automotive technicians while increasing employment opportunities for
    this untapped labor pool. This will be accomplished through the
    recruitment, training, and fostering of career paths for 20 Hispanic-
    Latino automotive technicians within Miami, Florida, and Los Angeles,
    California, leading to employment opportunities with dealerships in
    each city.
        Grant Recipient and Location: Delaware Workforce Investment Board/
    Delaware
        Partner(s) and Location(s): Delaware WIB (State WIB); Delaware
    Technical and Community College; Agilent Technologies; Delaware
    Department of Education; Delaware Economic Development Office/DE
        Funding Amount: $250,000
        Purpose of the Award: The grantee will demonstrate methods for
    engaging the workforce investment system and biotechnology business
    community in an effort to facilitate collaboration among teachers,
    school districts, the Department of Education, higher education, and
    the business community to improve student achievement in science. One
    key aspect being piloted is the development of mobile science vans that
    experienced instructors and mentors use to visit local schools. The
    objective of the mobile van it to transport science equipment for
    providing laboratory experiences to youth increasing their interest and
    exposure to Science, Technology, Engineering and Mathematics (STEM)
    careers in high growth, high demand industries. The project will train
    30 mentors and is expected to offer 1,500 students hands-on experiences
    with the van.
        Grant Recipient and Location: Forsyth Technical Community College/
    North Carolina (Partners: New Hampshire, Washington, Iowa, California)
        Partner(s) and Location(s): Forsyth Tech has a local Job Link One-
    Stop Career Center on campus; Forsyth Technical Community College; New
    Hampshire Technical College; Indian Hills Community College; Bellevue
    Community College; Miracosta Community College; Caldwell Community
    College and Technical Institute; Catawba Valley Community College;
    Davidson C; Regional Employers/NH, IA, WA, CA, NC
        Funding Amount: $5,000,000
        Purpose of the Award: The grantees, a group of five community
    colleges, will form Centers of Excellence in five different
    biotechnology sectors. They all come together as a National Center for
    the Biotechnology Workforce, which will: (a) allow workers to learn
    about the competencies and training availability for biotechnology
    careers, and (b) allow community colleges and the workforce investment
    system to access industry skill standards as well as training curricula
    and methods to implement in their location. Under this pilot, each
    college will implement various methods for providing biotechnology
    industry training to workers in this high growth industry. The training
    methods, skills standards, and curriculum developed from this
    demonstration project will be broadly disseminated for use by community
    and technical colleges resulting in an increased number of trained
    workers, meeting the workforce demands of the biotechnology industry.
        Grant Recipient and Location: Massachusetts Biotechnology Education
    Foundation/Massachusetts
        Partner(s) and Location(s): Massachusetts Workforce Board
    Association; Commonwealth Corporation; the Boston Private Industry
    Council (Boston PIC); the Metro Northwest Regional Employment Board;
    the Metro Southwest Regional Employment Board; Massachusetts
    Biotechnology Council; Boston University's School of Medicine; Henzyme;
    other local companies; the University of Massachusetts and the 5-campus
    Statewide system; local school systems in the urban and high-need
    areas/MA
        Funding Amount: $1,372,250
        Purpose of the Award: The grantee will research the early-stage
    (high school) pipeline for biotechnology and health care industries by
    developing and launching a demonstration model of the BioCareer Lab in
    25 urban and high-needs public schools to train and expose students to
    the emerging biotechnology industry. This pilot model is expected to
    train 100 science teachers and 2,000 students. The model will include
    new equipment, ongoing teacher training, a mobile biotech laboratory,
    access to curricula developed with National Science Foundation funds,
    and school to career pathways in partnership with workforce investment
    boards and colleges. This demonstration project will expose more young
    people to careers in the biotechnology sector.
        Grant Recipient and Location: San Diego Workforce Partnership/
    California
        Partner(s) and Location(s): San Diego Workforce Partnership is the
    local WIB; Miracosta Community College; BIOCOM/CA
        Funding Amount: $2,510,117
        Purpose of the Award: This demonstration is designed to support the
    workforce system in meeting its growing needs for skilled workers in
    the biotechnology industry. The grantee will create a clearinghouse for
    local and national biotechnology labor market information and to
    coordinate student internships (from high-school to post-doctoral
    levels) and teacher externships for the regional biotechnology
    community. The center will ultimately serve as a national clearinghouse
    for biotechnology industry labor market and occupational information;
    competency and skills requirement information; and training,
    internship, and research opportunities at all levels. As part of the
    grantee's activities, national and local labor market analyses will be
    performed; credit and non-credit classes that are flexible, short-term,
    and that will be recognized by multiple institutions will be developed;
    and local student internships and teacher externships at biotechnology
    companies will be provided.
        Grant Recipient and Location: Associated General Contractors of
    America/Virginia
        Partner(s) and Location(s): Chattanooga State Community College;
    San Antonio (TX) Chapter of AGC, AGC of East Tennessee; International
    Brotherhood of Electrical Workers Local 175; Laborers Local 846
    (Chattanooga, TN); East Ridge High School; East Tennessee State
    University/national
        Funding Amount: $235,500
        Purpose of the Award: The grantee will demonstrate the
    effectiveness of construction career academies by working with its
    partners to sustain existing construction career academies in
    Chattanooga and San Antonio, and to develop additional career academies
    in eight local communities. It is anticipated that the partnership will
    train 400-500 students to enter employment in the construction
    industry. Through the Construction Career Academy initiative, AGC will
    provide local academies with technical assistance in a number of areas,
    such as developing curriculum and forming partnerships between
    businesses and educational institutions. AGC also will provide students
    with materials and equipment and prepare instructors to teach in the
    academies.
        Grant Recipient and Location: Chicago Women in Trades/Illinois
        Partner(s) and Location(s): The Workforce Boards of Metropolitan
    Chicago; Illinois Community College Board; City Colleges of Chicago;
    The Builders Association; Construction Industry Service Corporation;
    Hispanic American Construction Industry Association; Mechanical
    Contractors Association of Chicago; Federation of Women Contractors; IL
    Departments of Labor, Employment Security, Transportation, and Commerce
    and Economic Opportunity; Mayor's Office of Workforce Development;
    Chicago Building Trades Council; Illinois Center for Professional
    Support Services/IL
        Funding Amount: $2,092,343
        Purpose of the Award: The grantee expects that nine thousand two
    hundred women (9,200) will gain awareness of career opportunities in
    construction through orientations and career fairs. In addition, the
    grantee expects that seven hundred fifty (750) women will gain
    acceptance into apprenticeship programs offering an average wage of $13
    per hour during the grant period. Of those entering into an
    appricitceship, 80 percent will be retained for a minimum of 90 days.
        As part of this demonstration, CWIT will launch an outreach
    campaign to attract women into the construction industry. This campaign
    will include professional outreach and marketing materials that focus
    on women, as well as orientation sessions and job fairs that focus on
    construction industry careers. CWIT and its partners will help women
    address their barriers to employment through an array of education,
    training, and support services, such as career planning, placement, and
    mentoring by women currently working in the industry. Finally, CWIT and
    its partners will work with One-Stop Career Centers, apprenticeship
    information centers, and community colleges to enhance their capacity
    to serve women.
        Grant Recipient and Location: Honolulu Community College/Hawaii
        Partner(s) and Location(s): Oahu Workforce Investment Board; Kauai
    Community College; Hawaii Department of Education; Eight local high
    schools; Hawaii Carpenters Union Local No. 745; Sheet Metal Workers'
    International Association Local Union No. 293/HI
        Funding Amount: $1,400,000
        Purpose of the Award: In this demonstration, HCC partners will
    creation a Construction Academy for providing 500 high school students
    with an array of construction-specific courses and career opportunities
    in the construction industry. In addition, 300 students will enter
    apprenticeship programs, construction associate degree programs, or
    construction baccalaureate programs. HCC and its partners will also
    develop and demonstrate a standards-based curriculum that articulates
    with construction certificate and degree programs that will be utilized
    by Hawaii's community colleges, increasing the applicant pool for the
    construction trades in the State. The curriculum developed will be
    shared broadly with community and technical colleges across the
    country.
        Grant Recipient and Location: St. Louis Carpenters Joint
    Apprenticeship Training Program (CJAP)/Missouri
        Partner(s) and Location(s): Workforce Investment Board of Southeast
    Missouri; Workforce Investment Board of St. Louis City; Workforce
    Investment Board of St. Louis County; Mineral Area College; St. Louis
    Community College; Jefferson Community College; Southeast Missouri
    Regional Industrial Training Group; Hazelwood and Affton School
    Districts/MO
        Funding Amount: $2,187,107
        Purpose of the Award: As part of this demonstration, CJAP and its
    partners will train and license high school instructors in skill
    standard certifications so that they can teach and certify students in
    advanced manufacturing and construction skills. The grantee expects to
    train 130 entry-level and dislocated workers and 120 incumbent through
    the initiative. As a result of this training, the grantee expects that
    750 youth will be trained to industry standards during the life of the
    grant. In addition, CJAP also will work with employers, community and
    faith-based organizations, and One-Stop Career Centers to identify
    incumbent workers with a strong interest in advancing their
    construction or advanced manufacturing careers and help them enhance
    their academic skills, access support services, and enroll in a
    maintenance mechanic program or other types of training. CJAP and its
    partners will also create an eight-week maintenance technician training
    program for dislocated workers and this curriculum, as well as the
    training model will be made available to community colleges across the
    country for possible replicaiton.
        Grant Recipient and Location: The Home Builders Institute (HBI)/
    Washington, D.C.
        Partner(s) and Location(s): York Technical College (SC); community
    and technical colleges in (FL, KY); American Association of Community
    Colleges; Home Builders Association of Kentucky; Florida Home Builders
    Association; Home Builders Association of Charlotte (NC); Building
    Contractors Association of Wood River Valley (ID); Home Builders
    Association of South Carolina; Tidewater Builders Association/national
        Funding Amount: $4,268,454
        Purpose of the Award: The grantee will demonstrate the creation of
    a systemic approach to construction industry workforce development that
    provides a continuum of recruitment, career exploration, education and
    training. The demonstration will increase the available applicant pool
    for the construction industry meeting their workforce shortages by
    training 2,500 individuals for the construction trade in construction
    academies in four States.
        Grant Recipient and Location: Youthbuild USA/Massachusetts
        Partner(s) and Location(s): local home builders associations;
    National Council of Churches; juvenile justice system; Home Depot/
    national
        Funding Amount: $12,202,600
        Purpose of the Award: This demonstration is designed to build on
    the success of the Youthbuild USA, model, supporting the transition of
    adjudicated youth into high growth industries. The grantee will
    participate in an established training program that combines academic
    instruction with construction skill development and, ultimately, builds
    affordable housing in their communities. The grantee will develop a
    national demonstration project in which 325 adjudicated youth will
    participate full-time for 9-12 months in a YouthBuild education, job
    training, and service program. Skills training will occur primarily in
    the construction industry through the building of affordable housing or
    community facilities. Graduates will be helped in finding placements in
    post-secondary education or in jobs. The grantee expects that 60
    percent of the 325 enrollees will complete the YouthBuild program; 85
    percent will be placed in employment or post-secondary education;
    Program completers will have a recidivism rate of 15 percent or less;
    34 percent will attain a GED or high school diploma; and 75 percent
    will be self sufficient over a 5-year period. Youthbuild USA includes
    significant support systems, such as mentoring that will continue for
    at least a year after the program; follow-up education, employment, and
    personal counseling services; and participation in community service
    and civic engagement. Youthbuild USA will work with local One-Stop
    Career Centers to place youth in employment upon completion of the
    program.
        Grant Recipient and Location: Institute for GIS Studies (IGISS)/
    Tennessee
        Partner(s) and Location(s): Charlotte-Mecklenburg Workforce
    Development Board; Central Piedmont Community College; Nashville State
    Community College; Motlow State Community College; Bank of America;
    Duke Energy; Smart Data Strategies; University of Southern Mississippi/
    TN, NC
        Funding Amount: $2,000,000
        Purpose of the Award: IGISS will pilot the development of an
    industry-led, apprenticeship-based career advancement ladder for
    specialty certificates and degrees in land records management and
    utilities-based geospatial technical applications. The pilot is
    expected to train over 500 unemployed and underemployed workers in a
    variety of learning environments such as apprenticeship and associate
    degree programs in 13 different community colleges across Tennessee and
    North Carolina with the goal of increasing the number of workers in the
    emerging geospatial technology sector.
        Grant Recipient and Location: Kidz Online/Virginia
        Partner(s) and Location(s): NAWB; Los Angeles Trade and Technical
    College, North Caronlina State University; ESRI; American Institute of
    Aeronautics and Astronautics; Institute of Electrical and Electronic
    Engineers; Society of Women Engineers; National Council of Teachers of
    Mathematics; National Science Teach Association; Virginia Space Grant
    Consortium; Digital Quest; Environmental and Spatial Technology
    Initiative; National Institute of Technology and Policy Research; North
    Carolina 4-H; Hampton City Public Schools; Council of Great City
    Schools; NEC Found of America/VA, CA
        Funding Amount: $1,000,000
        Purpose of the Award: Kidz Online will pilot the creation of a
    comprehensive youth and adult learner focused image building and career
    awareness effort by utilizing new distance learning methodologies.
    Specifically, grantee will deliver learning resources including video
    programming and live web casts, provide professional development
    services, and integrate geospatial concepts into existing programming
    and ETA's Career Voyages web site. Spanish language translation will be
    done for some content.
        Grant Recipient and Location: Rancho Santiago Community College
    District/California
        Partner(s) and Location(s): Rancho Santiago Community College; St.
    Louis Community College/CA
        Funding Amount: $187,939
        Purpose of the Award: The pilot project will assess local
    geospatial workforce needs and use the findings to develop new and
    innovative curriculum and career ladder workforce development systems
    for a cross-section of industries. The grantee expects to train 20
    community college faculty to teach the newly-developed geospatial
    curriculum as well as to host a training conference to train 75
    teachers from across the country (from schools not directly associated
    with the grant) in using the new curriculum. As a result of these
    activites, the grantee expects to train 200 students using the newly-
    developed geospatial curriculum.
        Grant Recipient and Location: W.F. Goodling Advanced Skills Center/
    Pennsylvania
        Partner(s) and Location(s): South Central Workforce Investment
    Board; Penn State York; Harrisburg University; Harrisburg Area
    Community College; Manufacturers Association of South Central
    Pennsylvania; York County Board of Commissioners; Pennsylvania
    Department of Conservation and Natural Resources; Pennsylvania Office
    of Admin; Pennsylvania Department of Community and Economic
    Development; Pennsylvania Department of Labor and Industry; York County
    Community Foundation; Oork Counts Commission; York County/PA
        Funding Amount: $990,125
        Purpose of the Award: The project will demonstrate the use of 2+2+2
    articulation agreements with high schools, community colleges, and
    universities to produce imagery analysis technicians through a
    certificate program in imagery analysis in private and municipal
    applications. These 2+2+2 articulation agreements will provide over 100
    students and/or workers with career and education advancement tracks,
    enabled by linked curriculum and levels of education, training and
    certifications at the high school, community college and university
    levels. The demonstration will also train 100 individuals in specific
    geospatial applications in homeland security, economic development, and
    land-use management.
        Grant Recipient and Location: Geospatial Information and Technology
    Association (GITA)/Aurora, CO.
        Partner(s) and Location(s): American Association of Geographers,
    National Association of Workforce Boards; National Association of State
    Workforce Agencies; Northrop Grumman, Lockheed Martin, Oracle,
    Intergraph, TeleAtlas/GDT, BAESystems, ObjectFX, ESRI, NavTeq, Smart
    Data Strategies; The University of Southern Mississippi; Jefferson
    Community College; Lake Land College; City College of San Francisco;
    Jackson State Community College; Moraine Valley Community College;
    American Association of Community Colleges; the Philadelphia Community
    College System; Central Piedmont Community College; Fulton Montgomery
    Community College; Colorado Community College; Mississippi Community
    College; and the University of Pennsylvania's Wharton School of
    Business/national
        Funding Amount: $695,362
        Purpose of the Award: GITA will (1) develop standard definitions
    for the geospatial industry, vet the definitions through industry
    leaders, and disseminate the results throughout the industry; (2)
    develop content for an on-line workforce information clearinghouse on
    industry jobs, education facilities, and program information; (3)
    create a geospatial career awareness campaign; and (4) work with
    community colleges, employers, and workforce development organizations
    in a selected region to test the use of the Geospatial Industry
    Workforce Information System (an industry-developed and funded
    information network that houses industry jobs, educational facilities
    and programs) and career awareness materials to help local One-Stops
    and educators meet local geospatial industry needs.
        Grant Recipient and Location: Lorain County Community College/Ohio
        Partner(s) and Location(s): Lorain County Chamber of Commerce and
    its Small Business Development Center; The Workforce Institute of
    Lorain County Lorain County Commissioners and the Lorain County
    Development Office/OH
        Funding Amount: $2,599,979
        Purpose of the Award: Grantee will demonstrate new methods for
    training workers in high growth careers, with a special emphasis on
    entrepreneurship, and for promoting the growth of existing businesses,
    especially small and medium business sector, as well as new business
    development--all within identified targeted industries. The first
    project objective is to develop a comprehensive education continuum and
    support system that provides a K-12 to master's degree pathway to
    prepare workers, at all levels, for high demand jobs. The second
    primary objective is to create a support system that combines economic
    and workforce development to collectively focus on providing easy
    access to resources that address the unique needs of existing
    businesses attempting to transition to the knowledge economy. The third
    primary objective is to grow and attract new high-growth businesses in
    the area to create jobs, and enhance objectives 1 and 2 through
    immersing entrepreneur education and support resources for both workers
    and businesses to create a pipeline of creative and innovative ideas.
    This pilot project is projected to train over 5,000 individuals in
    through a variety of learning opportunites including internships,
    certificate, and degree programs supporting small business growth in
    the community.
        Grant Recipient and Location: City of Los Angeles, Community
    Development Department/California
        Partner(s) and Location(s): City of Los Angeles Workforce
    Investment Board; Cedars-Sinai Medical Center/Kaiser Permanente
    Southern California Region/White Memorial Medical Center/East Los
    Angeles Doctors Hospital/Managed Career Solutions, Inc.; Valley
    Community College; City of Los Angeles Community Development
    Department; City of Los Angeles Health Care Career Ladder Training
    Program; Learn2excel/CA
        Funding Amount: $1,196,000
        Purpose of the Award: This pilot project will fund six strategic
    interventions to provide education and training to out-of-school
    disadvantaged youth: (1) an Out-of-School to Career Program that
    creates an articulated pathway through the training process and
    provides supports to participants during the program; (2) a Health Care
    Career Mentoring Program in which mentors will assist youth throughout
    their education and training and into careers; (3) a Hosted Web-Based
    Portal that will function as an on-line learning community meeting
    place to facilitate networking, collaboration, and information sharing
    throughout the Los Angeles healthcare system; (4) a Healthcare
    Vocational Assessment Tool used to determine vocational interest and
    aptitudes for specific health occupations; (5) a Bilingual English/
    Spanish Fast Track Health Care Basics Curriculum that includes basic
    skills, medical terminology, and introductory health science courses;
    and (6) a Bilingual English/Spanish Marketing Outreach Program to
    attract minority, disadvantaged youth to healthcare occupations. As a
    result of this pilot project the grantee anticipates that 500 youth
    will go through pre-work and orientation for work experience; 200 youth
    will go through work experience at partner hospitals; 133 youth will
    attend medical fast track pre-requisite training; 117 youth will enter
    training; 80 placements leading up to healthcare tracks will be
    received; 112 will receive job placements or entry into higher level
    education at graduation of healthcare tracks; and approximately 4,635
    individuals will enter the health care workforce pipeline annually.
        Grant Recipient and Location: Miami-Dade College/Florida
        Partner(s) and Location(s): South Florida Workforce; IVAX
    Corporation; MediVector; Onco-Venctor; BioFlorida; South Florida
    Biotechnology Consortium; Miami-Dade County Public Schools; Florida
    Atlantic University; South Florida Manufacturing Association; Greater
    Miami Chamber of Commerce/FL
        Funding Amount: $1,000,000
        Purpose of the Award: As part of this demonstration, Miami-Dade
    College and its partners will pursue a number of strategies to build
    the region's skilled biotechnology workforce. The college will partner
    with industrial pharmaceutical manufacturing (IPM) experts to develop
    IPM curricula, train college faculty on the new curricula, and recruit
    industry experts to serve as adjunct faculty. These three strategies
    will address challenges related to educational capacity. All curricula
    developed will address specialized skills sets in IPM and related
    specialty areas. Competency models, based on evolving industry
    standards, will support the mapping of biotechnology career ladders and
    cross-industry career lattices. Miami-Dade College will expand
    available labor pools through the recruitment of minority youth, low-
    income adult minorities, Limited English Proficient individuals,
    veterans, and individuals with disabilities. The grantee expects to
    train 800 incumbent and future IPM technicians and related workers.
        Grant Recipient and Location: United Regional Health Care System/
    Texas
        Partner(s) and Location(s): North Central Texas Healthcare
    Consortium (includes representatives from the workforce investment
    system, education and training providers, and hospital industry
    employers); United Regional Healthcare System; Wilbarger General
    Hospital; Electra Memorial Hospital; Seymour Hospital; Vernon College;
    Midwestern State University; Texas Christian University; North Texas
    Tech Prep Consortium; Partners-in-Education; Region 9 Education Service
    Center/TX
        Funding Amount: $846,325
        Purpose of the Award: In this demonstration, the grantee will focus
    on recruiting, training, and capacity building in post-secondary
    institution nursing programs: (1) Recruiting--develop a pipeline of
    young workers for employment in the healthcare industry by recruiting
    from new and untapped, diverse labor pools; (2) Training--train 35 new
    and 85 incumbent workers for hospital positions such as patient care
    associates/medical assistants, nurses, health information technicians,
    Spanish language hospital interpreters, and surgical technicians; and
    (3) Capacity Building--increase the pipeline of available workers by
    training faculty from partner organizations as advanced practice nurses
    and nurse educators to gain qualification needed to teach in
    professional nursing programs.
        Grant Recipient and Location: Claflin University/South Carolina
        Partner(s) and Location(s): Lower Savannah Workforce Development
    Board; Zeus Corporation, Albemarle Corporation; SuperSod; Regional
    Medical Center of Orangeburg and Calhoun Counties; Orangeburg-Calhoun
    Technical College; South Carolina Department of Education; Orangeburg-
    Calhoun Tech Prep Consortium; Orangeburg County Economic Development
    Board/SC
        Funding Amount: $750,000
        Purpose of the Award: As part of this demonstration, Claflin, a
    historically black college in rural Orangeburg, SC, and its partners
    will develop a pipeline of skilled biotechnology workers for all rungs
    of the biotechnology career ladder (high school diploma to Master's
    degree level). The grantee extimates that they will train 100 students
    in biotechnology certificates and degrees. In addition, the university
    will also develop curricula for each ladder of the biotechnology career
    ladder. As part of its efforts to stimulate youth enrollment in
    biotechnology training programs, Claflin will implement a comprehensive
    career development process for high school students, incumbent workers,
    and dislocated workers, and will also train local K-12 and secondary
    faculty to co-teach biotechnology modules with industry partners. This
    model of increasing the pool of minorities into high grow careers in
    biotechnology will be offered for broad dessemination to community
    colleges across the country for replication with partner 4-year
    institutions.
        Grant Recipient and Location: Orange County Workforce Investment
    Board/California
        Partner(s) and Location(s): Life Science Industry Council; Beckman-
    Coulter Inc.; Edwards Lifesciences Inc.; Allergan Inc.; Saint Joseph
    Health System; Coast Community College District; University of
    California-Irvine; Orange County Department of Education; Orange County
    Business Council; local One-Stop Career Centers; Central Labor
    Council--Local 441/CA
        Funding Amount: $1,000,000
        Purpose of the Award: The project will implement a regional skills
    development collaborative that will leverage workforce invesetment
    system resources to meet the demands of the biotechnology industry and
    its related occupations in healthcare sectors. This project will train
    and advance 75 incumbent workers in allied health occupations such as
    hospital technicians and technologists in radiology, surgical,
    ultrasound, and x-ray. Additionally, 75 workers dislocated from
    declining industries and 75 entry-level workers will receive training
    for high-growth occupations such as medical equipment repairers,
    inspectors and testers; pharmacy technicians; medical assistance;
    biological technicians; and others. The Orange County Workforce
    Investment Board will target services to minority trainees and
    economically-disadvantaged residents. The partnership will also work to
    standardize skill requirements, define biotechnology career ladders,
    and develop effective strategies for engaging and developing youth
    interested in biotechnology careers.
        Grant Recipient and Location: The University of Utah/Utah
        Partner(s) and Location(s): Utah Department of Workforce Services;
    Intermountain Health Care; University of Utah Hospitals and Clinics;
    Veterans Affairs Medical Center/UT
        Funding Amount: $871,707
        Purpose of the Award: In this demonstration project, The
    University's Clinical Faculty Associate model seeks to address the
    severe nursing faculty shortage through a number of connected
    methodologies. The purpose of the project is to promote career
    advancement for Registered Nurses (RNs) working in clinical settings
    through a collaborative clinical teaching model and education program
    that enhances retention and acquisition of the skills needed to teach
    nursing. Practicing RNs will augment their existing clinical skills and
    knowledge by acquiring formal education resulting in a Master's degree,
    post-Master's certificate, or specific coursework related to teaching
    nursing, clinical instruction, and nursing education. These RNs will
    then function as Clinical Faculty Associates under the mentorship of
    university master teachers. By upgrading RNs to Clinical Faculty
    Associate positions increased numbers of baccalaureate nursing students
    will be admitted into the program. The grantee expects to enroll 13
    Clinical Faculty Associates in the University of Utah's Teaching
    Nursing Program and enroll 32 students in the Baccalaureate Nursing
    program. Projected number of students supervised by CFAs is 336 at the
    end of the second project year.
        Grant Recipient and Location: Orange County Workforce Investment
    Board/New York
        Partner(s) and Location(s): 7 local workforce investment boards in
    middle Hudson Valley; Orange County Health Care Cluster; Hudson Valley
    Health Care Consortium; Healthcare Workforce Training Consortium,
    including NorMet (Northern Metropolitan Hospital Association); Pace
    University School of Nursing; Dyson College of Arts and Sciences/NY
        Funding Amount: $1,048,300
        Purpose of the Award: This demonstration project will fund a
    market-driven system trading educational credits for instructor hours.
    It will provide incentives for health care providers in the region to
    provide staff holding master's degrees to serve on the faculties of
    educational institutions in exchange for credits to meet providers'
    future training needs. As a result of this demonstration, the grantee
    project is to have 1,000 additional students admitted to healthcare
    education and training programs in 2 years as a result of the increased
    capacity of providers. Fifty clinical nurses will be trained as
    instructors in 2 years and 100 clinical nurses will be trained as
    preceptors in 2 years. The capacity of educational institutions to
    provide nurse training will increase with the addition of 70 adjunct
    instructors and 70 preceptors, offering a unique model for replicaiton
    by the health care industry.
        Grant Recipient and Location: CVS Regional Learning Center/Michigan
        Partner(s) and Location(s): Detroit Workforce Development
    Department; ORC Macro; Wayne County Community College District;
    Goodwill Industries of Greater Detroit; New Galilee Missionary Baptist
    Church; Perfecting Church; Little Rock Baptist Church/MI
        Funding Amount: $1,757,981
        Purpose of the Award: The major components of this pilot project
    include: a community education and outreach campaign designed to build
    awareness and interest in pharmaceutical careers; recruitment,
    screening, and training of 80 candidates to receive training in an
    apprenticeship program to first become a Pharmacy Service Associate and
    then a Pharmacy Technician; a peer support group; provision of ``wrap-
    around'' services, such as child support and transportation;
    identification and support of 130 incumbent CVS Pharmacy Service
    Associates faced with career advancement barriers to become Pharmacy
    Technicians through occupational English as a Second Language and
    customer service skill development instruction; and opportunities for
    both apprentices and incumbent workers to advance their pharmaceutical
    careers through 2-year or 4-year academic programs.
        Grant Recipient and Location: State of Wisconsin/Wisconsin
        Partner(s) and Location(s): Wisconsin workforce investment boards;
    Wisconsin Department of Workforce Development; private sector health
    care associations, including the Wisconsin Nursing Redesign Consortium;
    Wisconsin Technical College System/WI
        Funding Amount: $1,365,101
        Purpose of the Award: In this demonstration, the grantee proposes a
    two-part strategy to fast-track nurse educators to prepare the next
    generation of Registered Nurses (RNs) for the State of Wisconsin,
    including accelerated graduate study programs and a partner-based model
    for identification, recruitment and preparation of health professionals
    for nurse educator careers. The grantee will create an accelerated
    curriculum option and career ladder to facilitate movement of
    Associate's Degree nurses to the Master's degree level. This training
    model will decrease the time-to-degree by 18-24 months without diluting
    the quality of the graduate education programs. These efforts will
    result in fast-track preparation of 70 new and diverse nurse educators
    in Wisconsin by 2007 as replacement and expansion nurse faculty for all
    Wisconsin nursing programs, with an additional 50 Associate's degree
    nurses (ADNs) prepared to enroll in Master's programs Statewide by
    2007. Contracts between partnering employers and program participants
    will result in their contractual commitment as nurse faculty in a
    Wisconsin nursing school and as clinical care providers in sponsoring
    health facilities upon their graduation (2-3 years depending on course
    of study). Recruitment will focus on identifying underrepresented
    populations in nursing, including racial and ethnic minorities, men,
    and people with disabilities. The project will produce two major
    replicable innovations: a streamlined curriculum for rapid progression
    to the Master's degree along various career ladders and from various
    start points, and a Statewide partnership model for developing health
    care solutions.
        Grant Recipient and Location: Temple College/Texas
        Partner(s) and Location(s): Central Texas Workforce Investment
    Board and affiliated Workforce Centers; Scott & White Clinical
    Laboratory Science Program; Scott & White Hospital Clinics; Central
    Texas Veterans Health Care System; Cancer Research Institute;
    Cardiovascular Research Institute; Temple Health and Bioscience
    District; Temple Independent School District; Central Texas Tech Prep
    Consortium; Tarleton State University of Central Texas; Texas A&M
    University College of Medicine; Temple Economic Development
    Corporation/TX
        Funding Amount: $920,495
        Purpose of the Award: In this demonstration, the grantee will
    develop a pipeline of skilled biotechnology technician and research
    workers for all rungs of the biotechnology career ladder (high school
    diploma to Bachelor's degree level). Working with area tech prep
    schools, the project will establish an Advanced Technical Middle
    College for high school students to assist them in preparing for
    biotechnology careers, and will develop community college curriculum to
    advance the area's available biotechnology career lattice. This program
    will be piloted with at least 20 students receiving job placements. The
    grantee will also work with its industry partners to launch innovative,
    mentored, on-the-job and apprenticeship opportunities for students.
    Specific occupations to be targeted include medical laboratory
    technician, research technician, and genomic technician.
        Grant Recipient and Location: Indianapolis Private Industry
    Council, Inc./Indiana
        Partner(s) and Location(s): Indiana Department of Workforce
    Development; Wishard; St. Vincent's and St. Francis hospitals; Indiana
    Health Industry Forum; Roche Diagnostics; Dow Agro-Sciences; Eli Lilly
    and Company; Baxter Pharmaceutical; Ivy Tech State College; Indiana
    University School of Medicine; City of Indianapolis/IN
        Funding Amount: $1,000,000
        Purpose of the Award: Under this pilot project the grantee will
    execute four primary strategies First, work with Ivy Tech, the State
    community college, to expand the number of seats in the school's
    programs that prepare persons to become radiological technicians,
    registered nurses and respiratory therapists. The goal is to graduate
    and certify 80 people for the three positions. Second, work with
    Indiana University to develop an accelerated Master's of Science
    program for registered nurses. Third, expand or create on-site training
    opportunities for entry level workers at all hospitals, including basic
    skills training, job readiness and GED prep and testing. At least 120
    workers will access these services. Fourth, create state-of-the-art
    outreach and recruitment material to reach 14,000 area residents over a
    2-year period. These materials will provide information about career
    opportunities in medical manufacturing and biotechnology.
        Grant Recipient and Location: JobPath, Inc./Arizona
        Partner(s) and Location(s): BIO5; TGEN; BIOSA; Pima County College;
    Pima County Superintendent of Schools; University of Arizona; Pima
    County One-Stop; La Paloma Family Services; Arizona Biosciences
    Association/AZ
        Funding Amount: $276,393
        Purpose of the Award: This demonstration program will build a
    pipeline of youth interested in pursuing careers in biotechnology
    through the development of an Introduction to Biotechnology course
    taught by community college faculty to high school students in a
    biotechnology summer institute. The grantee expects to train 50
    graduates of Biotechnology Summer Institute; 40 community college
    students will complete introductory classes and advance to
    biotechnology prerequisites; 60 graduates of the biotechnology college
    program will move on to employment or higher education; and 30
    graduates from paid internships with bioscience employers. Paid
    internships with local bioscience employers will be offered to students
    upon completion of the program. The program will also recruit and
    support participants from untapped labor pools enrolled in
    biotechnology courses and certificate programs at the local community
    college.
        Grant Recipient and Location: The Pennsylvania Workforce Investment
    Board/Pennsylvania
        Partner(s) and Location(s): Pennsylvania's local workforce
    investment boards; Ben Franklin Technology Partners; Industrial
    Resource Centers; Penn State University; Pennsylvania College of
    Technology/PA
        Funding Amount: $3,750,000
        Purpose of the Award: This demonstration project will develop a
    Statewide network that supports multiple facets of the plastics
    industry's development. Specifically, ETA will fund: Incumbent Worker
    Training, Curriculum Transfer, Occupational Forecasting; Supply Chain
    Analysis; a Plastics Occupations Toolkit; Internships/Co-ops;
    Scholarships; and Research & Development Symposiums. The grantee
    anticipates training over 1,200 incumbent workers in the plastics
    industry, including machine operators, machine set-up technicians,
    process engineers and production supervisors. The Pennsylvania
    Workforce Investment Board will play an oversight role and serve as the
    clearinghouse for documenting the overall impact of the initiative.
    Penn State will be involved in technology transfer and Research &
    Development. Local workforce investment boards will be able to meet
    employers' needs and provide key support for developing Centers of
    Excellence. This model will be promoted for replication to the public
    workforce system.
        Grant Recipient and Location: RISE Business/Virginia
        Partner(s) and Location(s): Center for Women's Business Research;
    Council of Growing Companies, Inc. Business Resources; Kauffman Center
    for Entrepreneurial Leadership; Edward Lowe Foundation; National
    Foundation for Teaching Entrepreneurship; National Minority Business
    Council; National Small Business United/national
        Funding Amount: $150,000
        Purpose of the Award: In this research project conducted by
    RISEbusiness, RISEbusiness will act as an intermediary between the
    public workforce system and small business by researching and
    publicizing the key issues affecting small and emerging businesses.
    RISEbusiness aims to research the following topics in order to increase
    small business' support for, access to, and utility of the workforce
    system: review existing literature; define and refine research
    questions; launch a research effort; refine the research methodology;
    collect and analyze qualitative and quantitative data; and disseminate
    the findings and implications. A final report will be distributed to
    the State and local workforce system to further support their access to
    services provided by the public workforce system.
        Grant Recipient and Location: Jobs for the Future--Workforce
    Innovations Networks (WINs)/Massachusetts
        Partner(s) and Location(s): Great Lakes Innovation and Development
    Enterprise (GLIDE); the Enterprise Ohio Skills MAX Center; Mid-Ohio
    Securities; KS Associates; Ross Environmental Services; Beckett
    LogiSync; the Braye Group; JD Munch Integrated Solutions; Cash
    Strategies; CyStorm; Banyan Technology; Accurate Processing; Catalyst
    Strategies; Hot Dog Heaven; National Association of Manufacturers-
    Center for Workforce Success; U.S. Chamber of Commerce, Center for
    Workforce Preparation/national
        Funding Amount: $5,121,777
        Purpose of the Award: The Workforce Innovations Network--WINS--is a
    collaboration of the Center for Workforce Preparation of the U.S.
    Chamber of Commerce, the Center for Workforce Success/Manufacturing
    Institute of the National Association of Manufacturerers, and Jobs for
    the Future to accelerate, expand, and broaden employer engagement
    strategies. The first module provided a comprehensive analysis of
    employer engagement strategies, and identified approaches and models
    for the system to replicate for better engagement and involvement of
    employers. The WINs Module II Project demonstrated three primary
    strategy objectives: (1) that locally business-based organizations
    (e.g., Chambers of Commerce, employer's organizations) could
    effectively serve as ``intermediary'' agents to establish and
    strengthen relationships between local businesses and local Workforce
    Investment Boards and service offices; (2) that these intermediary
    organizations could work with local businesses and WIBs to develop
    ``talent'' supply chains to bring skilled workers to businesses; and
    (3) that intermediaries could contribute to improved governance of
    public workforce investment systems. WINs II established 12 local
    demonstration sites and three State-level sites where the objectives
    were validated. Among the sites hundreds of businesses have been
    connected to WIB services and in a few sites the WIB depends upon the
    intermediary for the majority of business connections. Local
    demonstration sites have received additional WIB grants to continue
    and/or extend the projects thereby leveraging the WINs II grant funds.
    Beyond the additional WIB funding, the sites have acquired more than $5
    million from State and private funding sources.
        Grant Recipient and Location: U.S. Chamber of Commerce, Center for
    Workforce Preparation/Washington, D.C.
        Partner(s) and Location(s): Lehigh Carbon Community College in
    Schnecksville, Pennsylvania; National Association of Workforce Boards;
    American Association of Community Colleges; Chicagoland Chamber of
    Commerce; Greater Seattle Chamber of Commerce; Greater New Orleans/
    national
        Funding Amount: $1,502,700
        Purpose of the Award: The Business Coalition for Workforce
    Development Project will demonstrate the employer benefits of accessing
    the public workforce system by improving services and relationships
    between employers and the public workforce system. This will include
    research identifying areas of successful business engagement with the
    workforce system, identifying specific issues to retaining and engaging
    business partnerships, and documenting insight and advice on how
    systems and services can be improved to support improved outcomes for
    workers.
        Question. Since the program has been up and running for 3 years,
    what performance data from these grants can you share with this
    Committee?
        Answer. In an effort to model innovative strategies for investment,
    the projects funded under the High Growth Job Training Initiative have
    included both training and curricula development activities. A
    significant number of these investments are in their first year of
    performance. As such, we have limited performance outcome data at this
    time. However, performance data is available for grants that have
    concluded their activities. The outcomes from these grants are detailed
    below. Active grantees are in the process of submitting quarterly
    reports. These reports are presently being analyzed by the Department.
    In addition, the Department is working to complete an analysis and
    conduct an evaluation of the grants awarded to date, as well as to
    refine performance standards for future investments.

         OUTCOMES OF GRANTS IN THE PRESIDENT'S HIGH GROWTH JOB TRAINING
                                   INITIATIVE
                           [Expiring by June 1, 2005]
    ------------------------------------------------------------------------
                Grantee                Expected outcome      Actual outcome
    ------------------------------------------------------------------------
    National Center for Integrated   Illinois--Train 288   Illinois--Grant
     Systems Technology (Illinois     dislocated workers.   completed. 302
     and Ohio)--Dislocated Worker     Place 80 percent      workers were
     Integrated Systems Technology    (230) of all          enrolled with
     Training Project.                participants in       262 completers
                                      jobs with 75          and 74 percent
                                      percent (216)         placed in jobs.
                                      placed in small or   Ohio--Grant
                                      mid-sized companies.  ongoing. To
                                     Ohio--Train 288        date, 249
                                      dislocated workers.   participants
                                      Place 80 percent      have enrolled,
                                      (230) of all          121 completed
                                      participants in       training, and 95
                                      jobs with 75          have received
                                      percent (216)         job placements.
                                      placed in small or
                                      mid-sized companies.
    National Restaurant Association  (1) Increase student  (1) 9,444
     Educational Foundation.          worksite experience   students
                                      to 6,000.             received
                                     (2) Add states to      experience.
                                      the program.         (2) 43 States
                                     (3) Increase number    added to
                                      of ProStart school    program.
                                      to 900.              (3) Increased to
                                     (4) Increase           1,075 schools
                                      industry              with enrollment
                                      involvement in        of nearly 44,000
                                      project.              students.
                                                           (4) No increase
                                                            reported.
    Community Learning Center, Inc.  (1) 1,024 dislocated  (1) 1,028 workers
                                      workers will          served
                                      receive training.    (2) 914 workers
                                     (2) Place 802          placed in
                                      workers in            unsubsidized
                                      unsubsidized          jobs.
                                      employment.
    U.S. Chamber of Commerce--       (1) Develop a         Report and
     Center for Workforce             research report       promotional
     Preparation.                     documenting           materials
                                      business needs,       developed and
                                      providing training    delivered to
                                      services in One-      ETA.
                                      Stop Centers, and
                                      developing
                                      successful
                                      promising practices
                                      in these areas.
                                     (2) Disseminate
                                      grant information
                                      through business
                                      conferences and
                                      development of
                                      grant-related
                                      promotional
                                      materials.
    RISEBusiness...................  Develop a research    Research report
                                      report to increase    developed and
                                      understanding of      delivered to ETA
                                      the workforce needs
                                      of small and
                                      emerging
                                      businesses..
    Workforce Innovation Networks--  Research report
     Jobs for the Future              developed and
     Partnership (1)Develop a         delivered to ETA..
     research report that:
      (1) Identifies obstacles to
     employer use of the workforce
     investment system and proposes
     solutions.
      (2) Documents the WINs
     demonstration projects at nine
     sites.
    ------------------------------------------------------------------------

        Question. Do these grantees perform better or worse than grantees
    who received awards through a competitive process?
        Answer. A significant number of these investments are in their
    first year of performance. As such, we have limited performance outcome
    data at this time. However, both solicited and unsolicited grants are
    integral to the goals of the Department in providing services to
    individuals and to employers, as well as in transforming the workforce
    investment system. The initial sole source investments under the High
    Growth Job Training Initiative were made in order to demonstrate and
    model new approaches to workforce education and investment and are
    providing learning opportunities that are informing investments as we
    move forward on a primarily competitive basis. Models and
    demonstrations, by their nature, are intended to try new approaches,
    not all of which will be successful. The Department is currently in the
    process of evaluating the initial High Growth grants and to develop an
    ongoing strategy for evaluating performance and outcomes for
    competitive grants as we move forward.
        The learning from these initial grants has already provided
    critical information for the development of criteria for future
    investments, which will improve the outcomes of these investments.
                                     ______

                Questions Submitted by Senator Daniel K. Inouye

                        NURSING SHORTAGE IN RURAL AREAS

        Question. Please provide a report on the Department's progress in
    addressing the nursing shortage, specifically within rural communities
    and ethnic minority populations, such as Native Hawaiians.
        What initiatives, such as summer employment opportunities for
    students, have the Department utilized to foster continued growth of
    the nursing profession?
        Answer. We share your interest regarding the training of nurses.
    The Department of Labor has invested over $4.3 million through the
    President's High Growth Job Training Initiative to support projects in
    rural areas that develop and implement innovative solutions to address
    shortages in nursing and other health professions. Each of these
    projects will increase the number of nurses and other health
    professionals trained, hired, and retained in rural communities
    throughout the nation, including in Hawaii. Further, it is the
    Department's vision that rural communities across the country will
    benefit from these investments for many years to come through
    replication of the models.
        We are aware that Maui Community College is interested in such
    initiatives, and there have been a number of Congressional earmarks for
    Maui in the areas of rural development and rural job training, as well
    as pending proposals. With respect to fiscal year 2004 earmarks, we are
    near completion of our review of a proposal from the University of Maui
    for training and employment of Hawaiians living in rural areas. That
    award should be made shortly. In addition, the Department of Labor's
    fiscal year 2005 Appropriation includes $1,500,000 for Maui Community
    College for the Remote Rural Hawaii Job Training Program. We are
    working closely with Maui Community College to ensure that they will be
    able to implement an exemplary project.
        It also is worth noting that the Department of Health and Human
    Services, through the Health Resources and Services Administration,
    currently invests $150 million in nursing workforce development
    activities, including $31 million for the Nursing Education Loan
    Repayment and Scholarship Program.
        Question. Education and job training services programs have
    provided employment opportunities for Native Hawaiians. How does the
    Department plan to continue supporting these programs and further
    develop programs already in existence?
        Answer. The Department of Labor's fiscal year 2005 Appropriation
    includes $1,500,000 for Maui Community College for the Remote Rural
    Hawaii Job Training Program. We are working closely with Maui Community
    College to ensure that they will be able to implement an exemplary
    project.
                                     ______

                  Questions Submitted by Senator Patty Murray

                                H-2A ENFORCEMENT

        Question. I am concerned about the lack of enforcement of H-2A
    program requirements by the Wage and Hour division of DOL for migrant
    and seasonal farm workers. A large farm labor contracting company,
    Global Horizons recruited and employed Thai nationals in central
    Washington fruit production under the H-2A guest worker program in 2004
    and is planning on doing so again this year.
        A number of my constituents have raised serious concerns with
    respect to Global's compliance with H-2A laws and regulations. I know
    you agree it is imperative that the DOL fully enforce these
    requirements to protect both U.S. workers and guest workers who enter
    our country under the H-2A program. In fact, while the H-2A program has
    not been used extensively in Washington State, there have been problems
    with enforcement of program requirements for many years.
        It appears that Global routinely violated State and Federal
    employment laws by:
      --Refusing employment to qualified U.S. workers under the Federal H-
            2A guest worker program,
      --Failing to provide the work promised in the employment contract,
      --Failing to pay the wage rate required by the H-2A program and
            contract; and
      --Providing substandard, unlicensed housing, with workers sleeping on
            the floor or two to a bed, with no cooking or washing
            facilities and no drinking water.
        Washington State's Department of Labor and Industry has denied
    Global's application for renewal of its State farm labor contractor's
    license. I also understand that there are outstanding complaints to the
    DOL from my State alleging various H-2A program violations by Global.
        Can you please provide a status report on DOL's investigation of
    these complaints?
        Answer. On February 10, 2005, the Wage and Hour Division of the
    Employment Standards Administration issued a notice of determination to
    Global Horizons under the H-2A program assessing civil money penalties
    totaling $154,700, and back wages totaling $131,267 for alleged
    violations occurring in Hawaii from September, 2002 through March 2003.
    These determinations have been appealed to the Department of Labor
    Office of Administrative Law Judges for a de novo hearing. Additional
    investigations involving other locations and periods of time are
    ongoing. However, because of their continuing nature we can not comment
    about those investigations at this time.
        In addition, on February 25, 2005, ETA issued a letter debarring
    Global Horizons from the H-2A program for a 3-year period based on
    Global Horizon's failure to fulfill requirements of its H-2A
    certifications and the Wage and Hour Division's prior findings of
    violations. Global Horizons requested a de novo hearing on debarment
    before an ALJ, and that has been consolidated with a Wage and Hour
    Division case against Global Horizon. The notice of determination for
    back wages and civil money penalties and the debarment proceeding have
    been consolidated and the hearing is presently scheduled for next year.
        While debarment is pending, ETA continues to process individual
    Global Horizon H-2A applications and to reach determinations on the
    merits of each. ETA continues to examine all applications for
    compliance with H-2A requirements and has rejected some of Global
    Horizons applications while certifying others. As one example, in
    January 2005, ETA denied Global Horizon's application for a new H-2A
    certificate for Eastern Washington based on the fact that Global
    Horizon at that time did not have a State-issued farm labor contract
    certificate, which is required by the State of Washington. Global
    Horizon appealed, and an ALJ upheld the denial on February 25, 2005.
        Washington State is taking its own actions involving Global
    Horizons. While the State had denied Global Horizon's application for
    renewal of its State farm labor contractor's license, we understand
    that the State has now extended that license until September 30, 2005.
    However, the State is also taking action to discontinue State provision
    of services to Global Horizons under the Wagner-Peyser Act, which
    includes such services as recruitment of local workers and placement of
    job orders in interstate clearance.
        Question. Please also inform me as to whether DOL is taking any
    action with respect to Global's Farm Labor Contractor registration
    under Federal law.
        Answer. Global is registered as a farm labor contractor under the
    Migrant and Seasonal Agricultural Worker Protection Act (MSPA). DOL has
    not initiated action to revoke this registration, but has pursued
    debarment action under H-2A. The Wage and Hour Division has an open
    investigation of Global. As with all such investigations, the Division
    will consider appropriate action at the conclusion of the
    investigation.
        Question. Are you willing to work with me to closely examine
    whether increased enforcement efforts are needed, including the
    imposition of penalties real deterrence?
        I know you agree with me that those who benefit from the H-2A
    program should do their part to make sure that the program operates
    lawfully. I also hope you will commit to work with me to educate
    growers who hire farm labor contractors for recruitment under the H-2A
    program to ensure that those growers monitor the contractor's
    compliance with the law.
        Answer. The Department of Labor is charged with two essential
    duties with respect to the enforcement of the H-2A program. First, the
    Department of Labor ensures that employers follow established rules and
    regulations for bringing foreign workers into the United States.
    Second, the Department of Labor vigorously enforces applicable labor
    standards. Guest worker programs cannot succeed without strict
    adherence to these responsibilities, and the Department takes them very
    seriously. In addition, the Department has an active H-2A compliance
    assistance program, which is designed to educate employers and
    employees of their responsibilities and rights under the law. The
    Department works with all interested parties to ensure that
    participants of the H-2A program are in full compliance with the law.

                                      PBGC

        Question. I commend you for tackling in the budget proposal the
    difficult issue of shoring up the Pension Benefit Guarantee
    Corporation. The PBGC insures the pensions of about 44 million American
    workers and is in danger of defaulting on those promises. Reforming
    this grossly under-funded insurance plan is long overdue. I am
    concerned, however, about the feasibility of some of your suggestions.
    For example:
      --You propose to increase fees on the corporations at the very time
            they are less likely to be able to pay them--once they are
            preparing to file for bankruptcy.
      --Your proposal would impose restrictions on pension benefits for
            rank-and-file workers, without restricting the pensions of
            executives.
      --The American Benefits Council (a group representing some of the
            country's largest corporations on their employee benefits
            program) predicts the Administration's plan could have the
            effect of encouraging companies to dump their defined benefit
            plans.
        Could you please explain why the plan discriminates against
    companies already in trouble and against rank-and-file workers?
        Answer. We appreciate your support for restoring the solvency of
    the PGBC. The Administration is committed to strengthening the pension
    insurance program and keeping defined benefit plans as a viable option
    for employers and employees. This requires a careful balancing of
    interests and inevitably will require trade-offs among various
    stakeholder interests. The Administration proposal strikes a necessary
    balance that will best protect the pension benefits earned by workers
    and retirees and alleviate the possibility that taxpayers will be
    called upon to rescue the insurance program.
        As you stated, the insurance program is grossly underfunded. Reform
    of the plan funding rules, by itself, will not eliminate PBGC's $23
    billion deficit. Premiums must be increased. The Administration's
    proposal is reasonable. It would increase the flat-rate premium for
    wage inflation since the last increase in 1991, and require a risk-
    based premium for all pension underfunding. We believe that the
    Administration's proposal equitably distributes the cost among
    employers and does not put too great a burden on financially weak
    companies.
        With respect to your question about benefit restrictions, the
    proposal is based on the principle that employers should pay for what
    they promise and not make promises to their workers and retirees that
    cannot be funded. Employers with severely underfunded plans would not
    be allowed to divert funds from rank-and-file pensions to deferred
    compensation plans for executives. If a financially weak employer has a
    severely underfunded plan, the employer would be prohibited from
    funding any nonqualified deferred compensation for executives. In
    addition, funding would be prohibited for executive compensation at any
    time within 6 months before or 6 months after the termination of an
    underfunded plan.
                                     ______

                Questions Submitted by Senator Richard J. Durbin

                           WORKER OVERTIME PROTECTION

        Question. An amendment to the bankruptcy bill that was on the
    Senate floor last week that would have marginally increased the minimum
    wage, but would have also eliminated the 40 hour work week and the
    overtime benefits of thousands of workers.
        This scheme would create an 80 hour, two week work period that
    would allow employees to work up to 50 hours one week and 30 hours the
    next week without receiving one dime of overtime pay.
        The amendment's sponsors said the plan is voluntary, but how
    voluntary is it when your boss threatens to hire someone else who will
    agree to his 50 hour/30 hour week schedule? This is an assault on
    workers, and it comes on top of the administration's elimination of 6
    million workers from overtime pay eligibility last year.
        Can you provide the Administration's perspective on such proposals
    to weaken overtime protection?
        Answer. The Administration has not taken a formal position on this
    specific legislation. However, the President has called on Congress to
    pass legislation to help working families juggle the demands of work
    and home through comp-time and flex-time and give private-sector
    workers the same flexible scheduling options that Federal employees now
    enjoy. Providing choices like whether to receive overtime pay as cash
    or as paid time off would allow workers to balance the demands of the
    workplace and the needs of their families.
        The minimum wage amendment to the bankruptcy bill would have
    doubled the scope of so-called small businesses that would be exempt
    from paying the minimum wage, but by doing this, he would also be
    stripping workers in those companies from other Federal protections,
    like equal pay, overtime pay and child labor safeguards under the Fair
    Labor Standards Act.
        The amendment would end individual worker protections under the
    FLSA, and expand the size of businesses that need not apply the Act
    from those grossing $500,000 annually to those grossing $1 million
    annually. This would exempt about 700,000 businesses from providing
    worker protections, and cover a total of about 10 million fewer workers
    than we do today.
        Question. In light of the work that has been done in this country
    to ensure that children are not working and that women are paid the
    same as men for the same work, why would we want to rollback these
    protections?
        Answer. The Administration has not taken a formal position on this
    specific legislation. However, the President has indicated that he is
    willing to work with Congress on a sensible proposal to increase the
    minimum wage in a way that does not price people out of jobs or hurt
    small businesses. In addition, the President has called on Congress to
    pass legislation to help working families juggle the demands of work
    and home through comp-time and flex-time and give private-sector
    workers the same flexible scheduling options that Federal employees now
    enjoy. Providing choices like whether to receive overtime pay as cash
    or as paid time off would allow workers to balance the demands of the
    workplace and the needs of their families.

                         PERSONAL REEMPLOYMENT ACCOUNTS

        Question. You talked about the Administration's proposal to
    consolidate four programs authorized by the Workforce Investment Act
    (WIA) into a single $4 billion block grant. You suggest this is done
    for flexibility, but even with the community colleges funding, the
    Department's job training funding is more than $300 million short of
    current year funding.
        The House Committee approved a WIA reauthorization bill that
    creates a nationwide pilot program to give unemployed workers
    considered at risk for long-term unemployment a $3,000 voucher they can
    spend on training. There is no specific budget request for this, but
    the Labor Department has already diverted funds from other
    discretionary programs to initiate a seven-State pilot. I understand we
    have no results yet from the Department's pilot program.
        How do you reconcile the House plan for expanding these untested
    personal accounts nationwide before your Department has completed its
    pilot study?
        Answer. The current seven-State Personal Reemployment Account (PRA)
    demonstration project builds upon the positive findings of earlier
    demonstrations by offering reemployment bonuses, targeting them using
    the Worker Profiling Reemployment System (WPRS), and increasing
    consumer choice through flexible worker accounts. PRAs are similar to
    current practice under the Workforce Investment Act, where workers can
    choose their training through Individual Training Accounts. PRAs give
    workers more opportunities and choices.
        Mathematica Policy Research Inc., a firm with wide experience in
    employment and training program evaluation, including the evaluation of
    the reemployment bonuses and individual training account experiments,
    is the evaluation contractor for the PRA demonstration. Although
    results from the demonstration are not yet available (accounts were
    first made available in March 2005), States are reporting some initial
    successes in implementing PRAs. For example, Minnesota has offered
    accounts to 301 individuals, and so far 188 individuals have accepted.
        Question. The Economic Policy Institute has said that the accounts
    are ``too small to purchase meaningful training but just large enough
    to discourage workers from pursuing cost-effective short-term services
    that could help them get back to work more quickly.'' To get the $3,000
    accounts workers would have to forfeit about $10,000 in other worker
    training programs. What kind of training and education does the
    Department anticipate an unemployed worker ``purchasing'' with a $3,000
    training voucher.
        Answer. First, this question assumes that all workers can access
    $10,000 in training when, in fact, most cannot. The estimated WIA unit
    cost for all types of services an individual would receive (in Program
    Year 2005) is $3,200 for dislocated workers and $2,064 for adults; no
    where near $10,000. Further, information in a recent GAO report, based
    on a survey of local workforce investment boards across the country,
    indicates that the average amount spent on training for adults and
    dislocated workers was slightly less than $2,300.
        Second, as you know, the community college system has and continues
    to be an important provider of training to our system, and the $3,000
    account level is based upon the average cost of 2 years of instruction
    at a community college. We believe that Personal Reemployment Accounts
    will provide individuals with opportunities to connect more directly
    with meaningful training at a community college or from another
    training provider.
        Question. With less money available, no data yet on a seven-State
    pilot, and a $7,000 reduction in investment per worker, it's hard for
    me to see how we are helping move people back into the workplace. Can
    you explain how we will gain $7,000 in ``administrative efficiencies''
    per worker? Or how $330 million in funding cuts will not lead to less
    opportunity for unemployed workers?
        Answer. As described earlier, the worker's forfeiture of $7,000 is
    not correct, as the average cost of 2 years at a community college is
    $3,000 and the unit costs for the WIA Adult and Dislocated Worker
    programs are $2,064 and $3,200, respectively. (Additionally, ITAs under
    WIA offer more limited choices in training, with no opportunity for a
    reemployment bonus). The Department of Labor anticipates that
    evaluation data will show that:
      --PRAs are significantly less staff-intensive than traditional forms
            of service delivery (reducing program overhead costs by
            directing resources directly into the hands of workers);
      --The time spent collecting Unemployment Insurance will likely
            decrease; and
      --The nature of placement into and retention of good jobs will remain
            constant or even increase as a result of more consumer choice
            and the ability to manage and customize one's plan for
            employment.

                         PROPOSED CHANGE TO CES SURVEY

        Question. The Bureau of Labor Statistics recently announced a
    decision to stop collecting data on women who work from its Current
    Employment Statistics program, claiming it is trying to reduce the
    paperwork burden on employers. By the agency's own admission, this
    survey takes only seven minutes to fill out.
        This data on women in the workforce is invaluable to researchers
    and policymakers in their efforts to understand gender inequality. At a
    time when women's employment may be changing in fundamental ways due to
    the economy, we should be expanding our ability to understand the
    evolving role of women in the labor force, not reducing it.
        I sent a letter, along with Senator Kennedy, to the Department
    about this issue on February 9. In your response, which I just
    received, you acknowledged that the Current Employment Statistics
    program is superior to the Department's other data collections programs
    for analyzing month-to-month trends. Help me understand why the
    Department would agree to eliminate a program that serves a valuable
    policy purpose and that experts agree is working?
        Answer. The BLS believes that its proposal to discontinue the
    Current Employment Statistics (CES) series on women workers is in the
    best interest of public policy. The discontinuation of the women
    workers series is part of a larger set of changes that the BLS has
    proposed for the CES survey. The BLS' decision to discontinue the women
    workers series is based on three factors: (1) the availability of
    extensive information on women's employment from the CPS, (2) the
    public's lack of use of the CES data, and (3) a desire to reduce
    respondent burden for a voluntary survey.
        Data on women's employment, occupations, earnings, and other labor
    force statistics will continue to be available from the Current
    Population Survey (CPS), a monthly survey of about 60,000 households.
    From the CPS, users have access to a rich source of data on women's
    employment, unemployment, and earnings by industry, occupation,
    education, age, marital status, and other characteristics. These data
    are used extensively in the study of women in the labor force.
        The BLS recognizes that one of the main concerns expressed about
    the proposed discontinuation of the women worker series is that the CES
    is superior to the CPS for analyzing month-to-month trends. However,
    the agency believes that such short-term measures are not appropriate
    for most assessments of the changing status of women (or any
    demographic group) in the labor market. When examining longer term
    trends, the advantage the CES has in sample size declines in
    importance. The two surveys have displayed similar trends for women's
    employment growth over the past several years.
        CPS data are used extensively in the study of women in the labor
    force. By contrast, CES women workers series are little used. In an
    effort to gauge the impact of the proposal to terminate the women
    workers series, the BLS undertook an analysis of the extent to which
    this data series is used by researchers and the general public. The BLS
    found that, while there was an average of 130,000 requests per month
    for CES national estimates through the BLS public use website, only
    about one-half of one percent of those requests were for the women
    worker employment series. Additionally, an informal literature search
    by BLS found almost no usage of CES women worker series. Articles that
    addressed women's employment and earnings issues nearly all used data
    from the CPS as their source.
        In addition, although the data it produces are used but rarely, the
    series imposes a significant reporting burden on some survey
    respondents because payroll records do not typically include gender
    identification. It is important to consider the context in which the
    women worker data is collected. The BLS relies upon the voluntary
    cooperation of approximately 155,000 businesses each month
    (representing about 400,000 individual worksites) in providing
    information from their payroll records on the employment, hours, and
    earnings of their workers. In an increasingly difficult data-collection
    environment, survey response burden is a crucial factor in survey
    design. We must minimize this burden to ensure the continued accuracy
    and integrity of the payroll data on which we rely to produce the
    Employment Situation, which is a principal Federal economic indicator
    and represents some of the nations most closely watched economic data.
    The individuals who complete the CES report often have indicated that
    gender information is not present on their standard payroll records and
    that they do not have ready access to the data. As an example of this
    burden, although 100 percent of employers who respond provide their
    total employment count, approximately one out of every six declines to
    provide data on female employment. In addition, the BLS proposal stems
    from a view that it is poor public policy to continue burdening several
    hundred thousand respondents each month to produce a data series with
    only a small handful of users.
        The BLS' proposed elimination of the women worker series in the CES
    survey is a part of a larger agency effort to improve the survey's
    relevance to the needs of data users and its value as input to other
    key economic statistics. For example, in mid-2005, the CES is changing
    its current policy of collecting data only for production and non-
    supervisory employees and will begin collecting data for two new
    series: hours and regular earnings of all employees, and a total
    earning series (including both regular and irregular pay) for all
    employees. These changes are designed to make the survey more
    responsive to the needs of data users and increase its value in
    relation to other key economic statistics. For example, the Bureau of
    Economic Analysis has long sought more timely data on all-employee
    earnings in its construction of national income statistics. The new all
    employee hours and earnings series will provide more comprehensive
    information than the present series for analyzing economic trends. They
    also will provide improved input for other major economic indicators,
    including series on non-farm productivity, as well as eliminate a
    potential source of bias in BLS estimates of the productivity growth
    rate.
        The Department believes that accurate data on women's employment
    are crucial to understanding the economic opportunities that are
    available to women today. As we have indicated, the BLS will continue
    to collect timely and accurate data on women workers through the CPS,
    which is an overall richer source of data for women workers than the
    CES.

                             FEWER WORKERS TRAINED

        Question. Page 41 of your Budget Justification Material states
    that, with the Fiscal 2005 appropriation, you expect to serve 870,000
    participants in the Dislocated Worker Programs; 475,200 participants in
    the Adult Block Grant program; and 329,000 participants in the Youth
    Block Grant program. Yet you estimate that only 400,000 persons will be
    trained when these programs are consolidated as you are requesting for
    2006. Why is it that the current level of more than 1.6 million
    participants will only lead to 400,000 trainees next year?
        Answer. The estimated participant levels for fiscal year 2005 for
    the Adult and Dislocated Worker programs reflect the number of
    individuals receiving all types of employment assistance--not just
    those receiving job training. Also, the figure of 870,000 for the
    Dislocated Worker program was included in error--the correct
    participant level is 368,700.
        The Employment and Training Administration's fiscal year 2006
    Budget request emphasizes the Administration's commitment to increasing
    employment and training opportunities by funding new Consolidated State
    Grants that merge the WIA Adult, Dislocated Worker, and Youth programs
    and the Wagner-Peyser Employment Service program into a single base
    grant. The fiscal year 2006 Budget estimates that between 18,535,700
    and 18,960,000 participants will be served through the consolidated
    grants.
        The President's proposal for job training reform would double the
    number of workers receiving job training through major WIA grant
    programs, from approximately 200,000 to 400,000 annually. By
    eliminating unnecessary overhead costs and simplifying administration
    through the consolidation of duplicative employment and training
    bureaucratic structures, we project an overall savings of at least $300
    million, which can be used by States for training an additional 100,000
    workers annually. In addition, the President has requested $250 million
    for Community Based-Job Training Grants for fiscal year 2006. This new
    initiative, which will begin July 1, 2005, will utilize our nation's
    successful community colleges to train 100,000 more workers annually.

                              SUBCOMMITTEE RECESS

        Senator Harkin. Thank you very much, Madam Secretary.
        The subcommittee will stand in recess to reconvene at 10:30
    a.m. on Wednesday, March 16, in room SD-138. At that time we
    will hear testimony from the Honorable Michael O. Leavitt,
    Secretary, Department of Health and Human Services.
        [Whereupon, at 11:37 a.m., Tuesday, March 15, the
    subcommittee was recessed to reconvene at 10:30 a.m.,
    Wednesday, March 16.]

    DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
                  AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2006

                                  ----------

                           WEDNESDAY, MARCH 16, 2005

                                           U.S. Senate,
               Subcommittee of the Committee on Appropriations,
                                                        Washington, DC.
        The subcommittee met at 10:42 a.m., in room SD-138, Dirksen
    Senate Office Building, Hon. Arlen Specter (chairman)
    presiding.
        Present: Senators Specter, Craig, DeWine, Harkin, Kohl,
    Murray, and Durbin.

                    DEPARTMENT OF HEALTH AND HUMAN SERVICES

                            Office of the Secretary

    STATEMENT OF HON. MICHAEL O. LEAVITT, SECRETARY
    ACCOMPANIED BY:
            KERRY WEEMS, ACTING ASSISTANT SECRETARY FOR BUDGET, TECHNOLOGY,
                AND FINANCE
            JENNIFER YOUNG, ASSISTANT SECRETARY FOR LEGISLATION

                   OPENING STATEMENT OF SENATOR ARLEN SPECTER

        Senator Specter. Good morning. The Subcommittee on Labor,
    Health and Human Services, Education, and Related Agencies will
    now proceed. We have established a record for starting these
    hearings on time so that we do not keep busy people waiting or
    people who are not busy waiting. But as I had said a moment or
    two ago, the floor manager had scheduled my amendment for
    increasing the budget of the subcommittee by $2 billion, $1.5
    billion for the National Institutes of Health, and $500 million
    for Education. We just concluded the argument and came right
    over here and have had a very brief discussion with the
    distinguished Secretary.
        We do welcome you here, Mr. Secretary. You come to this
    office with a very, very distinguished record with the
    governorship of Utah and Administrator of the Environmental
    Protection Agency, and a very distinguished record before
    public service. We look forward to working with you.
        My full statement will be made a part of the record and in
    view of our late arrival I will make only a very few
    introductory remarks. As I had commented to the Secretary when
    we moved the hearing from 9:30 to 10:30, that has compressed my
    schedule, and I've asked Senator DeWine to be here to take over
    the chairmanship here at 11.
        But the only introductory comments that I will make are the
    daunting tasks which we all have. We have a budget for the
    subcommittee which is several billion dollars under what it was
    last year. We have a 3.5 percent cut for the Department of
    Labor. We have a $500 million cut for Education. There is a
    proposed budget for your Department, Mr. Secretary, for $62.4
    billion, which is a reduction of almost $1.3 billion, and
    that's not calculating the inflation rate. So that means it's
    another $2 billion on top of a billion, probably $3.5 billion.

                               PREPARED STATEMENT

        But you come to this job with a great reputation for being
    a wonder worker, so we will watch your work and we will work
    with you. Now I yield to my distinguished colleague, the
    seamless Senator Harkin.
        [The statement follows:]
                  Prepared Statement of Senator Arlen Specter
        This morning, the subcommittee on Labor, Health and Human Services,
    Education, and Related Agencies will discuss the President'S $62.4
    billion 2006 budget request for the Department of Health and Human
    Services, which is $1.3 billion below the fiscal year 2005 level. We
    are Delighted to have before us the distinguished Secretary of Health
    and Human Services, the honorable Michael O. Leavitt.
        This subcommittee is pleased to see several shared priorities
    funded in the fiscal year 2006 budget, including $303 million over the
    fiscal year 2005 level for Community Health Centers and $203 million
    over the fiscal year 2005 level for the Strategic National Stockpile to
    protect our Nation against bioterrorism.
        However, this subcommittee is concerned by the small 0.5 percent
    increase in Biomedical Research Funding at the National Institutes of
    Health--which is a cut in real terms. Also of concern are the large
    cuts in funding of many HHS programs, including the complete
    elimination of 35 programs.
        Mr. Secretary, I know that you can appreciate the difficult
    tradeoffs that this subcommittee will need to negotiate in the coming
    months as we balance the competing pressures of biomedical research,
    worker protection programs and continued investment in our Nation's
    youth. Mr. Secretary, I look forward to working with you as we craft an
    appropriations bill that maintains our commitment to fiscal restraint
    while preserving funding for high priority programs.

                    OPENING STATEMENT OF SENATOR TOM HARKIN

        Senator Harkin. Thank you very much, Mr. Chairman. I will
    follow your lead and not make a full opening statement. Again,
    thank you, Mr. Chairman, for your leadership on the floor, on
    NIH, to get that funding back up. It just--at a time when we're
    making so many great breakthroughs, when we've finished mapping
    the human gene, when we've gotten a lot of young people now
    more interested in basic research because of the doubling of
    NIH, now it seems like, well, we did that and now we don't have
    to do anything more.
        But that was just catch-up ball. We were just playing
    catch-up ball. Now we've caught up, now all of a sudden we're
    moving back again. So I just want to compliment my friend and
    my chairman for taking the lead on the floor on this.
        Just a couple--three things, Mr. Secretary. Again, welcome
    you to your first appearance before our subcommittee.
    Congratulations on your new position. Like the chairman, we
    have met personally and I've just heard a lot of good things
    about you, and your reputation is sterling, I can say that.
        I just--a couple of comments on the budget, eliminating
    services for some 25,000 kids on Head Start. That's very
    bothersome. The community services block grant program. Now,
    you might say, well, we're continuing some of the things like
    LIHEAP and Head Start, things like that, but if you don't have
    the people that do it, how does it get done? Community services
    block grants being zeroed out is just--I don't know what we--
    what could be behind that.
        There's one other thing, the systems change grant. Your
    predecessor was very strong and the President was, the
    President spoke about this in the past, better check the record
    on the system change grants. This has to do with the court
    case--what am I thinking about--Olmstead case. The Supreme
    Court decision said that people with disabilities must live in
    the least restricted environment.
        Well, we've built up a system of nursing homes in this
    country that are still needed for some obviously. But for a lot
    of people with disabilities who can get to the community, they
    need these system change grants. Your predecessor and the
    President has spoken strongly about this and something called
    money follows the person, but there's nothing in this budget
    for it.
        So, again, just a few of those things I wanted to point to,
    but lest you think I think everything's bad in this budget, I
    compliment you for the increase in the community health
    centers. This is one thing that serves--the $300 million
    proposed increase is welcome, it's needed. They do a great job
    I'm sure in your State, mine, all over the country. So that is
    one right spot in this budget that will have our full support,
    you can be assured.
        Thank you, Mr. Secretary. Thank you, Mr. Chairman.
        Senator Specter. Thank you, Senator Harkin. We welcome you
    again, Mr. Secretary, and the floor is yours. We look forward
    to your testimony. Your full statement will be made a part of
    the record and our practice is to ask you to summarize to the
    extent you can, leaving the maximum amount of time for
    questions and answers. We have a very good attendance for the
    subcommittee today.

                  SUMMARY STATEMENT OF HON. MICHAEL O. LEAVITT

        Secretary Leavitt. Thank you, Mr. Chairman, and Senator
    Harkin. I will in the spirit of efficiency summarize quickly.
    As you indicated, the budget--the overall budget is $642
    billion. That's a 10 percent increase over last year. Much of
    that will be in the Medicare Modernization Act and its
    implementation.

                                    MEDICAID

        This subcommittee, as you pointed out, is $62.4 billion,
    and it's a lot of money, and we're here to do our best to
    defend how in fact we will do it efficiently. I hope we have a
    chance today to talk about Medicaid. Forty six million
    Americans are served by it. It's rigidly inflexible. The
    Governors are desperate to have some change so they can
    maintain coverage for people who have it and hopefully provide
    coverage for some who don't.
        I hope we have a chance to talk some about the
    implementation of the Medicare Modernization Act. That's the
    main event for 2005 in my opinion for HHS, and we're working
    hard to make certain that it's done well. We all have a
    substantial stake in its implementation.
        Community health centers is a favorite of mine to talk
    about too, Senator Harkin, and I'm hopeful that we'll get a
    chance to talk more about that.
        Homeland defense has been very much on my mind, as I
    suspect it is everyone else's, $4.3 billion to continue our
    work there, $600 million of it into strategic stockpiles. Our
    goal is to have needed medications within 12 hours of every
    man, woman, and child in the United States.
        NIH, a subject I know that's very important to you,
    Senator, and to others, $28.8 billion, $1.8 billion of that
    again in biodefense. The flu has become an area of major
    concern to me, particularly the--as we begin to see the avian
    flu become more prominent in Asia. I hope we have a chance to
    talk about our preparation there.
        The President has emphasized faith-based initiatives also,
    his hope that reauthorization of the Welfare Act of 1996 could
    be accomplished this year. This budget will support the
    administration's belief in both faith-based and also in
    abstinence education. The budget does support Head Start with
    $6.9 billion.

                               PREPARED STATEMENT

        A subject I hope we get a chance to talk about is Health
    IT. That's an issue that I intend to take on personally.
        It's what I believe to be a lean but strong and fiscally
    responsible budget, and I'm looking forward to more
    conversation.
        [The statement follows:]

                 Prepared Statement of Hon. Michael O. Leavitt

        Good morning Mr. Chairman, Ranking Member Harkin, and members of
    the Subcommittee. I am honored to be here today to present to you the
    President's fiscal year 2006 Budget for the Department of Health and
    Human Services (HHS). The President and I share an aggressive agenda
    for the upcoming fiscal year, in which HHS advances a healthier,
    stronger America while upholding fiscal responsibility and good
    stewardship of the People's money.
        In his February 2nd State of the Union Address, the President
    underscored the need to restrain spending in order to sustain our
    economic prosperity. As part of this restraint, it is important that
    total discretionary and non-security spending be held to levels
    proposed in the President's fiscal year 2006 Budget. The budget savings
    and reforms in the President's Budget are important components of
    achieving the President's goal of cutting the budget deficit in half by
    2009 and we urge the Congress to support these reforms. The President's
    fiscal year 2006 Budget includes more than 150 reductions, reforms, and
    terminations in non-defense discretionary programs, 19 of which affect
    HHS programs. The Department wants to work with the Congress to achieve
    these savings.
        The President's health agenda leads us towards a Nation of
    healthier Americans, where health insurance is within the reach of
    every American, where American workers have a comparative advantage in
    the global economy because they are healthy and productive, and where
    health technology allows for a better health care system that produces
    fewer mistakes and better outcomes at lower costs. The fiscal year 2006
    HHS budget advances this agenda.
        The fiscal year 2006 HHS budget funds the transition towards a
    health care system where informed consumers will own their personal
    health records, health savings accounts, and health insurance. It
    enables seniors and people with disabilities to choose where they
    receive long-term care and from whom they receive it. Equally
    important, it builds on the Department's Strategic Plan and enables HHS
    to foster strong, sustained advances in the sciences underlying
    medicine, in public health, and in social services.
        To support our goals, President Bush proposes outlays of $642
    billion for HHS, a 10 percent increase over fiscal year 2005 spending,
    and more than a 50 percent increase over fiscal year 2001 spending. The
    proposed fiscal year 2006 HHS budget increase accounts for almost two-
    thirds of the entire proposed federal budget increase in fiscal year
    2006. The overall discretionary portion of the President's HHS budget
    totals $67 billion in budget authority and $71 billion in program level
    funding. The discretionary portion of programs covered by this
    subcommittee totals $62.4 billion in budget authority and $65.3 billion
    in program level funding.
        The Department will direct its resources and efforts in fiscal year
    2006 towards:
      --Providing access to quality health care;
      --Enhancing public health and protecting America;
      --Supporting a compassionate society; and
      --Improving HHS management.
        The President and the Department considered a number of factors in
    constructing the fiscal year 2006 budget, including the need for
    spending discipline and program effectiveness to help cut the deficit
    in half over four years. Specifically, the budget decreases funding for
    lower-priority programs and one-time projects, consolidates or
    eliminates programs with duplicative missions, reduces administrative
    costs, and makes government more efficient. For example, the budget
    requests no funding for the Community Services Block Grant that was
    unable to demonstrate results in Program Assessment Rating Tool
    evaluation. Instead, the Administration proposes to focus economic and
    community development activities through a more targeted and unified
    program to be administered by the Department of Commerce. It is due to
    this scrutiny that I am certain the proposed increases in spending will
    enable the Department to continue to provide for the health, safety,
    and well-being of our People.
        Americans enjoy the finest health care in the world. This year's
    budget provides opportunities to make quality health care more
    affordable and accessible to millions more Americans. Our challenge is
    to ensure that everyone has access to health insurance.

                    PROVIDING ACCESS TO QUALITY HEALTH CARE

    MMA Implementation
        The next important step toward meeting this challenge is the
    implementation of the Medicare Modernization Act (MMA), including the
    Medicare Prescription Drug Benefit and the new Medicare Advantage
    regional health plans. The Centers for Medicare and Medicaid Services
    (CMS) administrative budget request of $3.2 billion includes $560
    million for implementing the new voluntary drug benefit that begins
    January 1, 2006, enhanced health plan choices in Medicare Advantage, as
    well as numerous other MMA provisions. The new prescription drug
    benefit will cost $58.9 billion in 2006 and will be financed through
    beneficiary premiums and general revenue. The President's Budget also
    proposes $75 million for program integrity efforts to combat fraud and
    abuse in the new Part D and Medicare Advantage programs.
        February 15, 2004 was the final date for plans to submit Medicare
    Advantage 2005 applications to provide coordinated care plans,
    including local preferred provider organizations (PPOs). The deadline
    for stand-alone prescription drug plans, new Medicare Advantage
    contractors, and regional PPOs to submit their ``Notice of Intent to
    Apply'' was February 18, 2005. CMS has received significant initial
    interest from potential prescription drug plan sponsors to offer the
    Medicare drug benefit throughout the Nation. In addition, insurance
    plans have expressed interest in significantly expanding Medicare
    Advantage service areas providing more options to Medicare
    beneficiaries.

    Medicaid
        The President and I are also committed to improving Medicaid.
    Medicaid provides health insurance for more than 46 million Americans,
    but as you are all aware, States still complain about overly burdensome
    rules and regulations, and the state-federal financing system remains
    prone to abuse.
        This year, for the first time ever, States spent more on Medicaid
    than they spent on education. Over the next ten years, American
    taxpayers will spend nearly $5 trillion on Medicaid in combined state
    and federal spending. The Department plans to make sure tax dollars are
    used more efficiently by building on the success of the State
    Children's Health Insurance Program (SCHIP) and waiver programs that
    allow states the flexibility to construct targeted benefit packages,
    coordinate with private insurance, and extend coverage to higher income
    and non-traditional Medicaid populations. Additionally, we estimate
    that proposals included in the President's Budget to strengthen program
    integrity and ensure that Medicaid doesn't overpay for drugs will
    create $60 billion in new savings over a ten-year period.
        The President plans to expand coverage for the key populations
    served in Medicaid and SCHIP by spending $15.5 billion on targeted
    activities over ten years. The President's Budget includes several
    proposals to provide coverage, including the Cover the Kids campaign to
    enroll more eligible uninsured children in Medicaid and SCHIP. In
    addition, the extension of the Qualified Individual and transitional
    medical assistance programs will ensure coverage is available to
    continue full payment (subject to a spending limit) of Medicare Part B
    premiums for qualified individuals, and provide coverage for families
    that lose eligibility for Medicaid due to earnings from employment. The
    Department projects that over 50 million individuals will be covered by
    Medicaid and SCHIP in fiscal year 2006, at a federal cost of $198
    billion.

    Community Health Centers
        In addition to expanding access through Medicaid and SCHIP, the
    President's Budget builds on the Department's aggressive efforts to
    help those who are uninsured or underinsured by expanding the good work
    of community health centers. These centers provide quality,
    compassionate care to the patients who need our help the most,
    regardless of their ability to pay.
        The President's Budget requests $2 billion, a $304 million increase
    from fiscal year 2005, to fund community health centers. This request
    completes the President's commitment to create 1,200 new or expanded
    sites to serve an additional 6.1 million people by 2006. By the end of
    fiscal year 2006, the Health Centers program will deliver high quality,
    affordable health care to over 16 million patients at more than 4,000
    sites across the country. Health centers are effectively targeted to
    eliminate health disparities and provide a range of essential services.
    In 2006, health centers will serve an estimated 16 percent of the
    Nation's population who are at or below 200 percent of the federal
    poverty level. Almost forty percent of Health Center patients have no
    health insurance and 64 percent are racial or ethnic minorities. In
    addition, the President has set a new goal to help every poor county in
    America that lacks a community health center by establishing a
    community health center in counties that can support one, or a rural
    health center. The President's Budget includes $26 million to fund 40
    new health centers in high poverty counties.

    Ryan White/HIV
        Our request also includes approximately $18 billion for domestic
    AIDS care, treatment, research, and prevention. We are committed to the
    reauthorization of the Ryan White CARE Act treatment programs,
    consistent with the President's reauthorization principles of
    prioritizing lifesaving services including HIV/AIDS medications and
    care; providing more flexibility to target resources; and ensuring
    accountability by measuring progress. The President's Budget requests a
    total of $2.1 billion for Ryan White activities, including $798 million
    for lifesaving medications through the AIDS Drug Assistance Program.

    Providing Access to Quality Health Care: The Administration's
            Comprehensive Plan
        These projects and reforms, as well as those at other Departments,
    cooperate to extend health care and insurance to millions of people.
    For instance, the President proposes to spend more than $125.7 billion
    over ten years to expand insurance coverage to millions of Americans
    through tax credits, purchasing pools, and Health Savings Accounts. The
    proposed Traditional Health Insurance Tax Credit would pay for 90
    percent of the cost of the premium of standard coverage, up to a
    maximum of $1,000 for an individual, and $3,000 for a family of four.
    The proposed Health Insurance Tax Credit for those with Health Savings
    Accounts (HSAs) would allow individuals to use a portion of the credit
    to purchase a high-deductible health plan while putting the remaining
    portion of the credit in an HSA. The Administration also proposes
    legislation that would that would allow small employers, civic groups,
    and community organizations to band together and leverage purchasing
    power to negotiate lower-priced coverage for their employees, members,
    and their families through Association Health Plans (AHPs). As opposed
    to previous proposals that limited AHPs to small businesses, this
    proposal also applies to private, non-profit, and multi-state entities
    outside the workplace.
        Thanks to the comprehensive nature of this vision, workers are
    already investing money tax-free for medical expenses through Health
    Savings Accounts, Americans have increasing flexibility to accumulate
    savings and to change jobs when they wish, and more Americans are
    accessing high-quality health care. We estimate that 12 to 14 million
    additional people will gain health insurance over the next ten years.

                 ENHANCING PUBLIC HEALTH AND PROTECTING AMERICA

    Bioterrorism Preparedness
        Since 2001, your support for HHS's bioterrorism efforts has been
    unwavering. As a result we have made tremendous strides in protecting
    our Nation from various threats. The HHS fiscal year 2006 budget builds
    upon these achievements to strengthen our ability to minimize the
    number of casualties that would occur as a result of a bioterrorist
    attack, or other attack with weapons of mass destruction. From 2001 to
    2005, HHS invested nearly $15 billion to prepare our Nation's health
    systems. The fiscal year 2006 budget requests $4.3 billion to continue
    this work, a 1,500 percent increase from the 2001, pre-9/11 level.
        The fiscal year 2006 request places the highest priority on those
    programs that address readiness issues for which there is a unique
    federal role. These include the new mass casualty initiative, the
    Strategic National Stockpile (SNS), and National Institutes of Health
    (NIH) research on next-generation countermeasures.
        HHS has a responsibility to lead public health and medical services
    during major disasters and emergencies. Toward this end, the
    President's Budget would invest $70 million in a new effort to develop
    federal mass casualty treatment capacity that can be rapidly deployed
    and staffed to supplement the surge capacity being developed at the
    state and local level. Of this amount, $50 million, financed through
    the SNS, will be used to procure and manage the mass casualty treatment
    units. The Medical Reserve Corps will be expanded by $12.5 million to
    support the enrollment, training, and credentialing of volunteers that
    could be deployed in the event of a national emergency. A new $7.5
    million effort will fund the development of a secure database that can
    consolidate healthcare provider credentialing information from federal,
    state, and non-government sources for quick retrieval in a major
    emergency. This activity will be fully coordinated with the state-based
    Emergency System for Advance Registration of Volunteer Healthcare
    Personnel that the Health Services and Resources Administration (HRSA)
    sponsors.
        The Strategic National Stockpile's goal is to provide state and
    local governments the pharmaceuticals and supplies they would need to
    minimize casualties from a bioterrorist attack or other major public
    health emergency within 12 hours. The budget requests a total of $600
    million for the SNS, an increase of $203 million above the fiscal year
    2005 enacted level (including the $50 million for mass casualty
    treatment units discussed earlier). The Administration has continued to
    reassess the stocks that are needed to best protect the American
    population. As a result, by the end of fiscal year 2006, the SNS will
    have sufficient antibiotics to provide prophylaxis to up to 60 million
    Americans exposed to the anthrax organism. The SNS will set up the
    highly specialized cold storage capacity needed for the IND vaccines
    procured through BioShield. Substantial funds will also be used to
    replace medications that are losing potency, and to maintain the
    capacity needed to deploy assets to any part of the Nation within hours
    of the detection of an event.
        Our Nation's ability to detect and counter bioterrorism ultimately
    depends on the state of biomedical science, and NIH will continue to
    ensure full coordination of research activities with other federal
    agencies in this battle. The President's Budget includes $1.8 billion
    for NIH biodefense research efforts, a net increase of $56 million.
    When this is adjusted for non-recurring extramural construction in
    fiscal year 2005, NIH biodefense research activities grow by $175
    million, or 11 percent, over fiscal year 2005. Included in this total
    is a $50 million initiative budgeted in the Public Health and Social
    Services Emergency Fund to develop new medical countermeasures against
    chemicals that could be used as weapons of mass destruction.
        HHS continues to have a strong commitment to preparing States and
    local public health departments and hospitals to prepare against public
    health emergencies and acts of bioterrorism. From fiscal year 2002 to
    fiscal year 2005, $5.4 billion has been invested in this work through
    the Centers for Disease Control (CDC) and HRSA's ongoing state and
    local preparedness programs. The fiscal year 2006 budget includes $1.3
    billion more for this work, increasing the cumulative total to $6.7
    billion.

    Influenza
        Since the H5N1 strain of avian influenza first appeared in 1997,
    public health officials have grown increasingly concerned about the
    possibility that a pandemic strain will emerge that could cause an
    additional 90,000 to 300,000+ deaths in the United States. Avian
    influenza has reappeared in Southeast Asia again this year, indicating
    that the virus has become endemic. The fiscal year 2006 budget
    continues to expand HHS's efforts to be prepared in the event this or
    another deadly influenza strain changes in a way that makes it easily
    communicable from person to person.
        Since fiscal year 2001, HHS has increased its direct expenditures
    related to influenza vaccine from $42 million to $439 million in fiscal
    year 2006, in addition to insurance reimbursement payments through
    Medicare. The fiscal year 2006 budget includes targeted efforts to
    ensure a stable supply of annual influenza vaccine, to improve access
    to influenza vaccine for children and Medicare beneficiaries, to
    develop the surge capacity that would be needed in a pandemic, and to
    improve the response to emerging infectious diseases before they reach
    the United States.
        Increasing the use of annual influenza vaccinations will both
    reduce annual morbidity/mortality, and make the Nation better prepared
    in the event of a pandemic. CDC estimates that 185 million people
    should receive annual immunizations but fewer than half of that number
    have ever been immunized in a given year. The President's Budget seeks
    to increase annual immunization rates by both making sure an ample
    supply is manufactured each year and working to ensure it is used. The
    President's Budget includes several initiatives within CDC's two
    immunization programs to expand the production of bulk monovalent and
    finished influenza vaccine for the 2006/7 influenza season. CDC will
    invest $70 million in new resources to build vaccine stockpiles. First,
    CDC will set aside $40 million in new mandatory Vaccines for Children
    (VFC) budget authority for a stockpile of finished pediatric influenza
    vaccine that can be used in the event of a late-season surge in demand;
    the first ever stockpile was purchased for the winter of 2004/5.
    Second, CDC's discretionary Section 317 program will invest $30 million
    in contracts to get manufacturers to make additional bulk monovalent
    vaccine over and above the amounts the companies expect to use for the
    2006/7 season. This added bulk vaccine will be available to be turned
    into finished vaccine if other producers experience problems, or if an
    unusually high demand for vaccine is anticipated. Bulk vaccine not used
    for the 2006/7 season will be kept for potential use the following
    year. Commonly, one or two of the strains in the trivalent influenza
    vaccine remain the same from one year to the next.
        HHS is also continuing its efforts to expand annual influenza
    immunizations. The Section 317 program will also use increased funding
    of $20 million over fiscal year 2005 to purchase an estimated two
    million doses of influenza vaccine for the 2006/7 influenza season to
    help states expand vaccination for children. Centers for Medicare and
    Medicaid Services has taken steps to ensure that physicians have
    appropriate incentives to improve vaccination rates. Since 2002, the
    Medicare reimbursement rate for the administration of influenza vaccine
    has increased more than four times, from an average of $3.98 in 2002 to
    $18.57 in 2005. The reimbursement rate for the vaccine product also
    increased, from $8.02 to $10.10.
        To ensure sufficient vaccine can be made quickly in a pandemic, the
    Nation needs to develop the ability to surge domestic vaccine
    production as soon as scientists determine that a pandemic strain has
    emerged. The President's Budget increases the Department's investment
    in pandemic preparedness efforts by $21 million, for a total of $120
    million in fiscal year 2006. This increase will be used to develop the
    year-round domestic surge vaccine production capacity that would be
    needed in a pandemic; this added surge capacity could also be used to
    respond to unexpected problems in the production of annual vaccines. It
    will finance contracts with vaccine manufacturers to develop and
    license influenza vaccines using new production techniques and
    establishing a domestic manufacturing capability. HHS will continue to
    ensure a year-round supply of specialized eggs needed for domestic
    production of currently licensed vaccines. Manufacturers will be
    encouraged to license and implement new processing and other
    technologies to improve vaccine yields from both new cell culture
    vaccines and existing egg-based vaccines. In addition, HHS will sponsor
    the development and licensing of antigen-sparing strategies that would
    increase the number of individuals who could be vaccinated from a given
    amount of bulk vaccine product. Finally, the President's Budget
    maintains the flexibility to redirect these funds to initiate pandemic
    vaccine production at any time a pandemic appears imminent.
        To improve our Nation's long-term preparedness and enhance the
    annual vaccine supply, NIH will invest approximately $120 million in
    influenza-related research nearly six times the fiscal year 2001 level.
    Research areas include new cell culture techniques for flu vaccine
    production, which complements the advanced development; vaccines for
    potential pandemic strains, including H5N1; next-generation antiviral
    drugs; rapid, ultra-sensitive diagnostic devices to detect influenza
    virus infection; and ways to make flu vaccine more effective among the
    elderly.
        These research and advanced development efforts will be
    complemented by expanding funding for CDC's Global Disease Detection
    initiatives by $12 million, from $22 million to $34 million in fiscal
    year 2006, to improve our ability to prevent and control outbreaks
    before they reach the United States.

    Childhood Immunization
        The President's Budget includes proposed legislation in the
    mandatory VFC program to improve low-income children's access to
    routine immunizations that I believe members of this committee should
    strongly support. This proposed legislation would ensure that all
    children have access to all routinely recommended vaccines regardless
    of cost such as the newly-approved meningococcal conjugate vaccine.
    This legislation would enable any child who is currently entitled to
    receive VFC vaccines to receive them at state and local public health
    clinics. There are hundreds of thousands of underinsured children who
    are entitled to VFC vaccines, but can receive them only at HRSA-funded
    health centers and other Federally Qualified Health Centers. When these
    children go to a state or local public health clinic, they are unable
    to receive vaccines through the VFC program and the State may decide
    not to use scarce discretionary dollars to provide newer, more
    expensive vaccines. This legislation will expand access to routine
    immunizations by eliminating this barrier to coverage and will help
    States meet the rising costs of new and better vaccines. As modern
    technology and research has generated new and better vaccines, that
    cost has risen dramatically. For example, when the pneumococcal
    conjugate vaccine became available, it increased the cost of vaccines
    to fully-immunize a child by approximately 80 percent. A new
    meningococcal vaccine has recently been approved that will further
    raise the cost to fully immunize a child making this legislation even
    more important.

    Focus on the Future--Health Information Technology and NIH
        Our fiscal year 2006 budget was also constructed with the knowledge
    that health information technology will improve the practice of
    medicine and make it more efficient. For example, the rapid
    implementation of secure and interoperable electronic health records
    will significantly improve the safety, quality, and cost-effectiveness
    of health care. To implement this vision, we are requesting an
    investment of $125 million. The Office of the National Coordinator for
    Health Information Technology would spend $75 million to provide
    strategic direction for development of a national interoperable health
    care system, and to address barriers to the widespread adoption of
    electronic health records. The Agency for Health Care Quality and
    Research continues to direct $50 million to accelerate the development,
    adoption, and diffusion of interoperable information technology in a
    range of health care settings.
        Equally important, major advances in knowledge about life sciences,
    especially the sequencing of the human genome, are opening dramatic new
    opportunities for biomedical research. Heretofore un-imagined prospects
    for more precisely predicting individual susceptibility to disease and
    responses to medication are now close at hand, as are new approaches to
    diagnosing, preventing, and treating disease and disability. These
    advances have been driven by the investments in research made by the
    National Institutes of Health (NIH), the world's largest and most
    distinguished organization dedicated to medical science.
        The fiscal year 2006 budget request for NIH of $28.8 billion seeks
    to capitalize on the opportunities these investments have created to
    further improve the health of the Nation. The NIH budget is built upon
    and reflects the tremendous growth in biomedical research spending in
    recent years. In fiscal year 2006, over $24 billion of the $28.8
    billion requested for NIH will flow out to the extramural community,
    which supports work by more than 200,000 research personnel affiliated
    with approximately 3,000 university, hospital, and other research
    facilities across our great Nation. These funds will support nearly
    39,000 investigator-initiated research project grants in fiscal year
    2006, including an estimated 9,463 new and competing awards. NIH will
    also fund close to 1,400 research centers, over 17,400 research
    trainees, and much more.
        In fiscal year 2006, NIH will also continue to implement the
    Roadmap for Medical Research by spending a total of $333 million, an
    increase of $98 million over fiscal year 2005, on initiatives to target
    research gaps and opportunities that no single NIH institute could
    solve alone. The budget request also emphasizes efforts to enhance
    collaborations for multidisciplinary neuroscience research and
    accelerate efforts to develop and evaluate vaccines against HIV/AIDS.
    Within this total, NIH will also increase funding to address critical
    requirements in biodefense, including a targeted $50 million research
    effort to develop new medical countermeasures for chemicals that can be
    used as weapons of mass destruction.

                       SUPPORTING A COMPASSIONATE SOCIETY

    Faith-Based and Community Organizations
        As part of the Administration's Faith-Based and Community
    Initiative, the HHS fiscal year 2006 budget maintains a commitment to
    strengthen the capacity of faith-based and community organizations,
    including the Access to Recovery program, the Compassion Capital Fund,
    the Mentoring Children of Prisoners program, and Maternity Group Homes.
        The toll of drug abuse on the individual, family, and community is
    both significant and cumulative. Abuse may lead to lost productivity
    and educational opportunity, lost lives, and to costly social and
    public health problems, including HIV/AIDS, domestic violence, child
    abuse, and crime. Through the Access to Recovery program, HHS will
    assist States in expanding access to clinical treatment and recovery
    support services and allow individuals to exercise choice among
    qualified community provider organizations, including those that are
    faith-based. This program recognizes that there are many pathways of
    recovery from addiction. Through Access to Recovery individuals are
    assessed, given a voucher for appropriate services, and provided with a
    list of providers from which they can choose. Fourteen States and one
    tribal organization were awarded Access to Recovery funding in fiscal
    year 2004, the first year of funding for the initiative. The funded
    entities have identified target populations that include youth,
    individuals involved with the criminal justice system, women,
    individuals with co-occurring disorders, and homeless individuals. The
    President's Budget increases support for the Access to Recovery
    initiative by 50 percent, for a total of $150 million, and will support
    a total of 22 States participating.
        The Compassion Capital Fund advances the efforts of community and
    charitable organizations, including faith-based organizations, to
    increase their effectiveness and enhance their ability to provide
    social services where they are needed. The President's Budget includes
    $100 million, an increase of $45 million in support of the Compassion
    Capital Fund.
        Within this program, the President has proposed a new focus on
    young Americans that will include support for programs that help youth
    overcome the specific risk of gang influence and involvement. This
    three-year, $150-million initiative will provide grants to faith-based
    and community organizations targeting youth ages 8-17, and will help
    some of America's communities that are most in need. These
    organizations will provide a positive model for youth one that respects
    women and rejects violence.

    Abstinence
        Expanding abstinence education programs are also part of a
    comprehensive and continuing effort of the Administration, because they
    help adolescents avoid behaviors that could jeopardize their futures.
    Last year, HHS integrated abstinence education activities with positive
    youth development efforts at the Administration for Children and
    Families (ACF), by transferring the Community-Based Abstinence
    Education program and the Abstinence Education Grants to States to ACF.
    The HHS fiscal year 2006 budget expands activities to educate
    adolescents and parents about the health risks associated with early
    sexual activity and provide them with the tools needed to help
    adolescents make healthy choices. The programs focus on educating
    adolescents ages 12 through 18, and create a positive environment
    within communities to support adolescents' decisions to postpone sexual
    activity. Where appropriate, the programs also offer mentoring,
    counseling, and adult supervision to promote abstinence with a focus on
    those groups which are most likely to bear children out of wedlock. A
    total of $206 million, an increase of $39 million, is requested for
    these activities.

    Head Start
        The Head Start program helps ensure that children, primarily in
    low-income families, are ready to succeed in school by supporting their
    social and cognitive development. Head Start programs also engage
    parents in their child's preschool experience by helping them achieve
    their own educational, literacy, and employment goals. The HHS fiscal
    year 2006 budget of $6.9 billion will provide comprehensive child
    development services to 919,000 children. This level includes an
    increase of $45 million to support the President's initiative to
    improve Head Start by funding nine state pilot projects to coordinate
    state preschool, child care, and Head Start in a comprehensive system
    of early childhood programs for low-income children.

    Temporary Assistance for Needy Families
        It has been three years since President Bush first proposed his
    strategy for reauthorizing TANF and the other critical programs
    included in welfare reform. During this time, the issues have been
    debated thoroughly but the work has not been completed and States have
    been left to wonder how they should proceed. We believe it is important
    to finish this work as soon as possible and set a strong, positive
    course for helping America's families. The proposal is guided by four
    critical goals that will transform the lives of low-income families:
    strengthen work, promote healthy families, give States greater
    flexibility, and demonstrate compassion to those in need.

    Administration on Aging
        The President's Budget requests a total of $1.4 billion in the
    Administration on Aging for programs that serve the most vulnerable
    elderly Americans, who otherwise lack access to healthy meals,
    preventive care, and other supports that enable them to remain in their
    home communities and out of nursing facilities. It also continues
    investments in program innovations to test new models of home and
    community-based care.

                            IMPROVING HHS MANAGEMENT

        The President's Management Agenda (PMA) provides a framework to
    improve the management and performance of HHS. HHS has taken
    significant steps to institutionalize its focus on results and achieve
    improved program performance that is important to the HHS mission and
    the American taxpayer.
        Budget and Performance Integration (BPI) aims to improve program
    performance and results by ensuring that performance information is
    used to inform funding and management decisions. For fiscal year 2006,
    HHS operating divisions produced their first ``performance budgets''
    which combine budget and performance information in a single document.
    With this new format the Department moved from the traditional approach
    of presenting separate budget justifications and performance plans to
    the use of one integrated document to present both budget and
    performance information. This move also enhanced the availability and
    use of program and performance information to inform the budget
    process.
        HHS has made significant steps in its implementation of the
    President's five government-wide management initiatives. The Program
    Assessment Rating Tool (PART) is an important component of the Budget
    and Performance Integration initiative and is used to assess program
    performance and improve the quality of performance information. Sixty-
    five HHS programs were reviewed in the PART process between fiscal year
    2004 and fiscal year 2006. HHS consolidated 40 personnel offices into
    four Human Resources Centers, which became operational in January 2004,
    and is planning several upcoming projects to support Human Capital
    strategic management. Since the start of the competitive sourcing
    initiative, HHS has competed almost 25 percent of its commercial
    activities, resulting in increased efficiencies and savings for the
    American taxpayer. For example, HHS anticipates gross savings of $55
    million from studies completed in fiscal year 2004, which will be
    redirected to mission critical activities at HHS. This year, HHS will
    focus on structuring competitions to maximize efficiencies and savings,
    as well as implement a savings validation plan. HHS also implemented
    several processes to improve the financial performance of the
    Department, such as streamlining and accelerating the annual financial
    reporting process and combining annual audited financial statements
    with program performance information in the Department's Performance
    and Accountability Report. HHS is also continues to implement the
    Unified Financial Management System throughout the Department. More
    than 95 percent of HHS' information systems have certified and
    accredited security plans. Finally, HHS has been working to achieve a
    more mature Enterprise Architecture that links performance to
    strategic, capital planning, and budget processes.
        Over the past four years, the Administration has worked diligently
    with the Department to make America and the world healthier. I am proud
    to build on the HHS record of achievements. For the upcoming fiscal
    year, the President and I share an aggressive agenda for HHS that
    advances a healthier, stronger America while upholding fiscal
    responsibility and good stewardship of the People's money. I look
    forward to working with Congress as we move forward in this direction.
    I am happy to answer any questions you may have.

                              MEDICAID PROTECTION

        Senator Specter. Well, thank you very much, Mr. Secretary,
    for many things, most recently brevity.
        Mr. Secretary, I begin with a question on the Medicaid. It
    has been a topic among Senators. It serves people who are
    desperately in need of medical attention. There is a projected
    reduction which is represented at 1 percent, but in the out-
    years it grows exponentially. You come with three terms as
    Governor of Utah, so you've been in the Governor's role. The
    Governors are very concerned about Medicaid.
        Senator Smith of Oregon has offered an alternative proposal
    to take a closer look at it on a commission, not satisfied with
    the review which has been made so far, which has--could have
    more depth. We can always study more. Of course it involves
    some delay. But how will the recipients of Medicaid at the
    present time be protected with the proposal which you have
    backed?
        Secretary Leavitt. Senator, that's the right question in my
    mind. How do we protect the coverage of people who are
    currently being served, and how in fact can we expand the reach
    of Medicaid? It's currently serving some 46 million Americans.
    But some of them are in jeopardy because the program has such
    rigid inflexibility that States are by the nature of that
    inflexibility being forced to look at diminishing the coverage
    substantially or eliminating the coverage of many optional
    groups.
        A couple of points. One is, if there is any perception that
    Medicaid is being cut, I would like to suggest that is not
    correct. The Medicaid budget will grow by in excess of 7
    percent over the next 10 years. We'll see almost $5 trillion
    spent at the end of that 10 years. We'll see $900 billion more
    from the Federal side be put into Medicaid. It is a rapidly
    growing program.
        What the budget does reflect is a desire to see it increase
    at a slightly slower rate. The Governors I believe are, as I've
    spoken with them, some--I think I've had conversations now with
    38 of them about this subject in direct and personal ways.
    There are a series of reforms that they're anxious to see that
    provide flexibilities that will allow them to continue the
    coverage of many who they believe are imperiled.
        The reforms are quite common sense in my mind. One is to
    reduce the amount that's paid for prescription drugs, not to
    reduce the number of people served by them or to reduce the
    number of drugs they can receive, but to change the way in
    which they are paid for. Medicaid would be widely known as the
    best payer in the business. They pay higher costs for
    prescription drugs than Medicare or for that matter most
    private plans. This would propose a statute change that would
    allow them to essentially pay the same rate as Medicare Part B
    will pay.
        The second reform is caring for what's known as an asset
    spend-down where people have learned to give their assets to
    their children so that the State can pay for their Medicaid,
    and Governors would like to see that changed.
        The third is in being able to provide a series of co-pays
    among those who are in higher income brackets served by
    Medicaid. Governors are interested to see Medicaid recipients
    become cost-conscious consumers in the same way that others are
    required.
        The fourth would be really a celebration of SCHIP, to use
    SCHIP more broadly to provide more flexibility in constructing
    benefit plans of again mostly mothers and children in higher
    income brackets that would provide the ability to serve more.
        The last is an important reform, and that is as the number
    of elderly served by Medicaid increases and will clearly
    increase in the future, there's a desire to in essence liberate
    Medicaid from exclusive use of nursing homes. We'd like to be
    able to have people served in their homes and in communities.
    It's more efficient, and frankly that's where they want to be
    served.
        So, Senator, those are the reforms that are on the table.
    They are reflected in the budget as a budget reduction, but
    only because they provide flexibility that in my judgement
    almost all the States will be using in health care in different
    ways to preserve the coverage of those who might lose it
    otherwise.
        Senator Specter. Mr. Secretary, let me compliment you on
    finishing your answer within 2 seconds of the allotted time
    which I have. That plus your opening statement on brevity gets
    you off to a very, very good start with this subcommittee.
        Secretary Leavitt. Thank you.
        Senator Specter. I'm now going to turn the gavel over to my
    distinguished colleague, Senator DeWine, to relieve me on the
    chairmanship. Thank you very much.
        Secretary Leavitt. Thank you, Senator.
        Senator DeWine [presiding]. Senator Harkin.

                           IOWA ARMY AMMUNITION PLANT

        Senator Harkin. Thank you very much, Mr. Chairman. Mr.
    Secretary, we visited earlier. We talked about briefly, a month
    or so ago, I forget when it was, about the situation at the
    Iowa Army ammunition plant that had to do with workers who had
    worked there for years in a nuclear weapons facility there.
        A little background. Several years ago a worker had
    contacted me there because of all the cancers that had been
    happening to people, asked me to look into this. I contacted
    the Department of the Army who informed me that they had never
    assembled nuclear weapons there, and so I went out on a limb
    and told this guy that he must be mistaken, and he never gave
    up, Mr. Anderson never gave up. He came back and we finally
    found out that in fact they had been assembling nuclear weapons
    there for many, many years, and many of the workers there were
    exposed to high levels of radiation, had no knowledge of this.
    They were sworn to secrecy. Many of them never talked to
    doctors, never talked to anyone, because of this oath of
    secrecy they had taken.
        Well, this has all gone through a lot of hearings and
    processes and stuff. Senator Bond and I have managed to win
    four votes on this. But basically the NIOSH Advisory Board on
    Radiation and Worker Health voted seven-zip, seven to nothing,
    to provide automatic compensation for former nuclear weapons
    workers at the Iowa Army ammunition plant.
        Now, under the law they are then to notify you by letter of
    their decision. Under the law you then have 30 days whether to
    approve or disapprove of this, and then of course Congress then
    can step in depending upon what the decision is. Have you
    received any--that notification yet?
        Secretary Leavitt. No.
        Senator Harkin. Well, this may be an unfair question, but
    I'll ask it. Do you have any explanation as to why you have not
    received an official notification?
        Secretary Leavitt. I don't. I've read accounts that the
    vote took place as you have indicated. I'm aware that--but I
    can't reconcile why they haven't. When I do receive it, we'll
    obviously act in a way that's timely.
        Senator Harkin. Well, Mr. Secretary, I--well, I wrote them
    a letter yesterday along with others to Mr. Howard, director of
    NIOSH, and Mr. Paul Ziemer, chairman of the Advisory Board on
    Radiation and Worker Health, because I didn't know, I really
    didn't know if they had transmitted or not. So I wrote them a
    letter saying, if you haven't, please do it. So I hope that we
    can find out why it is that they have not forwarded this,
    because these workers have been waiting a long time. It was a--
    wasn't even a--as I said, wasn't even a close vote, seven to
    nothing. So I'm hopeful we can move ahead on that.
        The other thing I wanted to talk about just for the record,
    Mr. Secretary, it was reported yesterday that the White House
    disagrees with the GAO opinion that prepackaged video news
    releases prepared and distributed by Federal agencies or their
    public relations firms that do not disclose, that this would
    not constitute illegal covert propaganda.
        One of the videos reviewed by GAO was funded by one of your
    agencies, CMS. Now, again, I don't expect you to have these
    numbers at your fingertips, but if your staff could take note
    of this, as the appropriations subcommittee here, could you
    provide this subcommittee with your anticipated budget for
    fiscal year 2006 for public relations activities, including any
    contracts with public relations firms, media buys, et cetera,
    if you could provide that for the committee.
        Secretary Leavitt. Indeed we will.
        [The information follows:]

        Senator Harkin. I appreciate that.

                         MEDICARE MODERNIZATION--PART D

        Secretary Leavitt. Senator, I might just comment----
        Senator Harkin. Sure.
        Secretary Leavitt [continuing]. Make one statement that we
    will obviously follow the guidance of our legal counsel on this
    matter and make certain that we are acting within the scope of
    the rules. We have a very demanding challenge in front of us
    collectively as a government during the next 15 months, and
    it's the rollout of Medicare Modernization, the Part D for
    prescription drugs.
        One of the--at the base of this conflict was the question
    of what tools we should deploy and use to provide people with
    information about their options under Part D. I mention that
    simply to put some perspective on the dilemma we're facing,
    reaching people, educating them. We enlist the help of the
    Senate, and at the risk of eliminating the good reputation I
    formed with Senator Specter on stopping when that red light
    goes on, I'll quit there.
        Senator Harkin. Well, Mr. Secretary, just summing up, we
    send out letters and information to our constituents all the
    time, but we sign our names to it, you know, and I'm certain
    those who in my State who disagree with me dismiss it because
    I've said it, and you know how that goes. But at least they
    know where it comes from.
        Secretary Leavitt. Right.
        Senator Harkin. Do you think that any information provided
    by HHS should be attributed to HHS? I mean, I realize you're
    going to get information out, but at least it ought to say
    where it comes from.
        Secretary Leavitt. That seems like a logical statement to
    me. I don't know the nature of this dispute. I know that there
    has been discussion between GAO and differences of opinion
    about it. At this point, our role is to first of all do the
    best job we can in being able to educate people on the
    opportunity that's there and at the same time make certain
    we're within the rules. I can assure you we'll do our best to
    stay within them.
        Senator Harkin. I thank you. We will, as I said, when you
    send those anticipated figures up, any contracts you have with
    media firms and stuff like that, we would like to analyze that
    closely.
        Secretary Leavitt. Thank you.
        Senator Harkin. Thank you, Mr. Secretary. Thank you, Mr.
    Chairman.
        Senator DeWine. Senator Craig.

                        STATEMENT OF SENATOR LARRY CRAIG

                              PANDEMIC FLU VACCINE

        Senator Craig. Thank you very much, Mr. Chairman. I would
    hope that any activity or publicity that has been garnered as a
    result of certain advertising and information flows does not
    put a chilling effect on what I believe is a fundamental
    responsibility of the agency to communicate with the public,
    and to do so in a forthright and direct way. Clearly as we
    struggled to bring folks on line with the prescription drug
    card and to get them into the system so that as we roll out the
    plan as you're talking about, there clearly needed to be an
    informational flow. There was a partnership at AARP at that
    time that was a cooperative effort, Mr. Secretary, that I think
    worked extremely well.
        So while I do believe there ought to be full disclosure, I
    don't think you or I would dispute that, I would hope that
    anyone who might charge that you're doing something beyond
    without good grounds, this Senate spends a lot of time and
    money getting out our point of view, and more importantly, once
    a policy is developed and ready for the public, I think it's
    important that we communicate it effectively.

                                  FLU VACCINE

        One question of you: Last year I wore a different hat than
    I wear today, and that was chairman of the Select Committee on
    Aging--Special Committee on Aging. We spent a lot of time prior
    to and after the announcement by Chiron that they had been
    forced to close their Liverpool plant and could not supply to
    the marketplace and to Americans the necessary flu vaccine that
    we had anticipated. We worked very closely with your
    predecessor in making sure that somehow we made it through, and
    we are making it through this year it appears. At least thank
    goodness we have not had a major outbreak, but the flu is out
    there and it's taking lives as it does.
        But I think you are right to be concerned of a pandemic,
    and therefore, clearly the need in this country to build a
    reliable supply of flu vaccine. We, by a--for a variety of
    reasons including liability, while our class action efforts of
    the past month may help some, we've run a lot of folks offshore
    or out of business. The business of making vaccines is not 100
    percent perfect in all instances. There is liability without
    question.
        Senator Bayh and I have introduced legislation, you're
    right. There are others who have looked at shaping the market
    or assisting the market. When we deal with the flu virus, and
    it is constantly in mutation, you cannot inventory this on the
    shelf and keep it there. It must be new with the season. You
    have to have the capability to produce it. I do believe there
    will come a day when you are right to be concerned about what's
    going on elsewhere in the world as it relates to flu vaccines.
    It is a killer of our elderly, there is no question about it.
        Could you for a moment spend some time on that issue with
    us as to what you anticipate you'll be doing? I see the
    Liverpool plant is back up in operation. It looks like Chiron
    is back in the market. That's wonderful. But we're still--we
    still have a very fragile system. We're looking at new
    techniques beyond the egg to cell for production purposes.
    Enlighten us if you would as to where you see it at this
    moment, and what we might do to assist you in ensuring a
    constant and reliable supply.
        Secretary Leavitt. Judgements on how much and when and what
    to buy are complex and often times required to be made with
    incomplete information, or at least imperfect information.
        Senator Craig. That's right.
        Secretary Leavitt. It's in some respects like many other
    commodity-type business or business decisions where there are
    peaks of use and the question as to whether you buy to the peak
    always or whether you buy what you think will be normal. The
    truth is they will not be manufactured unless there's a market,
    and often times government has to be that market. We've
    proposed in this budget for back-up guarantees some $20 million
    in 2005 and $30 million in 2006, and also $120 million for
    pandemic work for alternative production.
        I would like to just update you some, Senator, on efforts
    we are making to follow the avian flu in Asia. We have people
    on the ground who are now working with various governments in
    their clinics, in their--working with their governments, with
    their practitioners. We're trying to deploy more and more
    resources at the source. Pandemics have occurred on three
    different occasions during this century. There's no reason for
    us to believe they won't happen again. They strike quickly. We
    don't know when they will strike, we don't know where they will
    strike, and as you've suggested, we don't always know the
    strain of the flu, and we have to be in a position to respond
    quickly.
        It is a matter of grave concern to me. I am following this
    literally on a daily basis. I receive a daily briefing now from
    CDC and others involved. Currently I believe that we are
    following the right path, but we'll keep you and other members
    of the committee informed as things develop.
        Senator Craig. Well, I thank you very much. There are many
    of us following this. We're glad to see you fully engaged.
    You've made, in my opinion, the right statement. To ask
    companies to supply to an indeterminate market means that we
    have to stabilize the market, and the only way to do that is
    for government to be the stability. Therefore to, at the end of
    the cycle, to be able to buy out, if you will, excess, as long
    as the companies have met the level of projection, is something
    I think we ought to build a level of expectation for in the
    marketplace. It's in part why we don't have companies operating
    today. We bankrupt them by basically suggesting they supply to
    a market it didn't develop and then we weren't there to sustain
    them in the end.
        So I thank you for that. I'm glad to see there's increased
    money in the budget for those purposes and that we're moving as
    well as we can in relation to pandemic knowledge. Thank you.

                       STATEMENT OF SENATOR MIKE DE WINE

        Senator DeWine. Mr. Secretary, welcome.
        Secretary Leavitt. Thank you, Senator.

                     COMMUNITY ALTERNATIVE FUNDING SYSTEMS

        Senator DeWine. Ohio's Community Alternative Funding
    Systems, the CAFS program, serves individuals with mental
    retardation and developmental disability. However, the CAFS
    program apparently does not comply with Federal mandates, and
    as a result, Ohio will not be providing Medicaid services to
    this fragile population. You and I have talked about this, our
    staffs have talked about this, and I just want to again mention
    it to you that as we, Ohio, works its way through this problem,
    I hope that you will continue to work with Ohio to try to work
    this out. We understand Ohio has to comply with Federal law,
    but we need to make this transition as smooth as we can as we
    find other ways to serve this population. These are kids, these
    are kids in school, these are kids who really are a most
    fragile population. So I just look forward to working with you
    on that.
        Secretary Leavitt. Thank you. May I say that there is no
    disagreement on the nobility of the purpose and a commitment to
    find a solution.

                                MEDICAID FUNDING

        Senator DeWine. Good. We appreciate it. We'll work with
    you. We appreciate you working with us. Thank you very much.
        Last year, one of our Ohio children's hospitals in
    Cincinnati was pursuing a Federal grant trying to find money to
    continue a major project in improving the quality, the safety,
    and the efficiency of its care using technology, best
    practices, and sound management. But they looked around and
    they found that really there was no way to pursue Federal
    funding in regard to kids. It's rather ironic, I think, that
    that is true, because if they had been doing it, if it was an
    adult hospital, they had been doing it, there's Medicare money
    available. There's not Medicaid money available.
        So again we have a situation really where kids are
    discriminated against. I wonder what you can do to change that
    in your Department and what you see is the future to try to
    deal with this.

                            FLEXIBILITY IN MEDICAID

        Secretary Leavitt. I spoke briefly earlier about what I
    believe is a wide and broadly held view that Medicaid is
    rigidly inflexible and that it creates the kind of
    circumstances--we've talked a couple of times already today
    about where there are noble causes, noble pursuits that ought
    to be done, and there's no disagreement on the cause, but
    people are left without the capacity to respond to it.
        That's one of the reasons that we hope very much that the
    Congress will act to provide more flexibility in Medicaid. I
    believe one of those areas would be the ability to construct
    benefit packages that would be tailored particularly in the
    instances of mothers and children. We believe more flexibility
    will not result in anything other than more people being
    covered as opposed to fewer.
        Senator DeWine. Well, this is the type of thing that, you
    know, our children's hospitals really need the ability to deal
    with, and I would hope you would take a look at that as we may
    possibly design something to deal with that.

                      TREATMENT OF CHILDREN WITH HIV/AIDS

        Senator DeWine. Let me move to another area. Currently few
    programs specifically target the treatment of children with
    HIV/AIDS in developing countries. A primary reason is the lack
    of appropriate pharmaceuticals for use in children. We all of
    course know that children are not small adults and treating
    them that way jeopardizes their lives. With 2.5 million
    children infected with HIV around the world, it's essential
    that we have appropriate medications to treat them.
        How does your budget plan and your Department--how do you
    plan to ensure that HIV/AIDS drugs, both generic and brand name
    approved by the FDA expedited process, also include pediatric
    formulations as well as important dosing information needed for
    treating different age groups?
        Secretary Leavitt. Senator, NIH has provided $25 million in
    2004 and 2005, and they're proposing another $25 million in the
    2006 for pediatric drug research. I believe that information on
    the effects of those drugs in children is critically important
    as well, and I'm looking forward to working with you to ensure
    that we have success in this effort.
        [The information follows:]

                                 HIV/AIDS Drugs

        On May 17, 2004 FDA published guidance for the pharmaceutical
    industry encouraging manufacturers to submit marketing applications for
    fixed dose combination (FDC) and co-packaged versions of previously
    approved single entity anti-retroviral therapies. The guidance
    encourages the development of pediatric formulations for these
    products. Also, subsequent to the publication of the draft guidance,
    FDA expanded the expedited review program to include single product
    generic applications. Most of the first line antiretroviral agents are
    currently available in pediatric dosage forms, so these pediatric
    formulations can be made available through the generic drug approval
    process.
        Regarding fixed dose and co-packaged combination products, only one
    company thus far has expressed interest to FDA in developing a
    pediatric combination product. This could be explained in part by the
    challenges associated with establishing appropriate doses for pediatric
    patients for a fixed dose combination product. Such combination
    products generally do not provide the dosing flexibility needed for
    pediatric HIV therapy. Also, many of the pediatric formulations are in
    the form of oral solutions that are not amenable to combination product
    development. Combination therapy in younger pediatric patients might
    best be accomplished through the use of individually formulated
    antiretroviral products that can be made available through the generic
    approval process. The adult combination products can be used in the
    older pediatric population.
        Regarding the application of the Pediatric Research Equity Act
    (PREA) to PEPFAR (President's Emergency Plan for Aids Relief)
    applications, the Agency is enforcing PREA for these applications as it
    would with any other application. However, PREA does not apply to most
    generic products or co-packaged products. When PREA does apply to a
    drug (including HIV drugs) we do not hold up approval but grant
    deferrals as appropriate for these life-saving treatments.
        In addition, the pediatric exclusivity provision of the 1997 FDA
    Modernization Act and the subsequent 2002 Best Pharmaceuticals for
    Children Act have generated many clinical studies and useful
    prescribing information for many products, including several for the
    treatment of HIV infection. FDA has an HIV Written Request Template to
    facilitate the development of products. Following are a few examples of
    products that have been approved for treatment of HIV infection in
    children. These approvals resulted from studies submitted in response
    to a Written Request from FDA.
        Ziagen (abacavir), Zerit (stavidine), Videx (didanosine), and
    Viracept (nelfinavir mesylate), in combination with other
    antiretroviral agents, are indicated for the treatment of HIV-1
    infection in children. Use of Ziagen in pediatric patients aged 3
    months to 13 years is supported by pharmacokinetic studies and evidence
    from adequate and well-controlled studies of Ziagen in adults and
    pediatric patients. Use of Zerit in pediatric patients from birth
    though adolescence is supported by evidence from adequate and well-
    controlled studies of Zerit in adults with additional pharmacokinetic
    and safety data in pediatric patients. Use of Videx in pediatric
    patients two weeks of age through adolescence is supported by evidence
    from adequate and well-controlled studies of Videx in adults and
    pediatric patients. Use of Viracept in pediatric patients from age 2 to
    age 13 is supported by evidence from adequate and well-controlled
    studies of Viracept in adults with additional pharmacokinetic and
    safety data in pediatric patients.
        In addition, in March 2003, the Pediatric Subcommittee of the
    AntiInfective Drugs Advisory Committee of the Food and Drug
    Administration, Center for Drug Evaluation and Research discussed the
    development of antiretroviral drugs in HIV-infected and HIV-exposed
    neonates younger than four weeks of age. The Advisory Committee
    supported the continued need for development of products for neonates.
        These are just a few examples that demonstrate FDA's commitment to
    the principle that product development should include pediatric studies
    when pediatric use of the product is intended. In addition, through
    efforts to make safe and effective antiretrovirals available for
    treatment of HIV across much of the developing world, we expect to
    reduce the number of children born with HIV infection and thus
    significantly impact global health.

        Senator DeWine. Good. Well, my time is up, but we hope to
    continue to work with you on this. Thank you very much. Senator
    Kohl is gone. Senator Murray.

                       STATEMENT OF SENATOR PATTY MURRAY

        Senator Murray. Thank you very much, Mr. Chairman. Mr.
    Secretary, thank you for being here today. I can't think of an
    agency that doesn't have more direct impact on lives of every
    single one of the constituents we represent here, and it's a
    tremendous job and we appreciate you taking it on.

                                   HEAD START

        I do want to make one comment on Head Start. We had a
    conversation about this before and in a written response you
    sent to me you said that you are committed to ensuring the
    implementation of the President's proposals on Head Start that
    provide an opportunity for more children to be served by local
    Head Start programs at the highest level of quality.
        I liked the statement, but unfortunately the President's
    proposal does not provide for more kids to be in Head Start,
    and I just really urge you to go slow on this proposal. If we
    break the compact that these local communities have in
    providing Head Start, I think we're going to take away the
    basic tenet that Head Start was put together on. It's not just
    an education program. It's making sure that kids are ready to
    learn when they get to school.
        So I just--I ask you again, I will tell you I'm going to be
    working hard to make sure that we do this right and you'll be
    hearing more from me on that, because I'm very concerned the
    President's proposal will eliminate an important compact and
    just essentially put in another bureaucratic layer of
    government that won't help any child get to school ready to
    learn.

                             MIGRANT HEALTH CENTERS

        What I did want to ask you about today, however, is the
    budget request which we are here to discuss today, and I am
    very concerned about the mixed messages that we're sending
    communities. I really appreciate the President's leadership on
    funding for the community in migrant health centers. I couldn't
    agree more with the administration's support for these centers,
    because they do provide prevention-based affordable health
    care. They're not just a safety net. They really do a good job
    in providing health care for low income, often uninsured
    patients that often fall through the cracks in our health care
    system. So I applaud the administration's request for another
    $304 million. I think that's great.
        But what I am concerned about is a number of the other
    budget policies that are coming at us will make it impossible
    for these community health centers to meet their mission and to
    provide the health care that we're asking them to. The other
    proposals on New Starts and Medicaid and the elimination of
    coordination services like the Healthy Community Access Program
    are going to have a huge impact.
        We know that our community health centers are already
    seeing double digit increases in the number of patients that
    need care, and as the number of patients uninsured continue to
    increase, their load is going to continue to increase. We need
    to make sure that we're not just funding new health centers,
    but we're making sure that the existing ones get the support
    they need.
        Medicaid on average accounts for more than 30 percent of
    the revenue for these community health centers, so any policy
    cuts in Medicaid is going to have a direct impact on that. I'm
    already hearing from all of my community health centers that
    they are deeply concerned about the proposed cuts in Medicaid.
    We're already dealing with a mental health crisis under
    Medicaid. I think you know CMS just notified Washington State
    that they can no longer depend on the $82 million annually to
    provide community-based mental health care for low income
    patients.
        Another policy I'm very concerned about is you talked about
    providing flexibility, but you're taking away, but that's a
    point for another day. The community health centers are the
    ones who are going to absorb the impact of that on them.
        Then the elimination of the Healthy Community Access
    Program that works out in our communities. I know the
    administration in the past has said it's not effective. I
    really invite you out to Washington State or to talk to some of
    our HCAP grantees, because they really are making a difference.
    Elimination of that is going to be very hard for our community
    health centers to be able to succeed.
        So my question to you is, thank you for providing
    additional funds, but budget policies that impact these
    community health centers in very negative ways are going to
    make it impossible. How do you reconcile increasing the money
    but passing the policies that make it very difficult for them
    to be successful?
        Secretary Leavitt. Senator, let me respond on Head Start.
    I'll go through all of the three areas you talked about. The
    President's proposal would actually allow for 9,729 additional
    students to be served by Head Start. The President and the
    Secretary of HHS are enthusiastic about Head Start and want to
    make sure it continues not just to serve those, but to expand.
    I've had a number of meetings now with Secretary Spelling to
    talk about how we could coordinate activities between the
    Department of Education and HHS. We think that that will
    leverage those funds even further.
        With respect to health center funds and the whole subject
    of community health centers, that's another area where we share
    enthusiasm. We think that the President's proposal puts us
    again on a path to complete his objective of 1,200 new and
    expanding centers. This one will add 40 in the areas with the
    lowest incomes.
        We have made a policy decision to emphasize actual service
    delivery, and there are places in this budget, with health
    center funds being one of them, where the actual--where by
    statute only 15 percent of those funds could go for service
    delivery and went for other matters ancillary to it. So there
    was a priority put on our part for the actual delivery of
    funds.
        With respect to Medicaid, clearly community health centers
    are dependent upon continued participation by Medicaid. I
    think, as you pointed out and others have, that it's nearly 35
    percent of their overall budget. We want them to succeed. A cut
    in the number of dollars in Medicaid would in fact be alarming.
    However, this budget will reflect more than 7 percent more
    dollars going into Medicaid than did before. This is not a
    matter of cutting. We want Medicaid to increase. We want it to
    increase .2 of 1 percent than what had been proposed before,
    but there are very few large numbers in the President's budget
    that will reflect a 7 percent-plus increase, and Medicaid is
    one of them.

                                   HEAD START

        Senator Murray. Well, I appreciate your response. I know
    I'm out of time. I just would ask you again to go cautiously
    with Head Start, because it is more than just an education
    program, and it is a success story, and I want to make sure we
    don't undo that.
        I just am concerned that if we just focus on new community
    health centers we are going to leave the ones that are out
    there not doing a good job and then we'll be back here saying,
    well, they don't do a good job, let's not fund any of them, and
    I don't want to go there. I think it's really important to
    understand the health care impact, the crisis, the budget
    numbers that are hitting these, the number of uninsured that
    are increasing, and we need to be able to do our part here. I
    will continue to work on that. I know you care as well, so
    thank you very much.
        Secretary Leavitt. Thank you.
        Senator DeWine. Senator Durbin.

                     STATEMENT OF SENATOR RICHARD J. DURBIN

        Senator Durbin. Thank you very much, Mr. Chairman. George
    Carlin is a great observer of life and has a routine relative
    to riding on airplanes, most of which cannot be repeated at
    this hearing.
        But there is one thing he observes: When starting to land
    in an airplane, the flight attendant says, let me be the first
    to welcome you to Washington DC. Carlin asked, if you're on the
    same plane I'm on, how can you be welcoming me anywhere? I
    would like to welcome you to this committee, but since this is
    the first time I've ever been on this committee, I can't. I'm
    just happy to be here with you today.
        Secretary Leavitt. Thank you.

                             MEDICAID AND MEDICARE

        Senator Durbin. I can't officially welcome you, but I've
    wanted to be on this subcommittee for a long time and I'm glad
    that it finally happened. It's very critical and important.

                                SOCIAL SECURITY

        The President is on a 60-day tour around America to cities
    to talk about the crisis or challenge or problem, or whatever
    is the word du jour of Social Security. There are many of us
    who believe that Social Security does present a challenge that
    we should address and address now with sensible, common sense
    approaches that over the long term will help us meet our needs.
        I'd like to show you a chart though that compares the
    challenge of Social Security to other challenges. I'll make
    sure the Secretary can see it there. You'll note on this chart
    that over the period of time of our debate about the costs of
    Federal programs, we anticipate by 2075 a 48 percent increase
    in the cost of Social Security as a percentage of our gross
    domestic product. Look at the numbers for Medicare and
    Medicaid, dramatically larger, 318 percent for Medicare, 342
    percent for Medicaid.
        So if the President is looking down the track and seeing 40
    or 50 years from now this light of a train coming toward us and
    warning us about this, certainly we should be sensitive to the
    fact that looming directly behind us is a locomotive that says
    health care in America that is about to run us over.
        You are addressing through this budget some of the cost of
    programs like Medicaid and Medicare. Neither this
    administration nor this Congress apparently has the political
    will to address the much larger issue we face in this country.
    If there were another line in this chart, the cost of health
    insurance by the year 2075, it might even be larger in terms of
    increase. So how can we address these things so tentatively in
    such a piecemeal fashion and expect to really resolve the
    difficulty?

                          AFFORDABLE HEALTH INSURANCE

        I just left a meeting with the President of one of the
    largest unions in America. He says we're about to lose
    manufacturing through his union because of the cost of health
    care. I hear that from small and large businesses alike. Yet
    we're not talking about it. If the President were making a 60-
    day, 60-city tour about what to do to make sure that every
    American had affordable health insurance that provided basic
    protection for their family, he would have turnouts,
    unimaginable turnouts of people interested in this issue.

                                    MEDICAID

        So I ask you this. What is--what do you think we should do
    in this next year? Is the answer to cut coverage on Medicaid?
    Every time someone in Washington says flexibility, I grab my
    wallet, because flexibility means less money, I know that, I've
    been around here long enough. I understand we need to change
    some rules, but I'm afraid flexibility is just a cover for a
    reduction in cost.
        Shouldn't we be asking for some advantage for consumers and
    taxpayers in this process? We're still in a position where
    Medicare cannot bargain under the new prescription drug plan to
    bring pharmaceutical costs down. Medicaid in most States is
    really limited as to how it can bargain with drug companies to
    bring the cost of drugs down for recipients in those States.
    Yet we know over the border in Canada drugs are a fraction of
    the cost.
        How can we be honest and sincere about dealing with health
    care if all we're going to do is cut benefits for poor people
    and not address cost issues such as the ones that I just
    mentioned?
        Secretary Leavitt. Senator, I've become fond of observing
    that there is a point in the life of every problem when it's
    big enough you can see it but small enough you can still solve
    it. Your chart reflects three of them. The President has
    clearly taken two of them on this year. That's--two out of
    three is a very significant undertaking.
        But the matter that you've reflected on, health care costs,
    clearly is one that we will all have to deal with. Now I,
    recognizing the limit of time, may I just say--point out four
    things that I believe can and should be done in this budget
    year to get us started?

                                MEDICAID REFORM

        One is in fact Medicaid reform. These are reforms that will
    not result in anyone losing health insurance, but in fact will
    allow us to preserve health insurance for many who have it and
    who are at risk of losing it, and I believe would have the
    capacity of expanding health care to others for reasons that
    I've already enumerated and won't repeat.

                                   HEALTH IT

        The second is health IT. I believe health IT is the new
    frontier in health care productivity. Many things in this
    budget would point us toward being able to harness the powers
    of technology.
        But it leads us to, I think, a third, and that is we're
    measuring the wrong thing. We measure quantity of care, not the
    quality of care. We are not measuring outcomes. And I believe
    until we begin to measure performance outcomes and compensate
    providers and others on the basis of those outcomes, we will
    continue to see an unsatisfying result.

                           ACCESS TO HEALTH INSURANCE

        The fourth would be expanding health care to--or access to
    health insurance. The President's proposal would allocate $125
    billion over the next 10 years and would result in 12 to 14
    million people who currently do not have coverage to receive
    it. So Medicaid reforms, IT, pay for performance, and expanding
    access to health insurance through health savings accounts and
    other mechanisms I believe would be at least steps in the
    direction that you've pointed.
        Senator Durbin. I think they are steps in that direction.
    There may be some different--I don't know if association health
    plans is part of what you're suggesting here. They raise a lot
    of questions about standards and actual coverage and the like
    and the financial stability of the company's offering.

                            HEALTH SAVINGS ACCOUNTS

        Health savings accounts again have been a wildly popular
    theory here since Golden Rule Insurance Company became the
    favorite of then-Speaker Gingrich. We keep hearing about it
    every year. I'd like to see some demonstrated proof that it
    really does offer the kind of health insurance coverage that we
    want to see in the long term.
        I don't know, Mr. Chairman, if my time is expired here.
        Senator DeWine. Why don't you just continue.
        Senator Durbin. Thank you.
        Senator DeWine. Because I'm going to have some questions
    too, so why don't you just go ahead.
        Senator Durbin. Well, thank you very much.
        Senator DeWine. As long as the Secretary has a couple more
    minutes.

                                    TITLE X

        Senator Durbin. I will just try to make it as direct as I
    can and as brief as I can. Let me talk to you about Title X.
    Title X, of course, is the family planning program,
    particularly for low-income people. If there's one thing that
    divides this Congress and this Nation, it is the question of
    abortion, and we have spent more time and anguish over this
    issue, what is the right thing to do. Most people would
    conclude that the right thing to do is to give to that
    prospective mother and father the option of planning their
    family so that they don't find themselves in a position where
    there are unintended or unplanned pregnancies forcing decisions
    which may lead to abortion.
        I take a look at where we are today. Your fiscal budget for
    2006 flat funds Title X family planning programs at $286
    million. This level of funding does not keep up with inflation
    and meets the needs of fewer than half of the low-income women
    who qualify. If we are truly trying to reduce the number of
    unintended pregnancies and abortions, how can we do it with a
    budget that does not meet the obvious need for family planning
    information, counseling, medications for the lowest income
    people in America?
        Secretary Leavitt. Senator, you're correct in that the
    budget between 2005 and 2006 is the same. That follows,
    however, a year where we did increase our proposal by $10
    million. I'd also point out the fact that the Federal share of
    Medicaid during that period of time who served that same group
    went up $65 million, and the Indian Health Service went up $19
    million.
        So while that one category may have been level, the broader
    view was up $84 million on----
        Senator Durbin. On Medicaid as opposed to Title X.
        Secretary Leavitt. On Medicaid and Indian Health Services,
    and they serve basically the same population.
        Senator Durbin. I would not disagree, but certainly that
    money is being spent on many, many other things, not focused as
    Title X is on family planning.
        Let me ask you in the same vein, most parents that I know,
    certainly my family, raising children preached abstinence,
    saying to these children, my children and many other children,
    wait, don't make a mistake, make the right decision and have
    enough respect for yourself to make that right decision. That
    has become such a major part of our effort now in trying to
    reduce teen pregnancy and unintended pregnancy.

                                   ABSTINENCE

        The proposed budget includes a $38 million increase for
    abstinence only until marriage programs. The groups that have
    taken a look at this, like the National Academy of Sciences'
    Institute of Medicine, have criticized this investment in these
    abstinence-only programs. Some investigations by the House
    Committee on Government Reform have found that the abstinence-
    only programs contain errors and distortions in the messages
    that they are giving to people and young people. One federally
    funded curriculum, for example, was found to be teaching
    students that sweat and tears are risk factors for HIV
    transmission, which I don't believe any reputable medical
    doctor would agree with.
        So I ask you, when it comes to these abstinence-only
    programs and the amount of money that we're putting into them,
    do you believe that this is our best investment in terms of
    good public health policy to reach the goal of educating young
    people so that they make the right decisions about their own
    bodies?
        Secretary Leavitt. Senator, we serve many populations in
    many different ways. This is a commitment on the part of the
    administration to teach one principle that we know is true, and
    that is abstinence is 100 percent effective. I also recognize
    that there are times when one program or another will have the
    validity of one fact or another or approach on all sides of the
    ideologic spectrum, and we ought not to be defending things
    that aren't true in any of those.
        We need to have a commitment to the truth, and the
    President's commitment to include abstinence-only programs is
    real, because he believes, as do I, that it is in fact what we
    ought to be teaching our children.
        Senator Durbin. I don't quarrel with that premise, and as I
    said, most parents start there. Some parents and teachers and
    counselors and ministers come to the conclusion that more has
    to be said beyond ``say no.'' So I won't go any further than to
    say I hope that we will test each of these programs to make
    sure that the information given is accurate and then be honest
    about the outcomes.

                              DIETARY SUPPLEMENTS

        My last question if I might ask relates to dietary
    supplements. I've had a passion over this industry and the laws
    regulating it. I got up this morning and I took my vitamins,
    for the record, so I am not opposed to taking vitamins. I think
    it's good, it's healthy. I don't think it's going to hurt me.
    Maybe it'll help.
        But some of these dietary supplement companies are selling
    products that have never been tested. They are making claims
    about their products' efficacy which they cannot substantiate.
    They are marketing their dietary supplements to children. The
    ephedra scandal of just a year or so ago is an indication of
    that element of the dietary supplement industry that was
    clearly doing all the things that I just mentioned to the
    detriment of the health of America.
        Senator Hatch and I have debated this back and forth. We
    don't see it all the time eye to eye, but we have come to a
    conclusion, and I hope that you will consider supporting it,
    and that is that the dietary supplement industry should at a
    minimum make adverse event reports to the Food and Drug
    Administration. If some company is making a dietary supplement
    that results in a bad health outcome, a seriously bad health
    outcome or death, that should be reported to the Food and Drug
    Administration. That is not the law today.
        What is your opinion? Do you believe that those who are
    marketing dietary supplements should be required to report
    adverse events to the Food and Drug Administration as those
    making over-the-counter drugs and pharmaceuticals are required?
        [The information follows:]

                              Dietary Supplements

        With enactment of the DSHEA, Congress made the decision to create a
    new regulatory regime for dietary supplements modeled more on the
    Agency's regulation of food safety and less on the drug regulatory
    model. With the exception for new dietary ingredients, FDA's regulation
    of dietary supplements is essentially post-market program similar to
    food regulation.
        Under the Dietary Supplement Health and Education Act (DSHEA), FDA
    relies on voluntary adverse event reports as a major component of our
    post-market regulatory surveillance efforts. Voluntary reporting
    systems are estimated to capture only a small percentage of adverse
    events, but they provide valuable signals of potential problems. When
    such a signal identifies a possible safety hazard, the burden is on FDA
    has the ability to gather and evaluate any scientific literature or
    information regarding whether the substance produces a safety hazard
    FDA has used this information to open investigations that led to
    removal of ephedra from the market and is currently investigating the
    marketing of steroids as dietary supplements. FDA's enforcement actions
    are enhanced by a close working relationship with DEA, the FTC and
    other State and Federal agencies.
        Another important aspect of FDA's regulatory and surveillance
    programs are current good manufacturing practice (cGMP) requirements
    for dietary supplements authorized in the Act. These regulations will
    establish industry-wide standards to ensure that dietary supplements
    are not adulterated. This final rule is in the last stage of review and
    is expected to be published in the near future.
        In addition, FDA has a post-market surveillance program to support
    enforcement of labeling requirements for dietary supplements. This
    compliance program, Dietary Supplements--Import and Domestic, contains
    guidance to FDA field offices regarding field exams and sample
    collections to determine compliance with the labeling requirements for
    dietary supplements. Significant violations of the labeling
    requirements for dietary supplements may lead to an advisory action,
    such as a Warning Letter, or to a court action for seizure or
    injunction. Imported products that do not comply with FDA labeling
    requirements are subject to detention and refusal when offered for
    entry into the United States.
        FDA will continue in its efforts to take action against dietary
    supplement products that threaten the public health and will continue
    to provide guidance to the industry and outreach to consumers in this
    regard. We further believe that the promulgation of the GMP rule with
    provide another measure of safety for dietary supplements, and we look
    forward to working with the Committee to further examine these issues
    and ensure that appropriate steps are being taken.

        Secretary Leavitt. Senator, I have not had the benefit of
    being able to hear you and Senator Hatch debate these issues.
    It sounds like a colorful and rather interesting thing to hear.
    I'll look forward to hearing more--to find that the two of you
    have agreed on this. Sounds like something I ought to learn
    about.
        Senator Durbin. Let me share it with you. I won't put you
    on the spot any more on this, but I hope you'll take a look at
    it. It could be a reasonable way to bring some regulation to an
    industry which by and large is doing a wonderful job, but there
    are some players in this industry who are not.
        Mr. Chairman, thank you for your forbearance and patience,
    and Mr. Secretary, thank you for being here.

                                  OLMSTEAD ACT

        Senator DeWine. Mr. Secretary, just a few more questions.
    President Bush signed an executive order in response to the
    1999 Supreme Court decision in regard to the Olmstead Act. This
    Court said that the disabled have a right to live in a group
    home or other supportive system rather than being pushed into
    an institution, and the Court directed the government to
    develop opportunities for the disabled to better live in their
    communities. The Court also said forcing them into institutions
    is discriminatory.
        The executive order told the agencies to put together plans
    to make this happen. How are you proceeding in reaching this
    goal?
        Secretary Leavitt. Senator, it would be better if I could
    provide you with specifics. The actual plan and the execution
    of that plan inside either our agencies our broader would be
    unknown to me. But I would like to point out that the
    President's money follows the person it is designed
    specifically to----
        Senator DeWine. That was my next question anyway.
        Secretary Leavitt. Good. Well----
        Senator DeWine. We can--you can proceed.
        Secretary Leavitt. One of the----
        Senator DeWine. But you will give us, Mr. Secretary, you
    can follow up then in regard to this question about----
        Secretary Leavitt. Yes.
        Senator DeWine [continuing]. What the plan is and what the
    timing would be on that.
        Secretary Leavitt. We will be responsive on that query, and
    I'll also point out as one of the specific Medicaid, for
    example, proposals that we would like to see adopted this year
    would be a capacity, a flexibility, again stepping away from
    the rigid inflexibility that is currently there to serve those
    who are disabled and particularly those who are elderly.
        Medicaid is a good example of a policy that just needs to
    be changed, needs to be modernized. Medicaid was established in
    the 1960s. The state of practice at that point was to
    institutionalize basically those who were either disabled or
    elderly and disabled, and consequently Medicaid, without some
    waiver or without a change in the law, simply doesn't allow us
    to pay for any circumstances outside an institution, and that
    just needs to change. It's making the point that you have and
    we hope very much that Congress will act with some dispatch to
    give States that capacity.

                                    DISABLED

        Senator DeWine. Your President's proposal and your budget,
    the money following the person, I wonder if you could elaborate
    on that in regard to how that will affect the disabled, and
    specifically how that will work in the 50 States. Are we
    talking about 50 State programs, or how will that blend with
    national uniformity and how these programs will be
    administered?
        Secretary Leavitt. Well, specifically it would create----
        Senator DeWine. This is--my understanding of this--excuse
    me--this is a--these are pile-up programs.
        Secretary Leavitt. That's right. It would create a 5-year
    demonstration that finances services for individuals who are in
    transition from institutions to the community. The Federal
    Government would fund 100 percent of the community-based
    services for the first year and then funding would revert back
    to the States at the current Federal match, which means the
    Federal Government on average would pay about 65 percent.
        The demonstration would test whether the increased use of
    home and community-based services would reduce spending on
    institutional care as the advocates and as this Secretary
    believes that it will.
        Senator DeWine. How will that work in regard to the
    disabled community? I mean, this is designed in my
    understanding for the disabled community but also for older
    Americans. Is that correct?
        Secretary Leavitt. Well, the rationale of the program is
    that the proposal would encourage States to move from
    institutionalizing long-term care patients who are served by
    Medicaid into home and community services, which in turn may
    reduce the spending on institutional care. The proposal is an
    attempt to rebalance the system, as I've indicated, where long-
    term care has been essentially institutionalized under the
    Olmstead decision by increasing the care-setting choices and
    assisting individuals with disabilities. They will be able to
    live in the home and community-based settings.
        This is where they want to be served. Frankly, it's where
    their families want to serve them. It leverages the great
    American asset of people loving their families and choosing to
    care for them and it helps in the right spot. Disability groups
    have been very supportive of this and we'll continue to work
    closely with them and with you on various proposals as we learn
    more.
        Senator DeWine. Mr. Secretary, I'd like to commend FDA's
    actions in quickly enacting Best Pharmaceuticals for Children
    Act, as well as a pediatric rule. How those two programs
    interact can sometimes though be very tricky, but they interact
    nevertheless, and that's what they were designed to do.
        [The information follows:]

                     Best Pharmaceuticals for Children Act

        The BPCA is a critical tool in NIH's effort to ensure that adequate
    information is available concerning the effects and efficacy of
    pharmaceuticals in children. The NICHD is working with the FNIH and the
    Secretary to implement the provisions of the law, and to facilitate the
    testing of drugs.

                                   BACKGROUND

        The Best Pharmaceuticals for Children Act (BPCA) established
    procedures to identify health risks and effectiveness of drugs in
    children. The Secretary delegated the functions of developing the
    priority listing of drugs to be tested to NIH and FDA, and the program
    for testing those drugs to NIH. Dr. Zerhouni delegated the NIH duties
    to NICHD. Over the last few years we have had several communications
    with Sen. DeWine's staff about implementation issues. Most recently,
    they have raised questions about the testing of a particular on patent
    drug, Baclofen, which is proposed for treatment of spasticity in
    children with cerebral palsy.

                                      BPCA

        Under the BPCA program, different procedures are followed for
    testing on- and off-patent drugs for pediatric use and labeling.
    Following the BPCA's enumerated procedure for on patent drugs, NICHD
    tests a drug only after the manufacturer and current patent holder
    decline a request from the FDA to conduct the testing and after private
    donor decline to provide support through the Foundation for the
    National Institutes of Health (FNIH). (NICHD and FNIH have a Memorandum
    of Understanding in place to conduct the testing.) If the FNIH is
    unable to raise sufficient private funds to support the requested
    testing, and so-certifies to the Secretary, the Secretary refers the
    drug to NICHD for inclusion on the BPCA program priority list of drugs
    for testing in children.

                                ON-PATENT DRUGS

        Senator DeWine. I'd like to bring an issue to your
    attention. My staff has already raised this with NIH. And that
    is the on-patent drugs that are currently awaiting study in the
    NIH Foundation. The pediatric rule provides for the rule to be
    invoked when a Secretary makes a certification regarding
    insufficient funds. Preliminary discussions have suggested this
    would be an appropriate action for HHS, FDA, and NIH to take.
        I'd ask that you have your staff take a look at this issue,
    you take a look at it, and get in touch with the appropriate
    staff at NIH and FDA and begin the process of invoking the
    pediatric rule so clinical trials can begin. I would ask you do
    this and get back in touch with me in regard to this so we can
    get some resolution and move forward.
        Secretary Leavitt. I will do so, Senator. Thank you.

                               GLOBAL AIDS FIGHT

        Senator DeWine. I appreciate it. Let me turn if I could to
    the CDC's work in the global AIDS fight, and you and I have
    talked about this before. Specifically in the countries, the
    non-focus countries, countries such as India and China, let me
    ask you, does the CDC's global AIDS program do you believe have
    the infrastructure necessary to expand its programs in these
    non-focus countries? If not, what's needed to expand their
    response?
        Second, let me ask you, will you support providing
    increased program support and resources to the global AIDS
    program and other HHS programs that are part of the emergency
    plan?
        Secretary Leavitt. The President has made a commitment to
    expand appropriations to $15 billion to undertake that
    challenge. Obviously that will need to include the deployment
    of proper infrastructure in those countries as well as others.
    We're working hard now to target our efforts to provide for the
    greatest possible need. We've laid out a series of principles
    and we're working to follow those principles.
        Senator DeWine. I look forward to having further discussion
    with you in regard to this. It is a very difficult question, as
    I think your answer would indicate. Taking the finite resources
    that we have, even though this administration has made a major
    commitment, which I commend the administration for, and the
    Congress has done the same, when you look at the need, it's
    still finite resources, and trying to make a determination of
    how aggressively we move into countries like India and China is
    a very, very tough call.
        But, you know, if we don't--if the world does not stem the
    emerging AIDS problem in India or China or Russia, the
    ramifications are going to be absolutely unbelievable. When it
    moves, AIDS moves in India, for example, into the general
    population, the results are going to be absolutely devastating,
    and it's getting very close to that.
        So it's, you know, these are just tough questions, they're
    tough calls. I just look forward to working with you and
    sharing ideas.
        Secretary Leavitt. Thank you. I look forward to the same
    interaction.
        Senator DeWine. I appreciate it. Well, Mr. Secretary, we
    thank you very much for your time and attention and look
    forward to working with you on many issues.
        Secretary Leavitt. Thank you.

                              SUBCOMMITTEE RECESS

        Senator DeWine. Thank you very much Mr. Secretary.
        The subcommittee will stand in recess to reconvene at 9:30
    a.m., Wednesday, April 6, in room SD-124. At that time we will
    hear testimony from the Honorable Elias Zerhouni, Director,
    National Institutes of Health.
        [Whereupon, at 11:45 a.m., Wednesday, March 16, the
    subcommittee was recessed, to reconvene at 9:30 a.m.,
    Wednesday, April 6.]

    DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
                  AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2006

                                  ----------

                            WEDNESDAY, APRIL 6, 2005

                                           U.S. Senate,
               Subcommittee of the Committee on Appropriations,
                                                        Washington, DC.
        The subcommittee met at 9:30 a.m., in room SD-124, Dirksen
    Senate Office Building, Hon. Arlen Specter (chairman)
    presiding.
        Present: Senators Specter, Cochran, and Harkin.

                    DEPARTMENT OF HEALTH AND HUMAN SERVICES

                         National Institutes of Health

    STATEMENT OF ELIAS ZERHOUNI, M.D., DIRECTOR
    ACCOMPANIED BY:
            DR. JAMES F. BATTEY, JR., M.D., Ph.D., DIRECTOR, NATIONAL
                INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS
            DR. ANTHONY S. FAUCI, M.D., DIRECTOR, NATIONAL INSTITUTE OF
                ALLERGY AND INFECTIOUS DISEASES
            DR. ANDREW VON ESCHENBACH, M.D., DIRECTOR, NATIONAL CANCER
                INSTITUTE

                   OPENING STATEMENT OF SENATOR ARLEN SPECTER

        Senator Specter. Good morning, ladies and gentlemen. The
    hour of 9:30 has--having arrived, we will proceed with the
    hearing of the Appropriations Subcommittee on Labor, Health and
    Human Services, Education. Today our hearing will focus on the
    work of the National Institutes of Health, which I have
    characterized as the crown jewel of the Federal Government, and
    perhaps the only jewel of the Federal Government.
        We have the distinguished director, Elias Zerhouni, Dr.
    Elias Zerhouni, with us today, and other members. We have in
    the past had all of the directors of the Institutes, and it is
    not realistic to hear from that number of witnesses, and
    knowing of the important work, we have decided this year to
    limit the witnesses to those who have presidential
    appointments. We have also included Dr. Battey because of some
    recent issues as to the new policy on ethics, which will be a
    subject of some of our discussion here today.
        Before proceeding further, just a word or two about my
    health. I have a lot of questions about my health. I had my
    fourth treatment last Friday and I am on the job. During the 2-
    week recess when I could not travel abroad, I was in Washington
    most of the time, and aside from an involuntary new hair style,
    I'm accommodating to all of the rigors of the situation. I find
    that among all of the alternatives, the best alternative is to
    come to work and fight tigers, and we've got a lot of tigers
    around here, and fighting tigers is a great distraction and a
    great cure. So just that little bit of recommendation to the
    foremost scientists in the world, just how to handle one
    person's temporary medical problem.
        The work of the National Institutes of Health is a vital
    matter for America and for the world. Senator Harkin, who will
    be along in a few moments, and I, as is well known, have taken
    the lead on the increase in funding where we have moved from
    some $12 billion to $28 billion. This year the funding was
    almost flat, really not accommodating even inflation. Senator
    Harkin and I offered an amendment to add $1.5 billion to the
    budget resolution, which passed.
        It's been a long struggle. The first time we tried to add
    money to the budget resolution we lost 63 to 37, and we went
    back with a sharp pencil and established the priorities. That's
    become a virtual impossibility now with the very heavy demands
    on our subcommittee on education and health and community
    development block grants and many other items, and worker
    safety. It will be a battle to keep that extra $1.5 billion in
    terms of real dollars that we will have.
        We will want to discuss the issues of the new standards of
    ethics. When the issue came up before the House of
    Representatives, there was I think a, diplomatically stated, a
    pretty stern tone taken. When the matter came before this
    subcommittee, we reviewed the matter with Dr. Zerhouni and said
    we'd look forward to his response.
        But we also gave the people who were being charged an
    opportunity to come in and speak for themselves and to defend
    themselves on an extemporaneous basis. They were in the
    audience. They were welcome to come up and to do--and to talk.
    We had that hearing back on January 22, 2004.
        It's always a difficult matter to prescribe a cure,
    medically or politically or ethically. It may well be that
    there are some revisions which are necessary, and we're going
    to make some suggestions and engage in some dialogue. But the
    ultimate decisions have to rest with the professionals who are
    in the field.
        One word about stem cells, which we will take up in the
    course of the hearing. There is great concern about the Federal
    policy on stem cells contrasted with what is happening in the
    States with the $3 billion budget in California and the lure of
    top scientists to California. Now Massachusetts is coming in
    with a program. We have discussed in this subcommittee the
    concerns about a brain drain going to Europe. This is something
    that we have to deal with.
        There was very strong sentiment in the Congress about
    broadening the use of stem cells, moving away not necessarily
    from nuclear transplantation. We're not talking about creating
    another Dolly or about those sort of tactics, but just to use
    the stem cells which otherwise will be thrown away. There are
    hundreds of thousands which were created for in vitro
    fertilization and they're not being used, and they could be
    used to cure diseases.
        We understand the situation with the administration, Dr.
    Zerhouni, and the White House point of view, and I have
    suggested to you before that you might look for some greater
    latitude for advocacy within the administration. You're very
    respectful and you're very diplomatic and your voice might be
    heard and be influential.
        I've had an opportunity to talk to the President about the
    matter. He was in Pennsylvania 44 times during the campaign,
    and I was with him on most of the occasions. We had a lot of
    time to talk on the plane and in the car. His views are pretty
    firm, but so are mine, and so are, I think, a majority of the
    Congress, as you see with what's happening in the House.
    Senator Harkin, Senator Feinstein, Senator Hatch, Senator
    Kennedy, and I have re-introduced legislation. So that's a big
    matter for the research future of America and the world.
        That's longer than I usually talk, but since there are no
    other members present, I felt a little more latitude. Dr.
    Zerhouni, we welcome you here. We thank you for taking on this
    tough job and we look forward to your testimony.

                   SUMMARY STATEMENT OF DR. ELIAS A. ZERHOUNI

        Dr. Zerhouni. Thank you, Mr. Chairman, and first and
    foremost, let me tell you about our admiration for your
    continuing service while you're fighting cancer, and we're
    looking forward to seeing you support NIH, support medical
    research as you have in the past for many years to come.
        I would like to also----
        Senator Specter. Is there any shortcut to--Dr. Zerhouni--to
    returning Arlen Specter the kind of head of hair that Elias
    Zerhouni has?
        Dr. Zerhouni. I would be very happy to share.
        Senator Specter. I hope the camera will focus on Dr.
    Zerhouni's hair, so we don't just get this verbally.
        Dr. Zerhouni. I will do everything to share that with you,
    sir.
        Senator Specter. I don't want share, I want my own, Dr.
    Zerhouni.
        Dr. Zerhouni. I have submitted for the record written
    testimony.
        Senator Specter. Your full statement will be made a part of
    the record, Dr. Zerhouni, and in accordance with our standard
    practice, to the extent you can summarize, that would be
    helpful to leave the maximum amount of time for questions and
    answers. We have a vote scheduled at 10:00 and we have the new
    Prime Minister of the Ukraine speaking. But this is a very
    important hearing and I will return after the vote so we do
    full justice to the issues which we have here today.

                 THE PAST, THE PRESENT, AND THE FUTURE FOR NIH

        Dr. Zerhouni. Thank you. I will do so. First and foremost,
    let me summarize for us with a few slides where NIH is and
    where the budget is heading. Clearly, NIH has, as you said,
    been the crown jewel of medical research and of the Federal
    Government in promoting and advancing, through research, better
    health.

        I'll show you some results that I think all of us know. In
    heart disease, we've had a 60 percent reduction in mortality
    over the past 30 years, primarily due to discoveries in terms
    of metabolism, of cholesterol, in terms of inflammation, in
    terms of the management of hypertension. You can see over the
    slides there that we've seen for the first time a marked
    decrease in both mortality and morbidity, with 815,000 lives
    saved this year--in 2000.
        For the first time, over the past 10 years we're seeing a
    very real decrease in cancer mortality. The National Cancer
    Institute should really be commended for these results. We've
    seen, for example, mortality reduced in 11 of the 15 most
    common cancers in men and in 8 of the 15 most common cancers in
    women. We're continuing to see increased survivorship for
    cancer with a markedly increased number of Americans living
    with cancer today, from 3 to 9 million and rising.
        I think you can see the survival rates between 1974, 1976,
    1992, and 1999, and you can see improvements in all cancers.
    But you can see also in very specific cancers, survival rates
    right now in breast cancer are 87 percent, colon cancer 62
    percent, Hodgkin's disease 84 percent, and prostate cancer 98
    percent.
        We're continuing to do research on infectious agents and
    the new threats of biodefense agents. And you can see that in
    2003 for the first time we've developed an effective vaccine
    against ebola virus. Anthrax, we've crystallized the anthrax
    toxin and have identified new drug targets.
        In SARS, I'd like to remind you that because of the
    doubling of the budget that you have spearheaded and the
    research and the new tools that were made available to human
    genome research, we were able to identify the SARS virus in
    less than a month. Today there is the first vaccine in trial
    already in the works, and two more have been developed as well.
        So I think that the investment that you have really helped
    us with has paid off and is paying off. We're continuing to
    strengthen the NIH vision by doing systematic coordination
    across all the Institutes. In 2004 we presented the NIH Roadmap
    for Medical Research that involves all the Institutes and
    really engages in areas where no single Institute can do the
    job. In 2005, we announced the trans-NIH plan for obesity
    research, and in 2006, this year, the NIH neuroscience
    blueprint.
        The scope of the challenge is enormous, as you well know.
    We have hundreds of common diseases and 6,000 rare diseases to
    take care of. Clearly, the budget that we have is large, $28
    billion. But from our standpoint of scientists and physicians,
    we look at it on a per-American basis. When you look at that,
    what you realize is that we have to manage $96 per American per
    year. The NCI manages $16 per American per year to combat all
    cancer, NIAID $15, NHLBI $10. It is in this context that we
    have to invest our dollars to make the most impact on our
    health care costs, which are fast rising and come to $5,500 per
    American per year.
        Clearly, the budget this year is going to have to lead to
    difficult choices, and we've established priorities, such as
    the support of new and established scientists with new grants.
    We've increased the number of grants available for competition,
    obviously at the expense of inflation factors and other choices
    we had to make. We are accelerating research for treatments and
    prevention strategies through the NIH Roadmap for Medical
    Research. We're continuing to develop countermeasures for
    biological and chemical threats. This year we're announcing the
    neuroscience blueprint. We think that even though we have
    difficult budgets, it's important to do the right thing even if
    it's not the right budgetary time.
        Again, this year we have many new candidate vaccines----
        Senator Specter. What do you mean, Dr. Zerhouni, by doing
    the right thing even though if it's not the right budgetary
    time?

                            MAKING THE RIGHT CHOICES

        Dr. Zerhouni. What I mean is despite the fact that there is
    a flat budget there are scientific opportunities in
    neurosciences, behavioral sciences. And we believe, with the 15
    Institute directors that are primarily responsible for this
    area of science, that it was important to have a coordinated
    plan to advance our knowledge of the brain and the nervous
    system and the impact of behavioral--and behavioral factors on
    health.
        This year we have several new vaccines available for HIV/
    AIDS that will need to be tested, and that is very costly. We
    have moved $100 million within our tight budget to the
    priorities that we believe in 2006 will allow us to test for
    the first time very promising vaccines for HIV/AIDS.
        Senator Specter. Where do you take that money from?
        Dr. Zerhouni. Basically we've moved it from all categories
    of the total AIDS budget over the past 2 years, as we predicted
    with Dr. Fauci, that in 2006 we will need to engage in larger-
    scale clinical trials of HIV vaccines.
        Last, I think that it is clear that as the organization
    known as NIH has grown more complex, it is also important to
    coordinate and understand better the portfolio of investments
    we're making, especially when you consider that we are managing
    $96 per American per year. You want to make sure that all of
    that investment is maximally utilized. We are announcing the
    creation of a new Office of Portfolio Analysis and Strategic
    Initiatives in 2006 and requesting budgetary support for that
    office to do both strategic analysis of what is it we've done--
    --

       PROPOSAL TO CREATE THE OFFICE OF PORTFOLIO ANALYSIS AND STRATEGIC
                                  INITIATIVES

        Senator Specter. What do you mean or need by budgetary
    support?
        Dr. Zerhouni. We've requested a budget line for the Office
    of the Director to create this office and support it.
        Senator Specter. How much is that line?
        Dr. Zerhouni. We've started with a $2 million request.
        Senator Specter. $2 million?

                              PREPARED STATEMENTS

        Dr. Zerhouni. Yes. This office is going to allow us to
    develop better coding, better understanding of our databases,
    and coordinate them across Institutes so that we can have a
    standard way of looking at the entire activities of the Agency.
    We will work through the Institutes and centers to coordinate,
    as we've shown in the past with the trans-NIH obesity plan,
    that we could in fact find areas of synergy and improve on
    them, and obviously evaluate whether or not we are. As you
    often ask us: ``What have we accomplished?'' I think we need to
    evaluate it systematically to show you and the American people
    supporting us the results of this research.
        [The statements follows:]

                    Prepared Statement of Dr. Elias Zerhouni

        Mr. Chairman, Members of the Committee: I am pleased to present the
    fiscal year 2006 President's budget request for the Office of the
    Director (OD). The fiscal year 2006 budget includes, $385,195,000, an
    increase of $27,149,000 over the fiscal year 2005 enacted level of
    $358,046,000 comparable for transfers proposed in the President's
    request. The OD provides leadership, coordination, and guidance in the
    formulation of policy and procedures related to biomedical research and
    research training programs. The OD also is responsible for a number of
    special programs and for management of centralized support services to
    the operations of the entire NIH.
        The OD guides and supports research by setting priorities;
    allocating funding among these priorities; developing policies based on
    scientific opportunities and ethical and legal considerations;
    maintaining peer review processes; providing oversight of grant and
    contract award functions and of intramural research; communicating
    health information to the public; facilitating the transfer of
    technology to the private sector; and providing fundamental management
    and administrative services such as budget and financial accounting,
    and personnel, property, and procurement management, administration of
    equal employment practices, and plant management services, including
    environmental and public safety regulations of facilities. The
    principal OD offices providing these activities include the Office of
    Extramural Research (OER), the Office of Intramural Research (OIR), and
    the Offices of: Science Policy; Communications and Public Liaison;
    Legislative Policy and Analysis; Equal Opportunity; Budget; and
    Management. This request contains funds to support the functions of
    these offices.
        In addition, the OD also maintains several trans-NIH offices and
    programs to foster and encourage research on specific, important health
    needs. I will now discuss the budget request for the OD in greater
    detail.

                        NIH ROADMAP FOR MEDICAL RESEARCH

        The NIH Roadmap for Medical Research supports trans-agency research
    and training programs aimed at accelerating the pace of discovery and
    improving the translation of research findings into health
    interventions. The development of new tools and technologies will help
    scientists understand intricate cellular processes and will make large
    volumes of biologic data publicly available for analysis and use in
    other model systems. Nanomedicine concept development awards are
    defining the scope of future centers to explore molecular inventions
    and interventions for curing disease or repairing tissues. Innovative
    team approaches will facilitate the creation of new biomedical and
    behavioral interdisciplinary fields and contribute to our understanding
    of complex diseases and conditions. Studies examining outcomes such as
    pain, fatigue and obesity will be enhanced by NIH Roadmap projects
    supporting the integration of behavioral and social sciences with
    biomedical and physical sciences. The clinical research initiatives are
    exploring ways to promote the integration and extension of clinical
    research networks, support translational research, and facilitate the
    coordination and harmonization of clinical research policies across
    federal agencies. Critical to these new efforts will be an infusion of
    trained scientists and clinical researchers at all stages of their
    careers, able to apply interdisciplinary and multidisciplinary
    approaches to complex biomedical problems. And for the first time,
    physicians, nurses and dentists are being trained together to become
    leaders in this clinical research community. These and other projects
    will enhance the capacity of scientists to harness the knowledge base
    for specific applications in all areas of investigation. The fiscal
    year 2006 budget request for NIH Roadmap for Medical Research is
    $83,000,000, an increase of $23,280,000 over the fiscal year 2005
    level.

                          THE OFFICE OF AIDS RESEARCH

        The Office of AIDS Research (OAR) plays a unique role at NIH,
    establishing a roadmap for the AIDS research program. OAR coordinates
    the scientific, budgetary, legislative, and policy elements of the NIH
    AIDS research program. Our response to the AIDS epidemic requires a
    unique and complex multi-institute, multi-disciplinary, global research
    program. Perhaps no other disease so thoroughly transcends every area
    of clinical medicine and basic scientific investigation, crossing the
    boundaries of the NIH Institutes and Centers. This diverse research
    portfolio demands an unprecedented level of scientific coordination and
    management of research funds to identify the highest priority areas of
    scientific opportunity, enhance collaboration, minimize duplication,
    and ensure that precious research dollars are invested effectively and
    efficiently, allowing NIH to pursue a united research front against the
    global AIDS epidemic. OAR oversees the development of the annual
    comprehensive NIH AIDS-related research plan and budget, based on
    scientific consensus about the most compelling scientific priorities
    and opportunities that will lead to better therapies and prevention
    strategies for HIV disease. The Plan serves as the framework for
    developing the annual AIDS research budget for each Institute and
    Center; for determining the use of AIDS-designated dollars; and for
    tracking and monitoring those expenditures. OAR also identifies and
    facilitates multi-institute participation in priority areas of research
    and facilitates NIH involvement in international AIDS research
    activities. The fiscal year 2006 budget request for OAR is $60,899,000,
    which is the same as the fiscal year 2005 level.

                    THE OFFICE OF RESEARCH ON WOMEN'S HEALTH

        The Office of Research on Women's Health (ORWH), the focal point
    for women's health research for the Office of the Director,
    strengthens, enhances and supports research related to diseases,
    disorders, and conditions that affect women, and sex/gender studies on
    differences/similarities between men and women; ensures that women are
    appropriately represented in biomedical and biobehavioral research
    studies supported by the NIH to facilitate analyses by sex/gender; and
    develops opportunities for the advancement of women in biomedical
    careers and investigators in women's health research. These ORWH
    efforts are in full partnership with the NIH Institutes and Centers.
    New research has been expanded in the ORWH-funded Specialized Centers
    of Research through interdisciplinary research in women's health and
    sex and gender factors and through the unique ORWH interdisciplinary
    career development program that fosters the mentored development of
    junior faculty and assists them in bridging advanced training towards a
    goal of research independence. The fiscal year 2006 budget request is
    $41,363,000, an increase of $148,000 over the fiscal year 2005 level.

             THE OFFICE OF BEHAVIORAL AND SOCIAL SCIENCES RESEARCH

        The NIH has a long history of funding health-related behavioral and
    social sciences research, and the results of this work have contributed
    significantly to our understanding, treatment, and prevention of
    disease. The Office of Behavioral and Social Sciences Research (OBSSR)
    furthers NIH's ability to capitalize on the scientific opportunities
    that exist in behavioral and social sciences research by providing
    leadership in identifying and implementing research programs that are
    likely to improve our understanding of the processes underlying health
    and disease and provide directions for intervention. OBSSR works to
    integrate a behavioral and social science approach across the programs
    of the NIH.
        In response to a 2004 Institute of Medicine study entitled,
    ``Improving Medical Education: Enhancing the Behavioral and Social
    Science Content of Medical School Curricula'', OBSSR developed a
    program to promote the design and implementation of medical school
    curricula with coverage of behavioral and social sciences. This program
    will provide a mechanism whereby medical school students will receive
    training about issues such as the influence of psychological,
    biological, and social factors on health and disease; the role of
    physicians' beliefs, behaviors, and values in patient care; managing
    difficult physician-patient interactions; and the impact of policy on
    health behaviors and patient care. In addition to the benefits realized
    by individual physicians in training, funded medical schools may
    develop the infrastructures to permanently integrate behavioral and
    social sciences into their curricula. To continue such groundbreaking
    work in the behavioral and social sciences, the fiscal year 2006 budget
    request for OBSSR is $26,185,000, an increase of $94,000 over the
    fiscal year 2005 level.

                        THE OFFICE OF DISEASE PREVENTION

        The primary mission of the Office of Disease Prevention (ODP) is to
    stimulate disease prevention research across the NIH and to coordinate
    and collaborate on related activities with other federal agencies as
    well as the private sector. There are several other offices within the
    ODP organizational structure.
        The Office of Medical Applications of Research (OMAR) has as its
    mission to work with NIH Institutes, Centers, and Offices to assess,
    translate and disseminate the results of biomedical research that can
    be used in the delivery of important health interventions to the
    public. The ODP has two additional specific programs/offices that place
    emphasis on particular aspects of the prevention and treatment of
    disease the Office of Dietary Supplements (ODS) and the Office of Rare
    Diseases (ORD).
        In fiscal year 2006, the ODS within ODP requests a budget of
    $27,078,000, an increase of $97,000 over the fiscal year 2005 level.
    ODS promotes the scientific study of the use of dietary supplements by
    supporting investigator-initiated research, and stimulating research
    through the conduct of conferences and presentations at national and
    international meetings. Other current ODS efforts include:
      --Sponsorship of systematic review of the relationship between omega-
            3 fatty acids and a number of clinical indications,
            particularly coronary heart disease.
      --Collaborations for the development, validation, and dissemination
            of analytical methods and reference materials for dietary
            supplements.
      --Support and development of databases of dietary supplement
            information including:
        --National Health and Nutrition Examination Survey (NHANES);
        --Collaboration with USDA to develop an analytically-based database
                of dietary supplement ingredients;
        --Plan to contract for development of a dietary supplement label
                database;
        --International Bibliographic Information on Dietary Supplements
                (IBIDS);
        --CARDS, a database of federally funded research on dietary
                supplements.
      --Collaboration with other federal agencies to develop a coordinated
            approach to assessment of the health effects of bioactive
            factors in food and dietary supplements. Publishes Fact Sheets
            on dietary supplements for consumers.
        Another component of ODP, the ORD, was formally established through
    the Rare Diseases Act of 2002, Public Law 107-280. The budget request
    for fiscal year 2006 for ORD is $15,649,000, an increase of $56,000
    over the fiscal year 2005 level. The following are four highlights of
    ORD activities: (1) An Extramural Rare Diseases Clinical Research
    Network that involves 10 consortia, more than 70 sites, and 30 patient
    support organizations for almost 50 rare diseases. Thirty-three
    clinical protocols are under development. (2) The Rare Diseases
    Intramural Research Program is a collaborative effort between the ORD
    and the National Human Genome Research Institute at the NIH Clinical
    Center. Recently, the program initiated annual contracts for 25
    molecular diagnostic tests for specific rare diseases that will be made
    available by the contractor to the public at reasonable cost. (3) ORD
    also co-funds annually approximately 100 scientific conferences for
    scientific opportunities or where research is lagging or lacking. (4)
    The newly established Trans-NIH Rare Diseases Research Working Group is
    developing an assessment of rare diseases biospecimen collection,
    storage, and delivery issues, of genetic tests in extramural research
    programs, and plans for a conference on amyloidosis.

                        THE OFFICE OF SCIENCE EDUCATION

        The Office of Science Education (OSE) develops science education
    programs to enhance efforts to attract young people to biomedical and
    behavioral science careers and to improve science literacy in both
    adults and children. The OSE creates programs to improve science
    education in schools (the NIH Curriculum Supplement Series); creates
    programs that stimulate interest in health and medical science careers
    (LifeWorks Web site); creates programs to advance public understanding
    of medical science, research, and careers; and advises NIH leadership
    about science education issues. Programs target diverse populations
    including under-served communities, women, and minorities, with a
    special emphasis on the teachers of students from Kindergarten through
    grade 12. The OSE Web site is a central source of information about
    available education resources and programs. http://
    science.education.nih.gov. The fiscal year 2006 budget request for OSE
    is $3,878,000, the same as the fiscal year 2005 level.

                     LOAN REPAYMENT AND SCHOLARSHIP PROGRAM

        The NIH, through the Office of Loan Repayment and Scholarship
    (OLRS), administers the Loan Repayment and Undergraduate Scholarship
    Programs. The NIH Loan Repayment Programs (LRPs) seek to recruit and
    retain highly qualified physicians, dentists, and other health
    professionals with doctoral-level degrees to biomedical and behavioral
    research careers by countering the growing economic disincentives to
    embark on such careers, using as an incentive the repayment of
    educational loans. There are loan repayment programs designed to
    attract individuals to clinical research, pediatric research, health
    disparities research, and contraception and infertility research, and
    to attract individuals from disadvantaged backgrounds into clinical
    research. The AIDS, intramural Clinical, and General Research Loan
    Repayment Programs are designed to attract investigators and physicians
    to the NIH's intramural research and research training programs. The
    NIH Undergraduate Scholarship Program (UGSP) is a scholarship program
    designed to support and enhance the training of undergraduate students
    from disadvantaged backgrounds in biomedical research careers and
    employment at the NIH.
        The fiscal year 2006 budget request for OLRS is $7,213,000, the
    same as the fiscal year 2005 level.

             OFFICE OF PORTFOLIO ANALYSIS AND STRATEGIC INITIATIVES

        In fiscal year 2006, the NIH plans to create a new office within
    the Office of the Director--the Office of Portfolio Analysis and
    Strategic Initiatives (OPASI)--which will provide tools to facilitate
    planning for trans-NIH initiatives, including an improved process for
    collecting IC data on expenditures on various diseases, conditions, and
    research fields, and improvements in data about burden of disease. The
    office will also develop, with input from the ICs, common processes and
    formats, where necessary, for the conduct of NIH-wide planning and
    evaluation. For trans-NIH planning efforts, the office will seek broad
    public input--from the public, health care providers, policymakers, and
    scientists--in addition to soliciting advice from within NIH. The
    office will also coordinate and make more effective use of the NIH-wide
    evaluation process. The budget request for OPASI is $2,000,000.
        Thank you, Mr. Chairman for giving me the opportunity to present
    this statement; I will be pleased to answer questions that the
    Committee may have.
         national institutes of health buildings and facilities program
        Mr. Chairman and Members of the Committee: I am pleased to present
    the President's budget request for the Buildings and Facilities (B&F)
    Program for fiscal year 2006, a sum of $81,900,000.

                          ROLE IN THE RESEARCH MISSION

        State-of-the-science research and support facilities are a vital
    part of the research enterprise. The National Institutes of Health's
    (NIH) Buildings and Facilities (B&F) program designs, constructs,
    repairs and improves the agency's portfolio of laboratory, clinical,
    animal, administrative and support facilities at its six installations
    in four states. These facilities house researchers from the NIH
    Institutes' and Centers'(ICs) intramural basic, translational, and
    clinical research programs; science administrators who oversee NIH's
    grants; the NIH leadership, and various programs that support agency
    operations. The fiscal year 2006 B&F budget request focuses on the need
    for responsible utilization and stewardship of NIH's past and recent
    investments in the ``bricks and mortar'' of the research enterprise. In
    order to stay abreast of the changing needs of the NIH programs, it is
    imperative that we provide reliable, safe and secure research support
    facilities that are appropriately equipped, operated and maintained.
        The B&F budget request is the product of a comprehensive, corporate
    capital facilities planning process. This process begins with extensive
    consultation across the research community and the NIH's professional
    facilities staff. It works through the Facilities Working Group, an
    advisory committee to the NIH Steering Committee, and the HHS Capital
    Investment Review Board. Through this process, the program demand for
    more effective and efficient facilities designed to support current and
    emerging investigative techniques, technologies, and tools is
    integrated with, and balanced against, the need to repair, renovate,
    and improve the existing building stock to keep it in service and to
    optimize its utility.
        The fiscal year 2006 request provides the necessary funding support
    for the ongoing safety, renovation and repair, and related projects
    that are vital to proper stewardship of the entire portfolio.
        The fiscal year 2006 B&F budget request is organized among three
    broad Program Activities: Essential Safety and Regulatory Compliance,
    Repairs and Improvements and Construction. The fiscal year 2006 request
    provides funds for specific projects in each of the program areas. The
    projects and programs enumerated are the end result of the
    aforementioned NIH facilities planning process and are the NIH's
    capital facility priorities for fiscal year 2006.

                        FISCAL YEAR 2006 BUDGET SUMMARY

        The fiscal year 2006 budget request for Buildings and Facilities is
    $81.9 million. The B&F request contains a total of $14 million for
    Essential Safety and Regulatory Compliance programs composed of $2
    million for the phased removal of asbestos from NIH buildings; $5
    million for the continuing upgrade of fire and life safety deficiencies
    of NIH buildings; $1.5 million to systematically remove existing
    barriers to persons with disabilities from the interior of NIH
    buildings; $0.5 million to address indoor air quality concerns and
    requirements at NIH facilities; and $5 million for the continued
    support of the rehabilitation of animal research facilities. In
    addition, the fiscal year 2006 request includes $66.9 million in
    Repairs and Improvements for the continuing program of repairs,
    improvements, and maintenance that is the vital means of maintaining
    the complex research facilities infrastructure of the NIH; and $1
    million in Construction for pre-project planning including concept
    development studies and analyses of NIH-wide facility projects proposed
    in the facilities plan.
        My colleagues and I will be happy to respond to any questions you
    may have.
                            Office of AIDS Research

           FISCAL YEAR 2006 NIH AIDS RESEARCH BY-PASS BUDGET ESTIMATE

                                  INTRODUCTION

        In its report on the fiscal year 2005 budget for the Department of
    Health and Human Services, the Senate Committee on Appropriations
    stated:

        ``The NIH Office of AIDS Research [OAR] coordinates the scientific,
    budgetary, legislative, and policy elements of the NIH AIDS research
    program. Congress provided new authorities to the OAR to fulfill these
    responsibilities in the NIH Revitalization Action Amendments of 1993.
    The law mandates the OAR to develop an annual comprehensive plan and
    budget for all NIH AIDS research and to prepare a Presidential bypass
    budget.'' (Senate Report 108-345, page 175)

        Public Law 103-43, the National Institutes of Health Revitalization
    Act of 1993, requires that ``the Director of the Office of AIDS
    Research establish a comprehensive plan for the conduct and support of
    all AIDS activities of the agencies of the National Institutes of
    Health.'' It also requires that the Director ``shall prepare and submit
    directly to the President, for review and transmittal to the Congress,
    a budget estimate for carrying out the Plan for the fiscal year . . .''
    That budget ``shall estimate the amounts necessary for the agencies of
    the National Institutes of Health to carry out all AIDS activities
    determined by the Director of the Office to be appropriate, without
    regard to the probability that such amounts will be appropriated.''
        In accordance with the law, the Office of AIDS Research (OAR) has
    developed the fiscal year 2006 Professional Judgment (By-Pass) Budget
    Estimate for NIH AIDS Research to carry out the scientific priorities
    of the fiscal year 2006 NIH Plan for HIV-Related Research. This By-Pass
    budget estimate is based on the following criteria: the commitment to
    support only the highest quality research; and the urgent need to
    pursue priority scientific opportunities.

                                    OMB PART

        The NIH AIDS program received an overall score of 83 in the 2005
    PART. This score included a 100 percent in the Program Purpose and
    Design section. The human and economic toll of the AIDS pandemic
    requires a unique response that is complex, comprehensive, multi-
    disciplinary, and global. The NIH role in this response is
    unprecedented, comprising a comprehensive program of basic, clinical,
    and behavioral research on HIV disease to better understand the basic
    biology of HIV and develop effective therapies and prevention
    strategies. PART demonstrated that NIH provides effective scientific
    coordination and management of this diverse AIDS research portfolio
    through a comprehensive planning and budget development process, which
    was utilized to develop the fiscal year 2006 By-Pass Budget Request.

                             OAR COMPREHENSIVE PLAN

        The OAR has established a unique and effective model to develop a
    consensus on the scientific priorities of the annual comprehensive AIDS
    research plan, called the NIH Plan for HIV-Related Research, that is
    based on the most compelling scientific priorities that will lead to
    better therapies and prevention strategies for HIV infection and AIDS.
    The planning process involves the NIH Institute and Center Directors;
    NIH intramural and extramural scientists and program managers;
    scientists and researchers from other government agencies, academia,
    foundations, and industry; HIV-infected individuals; and other
    community representatives. The plan also is reviewed by the OAR
    Advisory Council.
        The NIH fiscal year 2006 Plan for HIV-Related Research is divided
    into five Scientific Areas including: Natural History and Epidemiology;
    Etiology and Pathogenesis; Therapeutics; Vaccines; and Behavioral and
    Social Science. The plan further addresses critical issues that cut
    across all of the scientific areas: Microbicides; HIV Prevention
    Research; Racial and Ethnic Minorities; Women and Girls; International
    Research; Training, Infrastructure, and Capacity Building; and
    Information Dissemination.
        The fiscal year 2006 NIH AIDS research agenda continues the
    following overarching themes: a strong foundation of basic science; HIV
    prevention research, including development of vaccines, microbicides,
    behavioral interventions, and strategies to prevent perinatal
    transmissions; therapeutics research to develop simpler, less toxic,
    and cheaper drugs and drug regimens to treat HIV infection and its
    associated illnesses, malignancies, and other complications;
    international research, particularly to address the crucial research
    and training needs in developing countries; and research targeting the
    disproportionate impact of the AIDS epidemic on racial and ethnic
    minority populations in the United States.
        The Plan shapes NIH investments in biomedical and behavioral AIDS
    research and provides the framework to translate critical research
    findings to benefit populations desperately in need both in our country
    and abroad. The Plan serves as the framework for developing the annual
    NIH AIDS research budget; for determining the use of NIH AIDS-
    designated funds; for tracking and monitoring AIDS-related
    expenditures; and for informing the scientific community, the public,
    and the AIDS-affected community about NIH AIDS research priorities. The
    entire plan can be found on the OAR web site: http://www.nih.gov/od/
    oar/public/pubs/fy2006/00_Overview_fiscal year 2006.pdf

                         OAR BUDGET DEVELOPMENT PROCESS

        The Plan initiates the budget development process. Based on the
    objectives and priorities established in the Plan, the NIH Institutes
    and Centers (ICs) prepare their AIDS research budget requests,
    detailing new or expanded program initiatives for each scientific area.
    The OAR reviews the IC initiatives in relation to the Plan, to OAR
    priorities, and to other IC submissions to eliminate redundancy and/or
    to assure cross-institute collaboration. The OAR allocates the AIDS
    research budget levels to each IC based on the scientific priority of
    the proposed initiatives.
        This process allows the OAR to ensure that AIDS research funds will
    be provided to the most compelling scientific opportunities, rather
    than distribution based solely on a formula.

                         OAR BY-PASS BUDGET PRIORITIES

        The fiscal year 2006 NIH By-Pass Budget for HIV/AIDS Research
    responds to several crucial scientific opportunities and needs. In
    fiscal year 2005, OAR initiated a comprehensive trans-NIH review of all
    grants and contracts supported with AIDS-designated funds to ensure
    that these projects represent the highest scientific priorities and
    opportunities. This process also included: (1) a review of the
    appropriateness of definitions of HIV/AIDS research in the institutes
    (i.e., coding of research as AIDS or AIDS-related) and the mix of
    investments in key priority areas in view of the current epidemic; and
    (2) a series of meetings with IC representatives to assess their AIDS
    portfolios relative to AIDS and AIDS-related priorities. This process
    will result in the redirecting of AIDS funds to higher priority
    projects and new scientific opportunities in fiscal year 2006.
        NIH-sponsored HIV/AIDS research continues to provide the important
    scientific foundation necessary to design, develop, and evaluate new
    and better vaccine candidates, therapeutic agents and regimens, and
    prevention interventions. In particular, this By-Pass budget places a
    renewed priority on the discovery, development, and pre-clinical
    testing of additional HIV vaccine candidates. The NIH priority in AIDS
    vaccine research to date has resulted in approximately 70 clinical
    trials of nearly 40 vaccine candidates. The evaluation of an AIDS
    vaccine will require extensive testing in the United States and in
    international settings where there is a high incidence of HIV. High
    priority is placed in this budget on funding to move promising vaccine
    candidates into large-scale clinical trials to evaluate the potential
    for efficacy.
        In the area of AIDS therapeutics research, current therapeutic
    regimens have resulted in extended survival and improved quality of
    life for many HIV-infected individuals in the United States and Western
    Europe. However, a growing proportion of patients receiving therapy are
    demonstrating treatment failure, experiencing serious drug toxicities
    and side effects, and developing drug resistance. This By-Pass budget
    provides critical support for the development of new and better drugs
    using sophisticated structural biology, combinatorial chemistry, and
    macromolecular techniques. The goal of this research is to develop new,
    safe, less toxic, less expensive, and more effective therapeutic agents
    and regimens.
        The increasing incidence of metabolic disorders, cardiovascular
    complications, major organ dysfunction, and physical changes associated
    with current antiretroviral drugs underscores the critical need for new
    and better treatment regimens. Improved regimens also are needed to
    treat HIV co-infections such as hepatitis B and C, as well as other
    opportunistic infections to reduce drug interactions and problems with
    adherence to complicated treatment regimens.
        In fiscal year 2005, the Office of AIDS Research spearheaded a
    critical and unique multi-IC inter-disciplinary collaboration to
    formalize plans for the innovative restructuring of the NIH clinical
    trials networks for HIV therapeutics, vaccines and prevention
    interventions in fiscal year 2006. OAR convened meetings of relevant IC
    high-level staff, established an OAR Working Group of United States and
    international clinical trialists, and convened a public meeting of over
    145 participants from universities, medical schools, the pharmaceutical
    and biotechnology industries, professional scientific societies,
    community advisory boards, constituency groups, and NIH IC program
    staff to develop a set of principles to guide the development of
    Request For Application (RFAs) for these multi-IC supported clinical
    programs. This effort made a significant contribution to the process of
    the recompetition of these networks in fiscal year 2006 and to ensuring
    that they will operate effectively and cooperatively, making the best
    use of research funds.
        The alarming continued spread of the pandemic in Southeast and
    Central Asia, Eastern Europe, Latin America, and the Caribbean
    underscores the urgent need for more affordable and sustainable
    prevention and treatment approaches that can be implemented in
    resource-limited nations. The high incidence of Hepatitis B and
    Hepatitis C, malaria, and TB in many of these nations further
    complicates the treatment and clinical management of HIV-infected
    individuals. This budget provides increased funds for the development
    and evaluation of new regimens for these HIV co-infections that will
    allow the treatment of these diseases without serious drug interactions
    and toxicities.
        The By-Pass budget provides funds for NIH international AIDS
    research including: HIV vaccine candidates and chemical and physical
    barrier methods, such as microbicides, to prevent sexual transmission;
    behavioral strategies targeted to the individual, family, and community
    to alter risk behaviors associated with sexual activity and drug and
    alcohol use; drug and non-drug strategies to prevent mother-to-child
    transmission (MTCT); therapeutics for HIV-related co-infections and
    other conditions; and approaches to using Antiretroviral Therapy (ART)
    in resource-poor settings. Specific international infrastructure needs
    include: (1) developing research sites through establishment of stable,
    targeted cohorts, development of recruitment strategies, and
    enhancement of laboratory, clinical, and data management capabilities;
    (2) increasing the number of scientists, clinicians, and health care
    workers trained in basic, clinical, and behavioral research, data
    management, and ethical considerations; (3) developing research
    collaborations; and (4) transferring appropriate clinical and
    laboratory technologies.

                          OAR BY-PASS BUDGET ESTIMATE

        NIH is enhancing collaboration, minimizing duplication, and
    ensuring that research dollars are invested in the highest priority
    areas of scientific opportunity that will allow NIH to meet its
    scientific goals.
        The total fiscal year 2006 By-Pass budget estimate for all NIH AIDS
    research is $3.387 billion. This represents an increase of $442 million
    or 15 percent over the fiscal year 2005 current estimate of $2.945
    billion.
        The NIH Office of AIDS Research is providing the following
    materials: NIH fiscal year 2006 Plan for HIV-Related Research; NIH
    Research Mechanism Table; and Table of Funding by the NIH fiscal year
    2006 Plan for HIV-Related Research.

                    ATTACHMENT 1.--OFFICE OF AIDS RESEARCH FISCAL YEAR 2006 BY-PASS SUMMARY MECHANISM
                                                  [Dollars in millions]
    ----------------------------------------------------------------------------------------------------------------
                                                                           Fiscal years
                                            ------------------------------------------------------------------------
                                              2004  estimate    2005  estimate     2006  by-pass     2006 over 2005
                                            ------------------------------------------------------   dollar change
                                                                                                  ------------------
                                               No.     Amount    No.     Amount    No.     Amount  Percent   Amount
    ----------------------------------------------------------------------------------------------------------------
    Research Projects:
        Noncompeting.......................   2,245   $1,173    2,407   $1,268    2,370   $1,087     -14.3    -$181
        Administrative supplements.........     (14)      18      (16)      19      (20)      17     -10.5       -2
        Competing..........................   1,035      376      804      307    1,178      712     131.9      405
                                            ------------------------------------------------------------------------
          Subtotal, RPGs...................   3,266    1,567    3,195    1,594    3,528    1,816      13.9      222
    SBIR/STTR..............................      91       31      103       35      105       41      17.1        6
                                            ------------------------------------------------------------------------
          Total, RPGs......................   3,357    1,598    3,298    1,629    3,633    1,857      14.0      228
                                            ========================================================================
    Research Centers:
        Specialized/comprehensive..........      61      104       61      111       63      120       8.1        9
        Clinical research..................  .......      43   .......      45   .......      49       8.9        4
        Biotechnology......................  .......       6        1        7   .......       7   .......  ........
        Comparative medicine...............      17       48       17       52       17       65      25.0       13
        Research centers in minority         .......      10   .......      10   .......      11      10.0        1
         institutions......................
                                            ------------------------------------------------------------------------
            Subtotal, Centers..............      78      211       79      225       80      252   .......       27
    Other Research:
        Research careers...................     235       30      240       31      235       34       9.7        3
        Cancer education...................  .......  .......  .......  .......  .......  .......  .......  ........
        Cooperative clinical research......      25       44       25       44       25       44   .......  ........
        Biomedical research support........       1        2        1        2        1        3      50.0        1
        Minority biomedical research              2        1        2        1        3        1   .......  ........
         support...........................
        Other..............................     115       62      114       64      115       72      12.5        8
                                            ------------------------------------------------------------------------
          Subtotal, Other Research.........     378      139      382      142      379      154   .......       12
                                            ------------------------------------------------------------------------
          Total, Research Grants...........   3,813    1,948    3,759    1,996    4,092    2,263   .......  ........
                                            ========================================================================
                     FTTPs
    Training:
        Individual.........................      62        3       62        3       62        3   .......  ........
        Institutional......................     703       31      723       32      737       33       3.1        1
                                            ------------------------------------------------------------------------
          Total, Training..................     765       34      785       35      799       36       2.9        1
                                            ========================================================================
    Research & development contracts.......     181      364      190      415      225      553      33.3      138
        (SBIR/STTR)........................     (10)      (2)     (10)      (2)     (10)      (1)    -50.0       (1)
    Intramural research....................  .......     325   .......     331   .......     356       7.6       25
    Research management and support........  .......      96   .......      99   .......     106       7.1        7
    Construction...........................  .......       5   .......  .......  .......  .......  .......  ........
    Library of Medicine....................  .......       7   .......       8   .......      10      25.0        2
    Office of the Director.................  .......      61   .......      61   .......      63       3.3        2
    Buildings and Facilities...............  .......  .......  .......  .......  .......  .......  .......  ........
                                            ------------------------------------------------------------------------
          Total, Budget Authority..........  .......   2,840   .......   2,945   .......   3,387      15.0      442
    ----------------------------------------------------------------------------------------------------------------

        ATTACHMENT 2.--OFFICE OF AIDS RESEARCH, FISCAL YEAR 2006 BY-PASS, FUNDING BY THE NIH PLAN FOR HIV-RELATED
                                                        RESEARCH
                                                  [Dollars in millions]
    ----------------------------------------------------------------------------------------------------------------
                                                                            Fiscal year
                                             -----------------------------------------------------------------------
                                                                                                2006 over 2005
                                                                                   2006  ---------------------------
                                               2002    2003     2004      2005      by-            Percent
                                              actual  actual  estimate  estimate   pass   Dollar      of     Percent
                                                                                          change  increment   change
    ----------------------------------------------------------------------------------------------------------------
    Natural History and Epidemiology........    $276    $295     $293      $296     $315     $19       4.3       6.4
    Etiology and Pathogenesis...............     685     727      716       728      812      84      19.0      11.5
    Therapeutics............................     689     726      754       771      848      77      17.4      10.0
    Vaccines................................     329     407      467       529      714     185      41.9      35.0
    Behavioral and Social Science...........     346     370      402       408      457      49      11.1      12.0
    Training and Infrastructure.............     121     137      165       169      191      22       5.0      13.0
    Information Dissemination...............      53      55       43        44       50       6       1.4      13.6
                                             -----------------------------------------------------------------------
          Total.............................   2,499   2,717    2,840     2,945    3,387     442       100      15.0
    ----------------------------------------------------------------------------------------------------------------

                                     ______

                   Prepared Statement of Dr. Anthony S. Fauci

        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2006 President's budget request for the National
    Institute of Allergy and Infectious Diseases (NIAID) of the National
    Institutes of Health (NIH). The fiscal year 2006 budget of
    $4,459,395,000 includes an increase of $56,554,000 over the fiscal year
    2005 enacted level of $4,402,841,000, comparable for transfers proposed
    in the President's request.
        NIAID conducts research to understand, treat, and prevent
    infectious and immune-related diseases. Infectious diseases include
    well-known killers such as tuberculosis and malaria, emerging or re-
    emerging threats such as HIV/AIDS, SARS, West Nile Virus and influenza,
    and ``deliberately emerging'' threats from potential agents of
    bioterrorism such as those that cause anthrax and smallpox. Examples of
    immune-related diseases include autoimmune disorders such as type 1
    diabetes, systemic lupus erythematosus, rheumatoid arthritis,
    transplantation-related illnesses, asthma, and allergies.
        Historically, NIAID has accomplished its mission with a strong
    commitment to basic and targeted research in immunology, microbiology,
    and infectious disease. In the 57 years since NIAID was founded, this
    approach has led directly to new therapies, vaccines, diagnostic tests,
    and other technologies that have improved the health of millions of
    people worldwide. In recent years, however, the growing realization
    that the nation needs a stronger defense against both naturally and
    deliberately emerging infectious diseases has led NIAID to adopt a new
    research paradigm that accelerates the development of safe and
    effective medical countermeasures. To accomplish this, we have sought
    creative ways to modify our traditional process of research and
    development to move potential products ahead more rapidly while
    continuing to preserve the excellence in basic research that is a
    hallmark of NIAID, and all of NIH. The result is that we now take a
    much more proactive role in collaborating with academia, industry and
    other partners to move promising concepts into advanced product
    development and clinical testing.

                              BIODEFENSE RESEARCH

        In the wake of the 2001 terrorist attacks, NIAID substantially
    expanded and accelerated its biodefense research program. The fiscal
    year 2006 President's budget request for NIAID includes $1,664,505,000
    for these biodefense research and development activities. The NIAID
    Strategic Plan for Biodefense Research provides a blueprint for the
    construction of three essential pillars of the NIAID biodefense
    research program: infrastructure needed to safely conduct research on
    dangerous pathogens ($30,000,000 in fiscal year 2006); basic research
    on microbes and host immune defenses that serves as the foundation for
    applied research ($612,190,000 in fiscal year 2006); and targeted,
    milestone-driven research and development of medical countermeasures to
    create the vaccines, therapeutics and diagnostics that we would need in
    the event of a bioterror attack ($1,022,315,000 in fiscal year 2006).
        The investment Congress has made in the NIAID biodefense research
    program has already begun to return substantial dividends in all three
    of these aspects of biodefense research. Dramatic advances have been
    achieved in the development of medical countermeasures against an
    attack with biological agents, and, although there is much more to be
    accomplished, we are in a far stronger position today than we were only
    a few years ago. In September 2001, we had 15.4 million doses of
    smallpox vaccine available; today, we have more than 300 million doses.
    A next-generation smallpox vaccine called modified vaccinia Ankara
    (MVA) is in clinical testing and other vaccine candidates are in pre-
    clinical development stages. A new oral form of the antiviral drug
    cidofovir is in advanced product development for use in the event of a
    smallpox attack, as well as to treat the rare but serious complications
    of the classic smallpox vaccine. For anthrax, NIAID has aggressively
    pursued development of a new vaccine called rPA; the Department of
    Health and Human Services (DHHS) has contracted with VaxGen, Inc. to
    purchase 75 million doses of rPA under the BioShield legislation passed
    last year. This vaccine is derived using molecular biological
    methodologies and is produced using modern vaccine manufacturing
    techniques and may require fewer doses than the currently licensed
    vaccine. New anthrax therapies that can neutralize the anthrax toxin,
    such as monoclonal and polyclonal antibodies, are being developed.
    Candidate antibody treatments for the toxin that causes botulism are in
    development, as is a new vaccine to prevent the disease. Finally, an
    Ebola recombinant DNA vaccine is in initial human clinical trials at
    the NIAID Vaccine Research Center.
        With regard to research infrastructure, many integrated research
    facilities are under construction to safely contain and study
    pathogens, including several new biodefense laboratories that will be
    owned and operated by NIAID. In addition, sites have been selected for
    the construction of two National Biocontainment Laboratories (NBLs) and
    nine Regional Biocontainment Laboratories (RBLs) at major universities
    around the United States. All of these research laboratories will
    provide the secure facilities needed to carry out the nation's expanded
    biodefense research program in settings that protect workers and the
    surrounding communities. NIAID also has funded eight Regional Centers
    of Excellence for Biodefense and Emerging Infectious Diseases Research
    (RCEs). This nationwide network of multidisciplinary academic centers
    will conduct wide-ranging research to better understand infectious
    agents that could be used in bioterrorism, and will develop
    diagnostics, therapeutics and vaccines needed for biodefense against
    these agents. In 2005, NIAID will fund two additional RCEs and three to
    four additional RBLs. NIAID also has developed and expanded contracts
    to screen new drugs against bioterrorism threat agents, developed new
    animal models for bioterrorism threat agents, and established a
    biodefense reagent and specimen repository.
        Advances in Medicine rest on a foundation of basic research into
    the fundamental properties and mechanisms of life. In biodefense, these
    basic studies include sequencing and understanding of microbial genomes
    (genomics) and their products (proteomics), deciphering how microbes
    cause disease (pathogenesis), and examining how the human immune system
    and pathogens interact (immunology). NIAID-funded basic researchers
    have made significant progress since 2001 in each of these areas. For
    example, researchers have now determined the genetic sequence of at
    least one strain of every pathogen identified as a potential bioterror
    threat, and NIAID has established the Pathogen Functional Genomics
    Resource Center to help researchers apply and analyze these new genome
    sequence data. In pathogenesis, NIH researchers recently determined the
    three-dimensional structure of the anthrax toxin bound tightly to a
    target cell surface receptor. This finding has provided new leads for
    the development of novel antitoxins that could save lives late in the
    course of anthrax disease when large amounts of toxin are present and
    antibiotics alone are no longer sufficient to save the patient.
    Finally, basic molecular and cellular studies of the human innate
    immune system, which is comprised of broadly active ``first responder''
    cells and other mechanisms that are the first line of defense against
    infection, have been moving forward rapidly. These advances suggest it
    may be possible to develop fast-acting countermeasures that boost
    innate immune responses to mitigate the effects of a broad spectrum of
    bioterror pathogens or toxins. Manipulation of the innate immune system
    also could lead to the development of powerful adjuvants that can be
    used to increase the effectiveness of vaccines.
        The knowledge and products that will flow from the NIAID biodefense
    research program, including research results, intellectual capital,
    laboratory resources, and countermeasures in the form of diagnostics,
    therapeutics, and vaccines, will help us cope with naturally emerging,
    re-emerging, and deliberately released microbes alike. Recent
    experience tells us that knowledge developed to understand one pathogen
    invariably applies to others. For example, when HIV first emerged,
    antiviral drug development was in its infancy. Now, new technologies
    have led to the development of more than 20 antiretroviral drugs that
    can effectively suppress HIV replication and dramatically reduce AIDS
    morbidity and mortality. These same technologies, and the lessons
    learned about antiviral drug development, are being applied to the
    development of new generations of drugs against many viruses, including
    influenza, SARS, smallpox, and Ebola. Even if we are never confronted
    with another bioterror attack, the biodefense research and preparations
    being carried out now will without question prove to be very valuable.

                               HIV/AIDS RESEARCH

        Only a few statistics are needed to present a profoundly disturbing
    picture of the still-emerging HIV/AIDS pandemic. Approximately 40
    million people worldwide are living with HIV/AIDS, according to the
    Joint United Nations Programme on HIV/AIDS (UNAIDS). Every year, more
    than 5 million people worldwide are newly infected with the virus--
    about 14,000 each day; more than 95 percent of these people live in low
    and middle income countries. In the United States, nearly one million
    people are living with HIV/AIDS, and approximately 40,000 new
    infections occur annually, according to the Centers for Disease Control
    and Prevention. The death toll continues to climb steadily; worldwide,
    more than 20 million people with HIV have died since the pandemic
    began, including more than 520,000 in the United States. In 2004, there
    were 3 million deaths due to HIV/AIDS. As shocking as these numbers
    are, they do not adequately communicate the physical and emotional
    devastation to individuals, families, and communities coping with HIV/
    AIDS, nor do they capture the terrible impact of HIV/AIDS on the
    economies and security of nations, and indeed on entire regions.
        Even as the burden of HIV/AIDS continues to grow, recent progress
    in research is providing reasons for optimism. For example, several new
    antiretroviral drugs recently have entered the market, all of which
    were built on NIAID-sponsored research and/or were tested in NIAID
    clinical trials networks; many other new anti-HIV drugs are in clinical
    trials. Other novel approaches to anti-HIV drugs are in the research
    ``pipeline.'' For example, NIAID scientists, in collaboration with
    extramural colleagues and with industry, recently conducted a clinical
    trial to test a product, anti-CCR5, that binds to a new therapeutic
    target, the HIV co-receptor, thus preventing HIV infection of host
    cells.
        The development of a safe and effective HIV vaccine is one of
    NIAID's highest priorities. The scientific barriers to the creation of
    such a vaccine are extraordinarily high, and better coordination,
    collaboration and transparency of research worldwide would help to
    overcome them. To facilitate such an approach, NIAID participated
    heavily in the creation of a new initiative called the Global HIV/AIDS
    Vaccine Enterprise, which was endorsed by President Bush and the other
    G8 countries at their June, 2004 Summit meeting in Sea Island, GA. The
    project creates a worldwide consortium of people and organizations with
    a stake in HIV vaccine research who agree to harmonize their individual
    HIV vaccine efforts by following a unified Strategic Plan for HIV
    vaccine development. This plan was published on a publicly-accessible
    website in February 2005.
        Other measures to prevent HIV transmission also are being
    vigorously pursued. For example, when I testified here last year I
    discussed our efforts to develop topically applied microbicides that
    women could use to protect themselves from HIV and other sexually
    transmitted pathogens. More than 50 candidate agents have shown
    activity against HIV and other sexually transmitted diseases in the
    laboratory, and several of these have been shown to be safe and
    effective in animal models. In February 2005, a large international
    study, sponsored by NIAID and involving more than 3,000 women at high
    risk of acquiring HIV in the United States and five African countries,
    opened for enrollment. If these microbicides are proven to be safe and
    effective, they likely will become a very important means of slowing
    the pace of the HIV/AIDS epidemic.

         RESEARCH ON OTHER EMERGING AND RE-EMERGING INFECTIOUS DISEASES

        Infectious diseases do not remain static, but continually and
    dramatically change over time. New pathogens, such as the Severe Acute
    Respiratory Syndrome (SARS) coronavirus, can emerge suddenly and
    familiar ones, such as influenza virus and West Nile virus, can re-
    emerge with new properties or in unfamiliar settings. We must always be
    on guard for such changes and be prepared to react to them as quickly
    as possible. SARS is a prototypical example of a newly-emerging
    infectious disease. When SARS first came to the world's attention in
    early 2003 as an unknown, highly lethal and transmissible disease,
    researchers and public health authorities the world over immediately
    began to collaborate to understand it. In short order, NIAID-supported
    researchers and others in Hong Kong showed that SARS was caused by a
    previously unrecognized coronavirus, epidemiologists unraveled its
    modes of transmission, and public health authorities were able to
    contain the initial outbreak.
        Since then, NIAID has continued to pursue several approaches to the
    development of SARS antiviral therapies. For example, NIAID screening
    contracts have supported the evaluation of more than 20,000 chemicals
    for anti-SARS coronavirus activity. More than 1,400 compounds with
    activity against SARS coronavirus have been identified, including alpha
    interferon, a drug already approved by the FDA for the treatment of
    hepatitis B and C infections.
        NIAID scientists and grantees also are working on several
    approaches to a SARS vaccine, including one that entered human clinical
    testing in December 2004. It is truly remarkable that two years ago we
    were facing an unknown global health threat, and now we are already
    testing a promising vaccine that may help us to counter that threat
    should it re-emerge.
        When West Nile virus (WNV) first appeared in the Western hemisphere
    in 1999, NIAID immediately increased its basic research on the virus
    and undertook the development of new vaccines and treatments for the
    disease. NIAID currently supports the development of three types of WNV
    vaccine--one of which has entered initial clinical testing--and is
    developing candidate WNV therapies. For example, in 2004, NIAID
    expanded an ongoing clinical study in human volunteers that is
    evaluating the safety and efficacy of the administration of antibodies
    against the virus as a means of treating or preventing West Nile virus
    encephalitis.
        Influenza is a classic example of a re-emerging disease. Because
    the influenza virus continually changes, the U.S. influenza vaccine
    supply must be renewed each year. Although the egg-based technology
    currently in use has served us reasonably well for more than 40 years,
    it has limitations in flexibility in that surges in the need for
    additional or new vaccines cannot be readily accommodated due to the
    advance time that is required to provide for the annual requirement for
    hundreds of millions of fertilized chicken eggs to manufacture the
    vaccine. In addition, there is the ever present risk of contamination
    and the vicissitudes of yield of virus from this technique. The serious
    vaccine shortage that occurred this flu season underscores the
    difficulties we face in annually renewing the influenza vaccine supply,
    and highlights the pressing need to move toward adoption of newer
    vaccine manufacturing techniques to improve the flexibility and speed
    with which vaccines can be made.
        NIAID supports several research projects and other initiatives
    intended to foster the development of new influenza vaccines and
    manufacturing methods that are simpler and more reliable, yield
    products that work against multiple influenza strains, and provide
    greater protection. DHHS has requested $120 million in fiscal year 2006
    to help shift vaccine manufacture toward new cell-culture technologies,
    new production technologies, as well as to provide for year-round
    availability of eggs to provide for a secure supply and surge capacity.
    In addition, a technique developed by NIAID-supported scientists called
    reverse genetics allows scientists to manipulate the genomes of
    influenza viruses to make the process of development of seed viruses
    for vaccines faster and more predictable.
        Although the impact of influenza in a normal epidemic year is
    substantial, influenza viruses from animals occasionally cross into
    humans and, if the virus then acquires the ability to be easily
    transmitted between people, can cause a much more serious influenza
    pandemic. NIAID conducts a great deal of research to understand the
    viral biology and epidemiology that underpinned past pandemics and
    funds surveillance activities in Asia to detect the emergence of
    influenza viruses with pandemic potential. In addition, the DHHS draft
    Pandemic Influenza Response and Preparedness Plan directs NIAID to help
    develop and produce an effective vaccine as rapidly as possible that
    could be used should a pandemic alert be declared.
        In recent years, avian influenza virus strains that can infect
    humans have emerged; the most worrisome are known as H9N2 and H5N1. In
    1999 and 2003, an H9N2 influenza strain caused illness in people in
    Hong Kong. The H5N1 ``bird flu'' influenza strain was first detected in
    1997 and has spread widely among wild and domestic birds. This latter
    virus has infected at least 55 people and killed 42 since January 2004,
    and there has been at least one documented case of human-to-human
    transmission.
        NIAID has taken several steps to develop vaccines against both of
    these potential pandemic strains. NIAID contracted with Chiron
    Corporation to produce investigational batches of an inactivated H9N2
    vaccine, which will be evaluated clinically by NIAID this year. For
    H5N1, Aventis-Pasteur, Inc. and Chiron are both producing
    investigational lots of inactivated H5N1 vaccine preparations;
    additionally, DHHS has contracted with Aventis to produce up to 2
    million doses to be stockpiled for emergency use, if needed, to
    vaccinate health workers, researchers, and, if indicated, the public in
    affected areas. Development and evaluation of a combination antiviral
    regimen against these potential pandemic influenza strains are also now
    under way.

                      RESEARCH ON IMMUNE-MEDIATED DISEASES

        Immune-mediated diseases, including autoimmune diseases, allergic
    diseases, and asthma are important health challenges in the United
    States and abroad. One of the most promising strategies for developing
    treatments for a wide variety of these disorders is known as immune
    tolerance, in which researchers hope to selectively turn off injurious
    immune responses while leaving intact the protective responses needed
    to fight infection. To foster this research, NIAID sponsors the Immune
    Tolerance Network (ITN), a consortium of more than 80 investigators in
    the United States, Canada, Western Europe, and Australia dedicated to
    the clinical evaluation of promising therapies that can induce immune
    tolerance. The ITN will be recompeted in fiscal year 2006.
        Reducing the growing burden of asthma among inner-city minority
    children is another NIAID priority. NIAID-supported investigators
    recently reported the largest study of its kind, showing that an
    intervention to reduce exposure to indoor allergens and tobacco smoke
    substantially reduced asthma severity and healthcare utilization among
    inner-city children. In 2004, NIAID's Inner-City Asthma Consortium
    launched a large study to define and analyze immunological and
    environmental influences upon the development of childhood asthma in a
    cohort of urban children followed from birth.
        In closing, Mr. Chairman, I would like to take a moment to remember
    John R. La Montagne, Ph.D., the former deputy director of NIAID, who
    died suddenly on November 2 while traveling to a meeting of the Pan
    American Health Organization in Mexico City. Human infrastructure, in
    the form of a highly trained and deeply committed work force, is a
    critical component of any kind of medical research. Throughout John's
    almost 30 years at NIAID, his leadership and dedication to improving
    global health, as well as his generosity, wit, even-handedness and
    kindness, made him a cornerstone of the human infrastructure at NIAID.
    Personally, he was a dear friend and one of the finest people I have
    ever known. He is sorely missed.
        Thank you, Mr. Chairman. I would be pleased to answer any questions
    that the Committee might have.
                                     ______

               Prepared Statement of Dr. Andrew C. von Eschenbach

        Mr. Chairman and Members of the Committee: I am pleased to present
    the President's budget request for the National Cancer Institute (NCI)
    for fiscal year 2006. The fiscal year 2006 budget includes
    $4,841,774,000, an increase of $16,516,000 over the fiscal year 2005
    enacted level of $4,825,258,000 comparable for transfers proposed in
    the President's request.

                                 LONG-TERM GOAL

        The accelerating progress that the National Cancer Institute (NCI)
    and its partners in the cancer community have made over the past three
    decades in understanding the molecular mysteries of cancer is now
    extending the years and enhancing the quality of patients' lives. Now
    we are closer to the reality of eliminating the suffering and death due
    to cancer--the goal that NCI set to be achieved by 2015. The fiscal
    year 2006 budget continues to accelerate the discovery, development,
    and delivery of the interventions that will transform our traditional
    view of cancer as a death sentence into a disease that we can prevent,
    eliminate, or control. Accomplishing this goal is the legacy we strive
    to leave our children.
        Our increased knowledge in several clinical approaches has led to
    new treatments approved for use. For example, our understanding of the
    molecular mechanisms required for tumors to develop the blood supply
    necessary for their growth led to the Food and Drug Administration's
    (FDA) approval of the monoclonal antibody Avastin as a first-line
    treatment for patients with metastatic colorectal cancer. Similarly,
    knowledge of the growth factors necessary to stimulate cancer cell
    proliferation led to development and approval of another targeted
    monoclonal antibody Erbitux for the treatment of metastatic colorectal
    carcinoma and to the accelerated approval of Alimta for locally
    advanced or metastatic non-small cell lung cancer. These are just a few
    of the new drugs offering fresh hope for patients with advanced cancer.
        We have made progress in preventing cancer from ever developing in
    the first place, especially in people at high risk. An example is the
    creation of a vaccine that has prevented women from becoming
    persistently infected with human papilloma viruses (HPV), an infection
    that is responsible for half of all cervical cancers.
        Now we must quicken the pace of progress because the trajectory is
    clear: discovery of cancer's genetic and molecular mechanisms leads to
    development of innovative interventions that--when delivered to
    patients--save lives. Building on this knowledge, the promise of
    tomorrow's advances is just over the horizon. This hopeful prospect
    will be realized by investing in strategic research areas, including:
    cancer genomics, biomarkers, molecular imaging, nanotechnology, and
    bioinformatics.

                        ADVANCED TECHNOLOGY INITIATIVES

        The technology revolution is speeding up and enabling the discovery
    process. Recent advances in molecularly-targeted imaging will allow us
    to locate very small tumors and interrogate their features.
    Nanotechnology has emerged as a key strategy for imaging molecular
    features of cancer that are notoriously difficult to detect. In one
    case, a team of NCI-supported scientists has crafted a nano-sized
    device--less than 1/80,000 the width of a human hair--to identify areas
    of new blood vessel growth, which is characteristic of growing tumors.
    Further, drugs attached to agents that seek out the proteins on cancer
    cells will target therapy to exactly where it is needed without damage
    to healthy cells.
        The development, integration, and coordination of advanced
    technologies are pivotal to enabling the biomedical and cancer research
    advances that are necessary to achieve NCI's 2015 goal. The Institute
    has played a crucial role in charting the path and collaborating in
    efforts to support bold new programs in this crucial arena.
        For instance, the National Advanced Technologies Initiative for
    cancer (NATIc) is a plan to create a nationwide ``virtual'' laboratory
    for cancer. The NATIc plan envisions a network of state and regional
    technology ``hubs'' focused on several strategic areas, including
    advanced computing, nanotechnology, and biorepositories.
        NCI has already begun development of the cancer Biomedical
    Informatics Grid (caBIG) to create a ``world-wide web'' for cancer
    research. The goal is to create a network of interconnected data,
    applications, individuals, and institutions that will redefine how
    cancer research is conducted and care is provided. During its initial
    year, the caBIG enterprise began bearing its first fruits with the
    release of NCI's caArray, a prototype software application that is made
    freely available to facilitate the sharing and analysis of microarray
    data by the medical research community. NCI and its partners in
    academia and industry are also developing an online information
    infrastructure to support clinical trials management and electronic
    drug approval submissions to the FDA. The first system module--the
    Federal Investigator Registry (Firebird)--starts pilot testing this
    spring.
        In addition, NCI has for the first time adopted a modern business
    model approach to our research and development program for cancer-
    imaging technologies. This entailed creation of an Imaging Integration/
    Implementation (I\2\) Team that recently submitted a proposed business
    plan for a new entity to be called I\2\ Imaging, Inc. The goal is to
    create distinct product lines to organize NCI's imaging program and
    clearly define measurable goals for each of the product lines. The plan
    includes four R&D programs encompassing imaging technologies for: (a)
    understanding of cancer biology and microenvironments; (b) cancer
    prevention and preemption; (c) development and preclinical validation
    of therapies; and (d) tools for clinical trial support.

                         STRATEGIC RESEARCH INITIATIVES

        Exponential advances in cancer research are defining, with ever
    increasing specificity, the many genetic, molecular, and cellular
    events that influence the cancer process. We now understand cancer as
    an ongoing process that can be interrupted at many stages--from
    susceptibility to initiation to disease progression. We are translating
    this new knowledge into innovative strategies to prevent cancer from
    developing, eliminate it early when it does occur, and modulate its
    devastating effects. This involves NCI making strategic investments in
    several research areas.
        Cancer prevention, early detection, and prediction.--New evidence-
    based interventions encourage lifestyle improvements in diet and
    physical activity, discourage tobacco use, and promote safe and fully-
    tested chemoprevention approaches for people at risk. Pioneering
    proteomic and biomarker advances, and the promise of nanotechnology,
    give us new hope for the early detection of cancer and prediction of
    patient responses to treatment.
        Development of strategic cancer interventions.--One of NCI's key
    strategies is to optimize the development and speed delivery of
    targeted cancer diagnostics, therapies, and preventives to patients.
    This is evidenced by NCI's investments into the Cancer Genome Anatomy
    Project, Academic Public-Private Partnership programs, and Rapid Access
    to Intervention Development (RAID).
        An integrated clinical trials system.--NCI provides leadership,
    resources, and expertise for clinical trials programs that span the
    discovery of novel molecules to the evaluation of new agents and
    interventions. To make clinical trials more efficient and to accelerate
    and improve the regulatory approval process, NCI is enhancing its
    working relationship with the FDA and the Department of Health and
    Human Services' (DHHS) Office of Human Research Protections to develop
    more streamlined policies and procedures for the conduct of clinical
    trials.
        Integrative cancer biology.--Integrative cancer biology is the
    study of cancer as a complex biological system. NCI's initiatives in
    this cutting-edge area include creating computational models of the
    complex networks within and among cancer cells, building our
    understanding of the tumor microenvironment, and studying the role of
    the tumor macroenvironment in cancer development.
        Molecular epidemiology.--NCI is developing novel ways to unravel
    the complexities of inherited and environmental contributions to cancer
    causation. Future investments will help scientists uncover risk
    factors, identify genetically susceptible individuals, and generate
    individual and public health strategies to avoid or mitigate adverse
    genetic exposures.

                           INTERAGENCY COLLABORATIONS

        Cancer is a large and complex problem with scientific, medical,
    social, cultural, and economic dimensions. Addressing this problem
    requires that NCI work across institutional and sector boundaries,
    share knowledge, and bring together the diverse members of the DHHS
    family of agencies, as well as other Federal offices, that can help
    develop systems-based solutions to the cancer problem. Just within the
    National Institutes of Health (NIH), NCI collaborates with virtually
    all of the 27 Institutes and Centers. Likewise, NCI also has many
    ongoing collaborations with several DHHS agencies. The ultimate
    beneficiaries of this continued cooperative effort will be cancer
    patients and their families.
        NCI and FDA created an Interagency Oncology Task Force (IOTF) to
    remove bottlenecks in the process of developing and approving safe,
    more effective cancer interventions. IOTF, which is comprised of senior
    representatives from both agencies, has been meeting regularly to
    define key areas of mutual interest and concern. As a result, the NCI-
    FDA Cancer Training Fellowship Program was launched in 2005. The
    program will train a cadre of scientists in research and research-
    related regulatory review so that they can develop skill sets that
    bridge the two distinct processes.
        NCI is also an active participant in the Medical Innovation Task
    Force established last year by DHHS. The group--which also includes the
    FDA, the Centers for Disease Control and Prevention, the Centers for
    Medicare & Medicaid Services, and the NIH--is weighing new ideas and
    solutions to encourage innovation in health care. The interagency panel
    seeks to speed the delivery to market of effective new medical
    technologies, such as drugs, biological products, and medical devices.

                                  NIH ROADMAP

        NCI's contributions to NIH Roadmap initiatives will increase NCI's
    ability to support the collaborative research critical to cancer
    studies. Cooperation across the cancer continuum is vital for continued
    progress. The NIH Roadmap mechanisms support research in cancer biology
    that will also enhance continued interdisciplinary research to address
    vital questions related to cancer and the immune system, the interface
    of aging and cancer, and the role of microbial agents in the etiology
    of human cancers. By encouraging interdisciplinary teams to evolve in
    both directed and serendipitous ways, these new funding mechanisms
    complement and enlarge NCI's efforts toward the integration and cross-
    fertilization of research efforts that span the cancer spectrum.

                          CHALLENGES AND OPPORTUNITIES

        In the coming years, we will face a number of critical challenges
    and opportunities. We stand on the brink of a new age of ``personalized
    oncology''--delivering the right treatment to the right patient at the
    right time to halt cancer-causing processes in the body before they
    cascade into advanced disease states. NCI is driven to meet the 2015
    challenge goal. Cancer is a public health and financial challenge for
    the United States. NIH estimates that in 2003, the total cost of cancer
    was over $189 billion: $64 billion in direct medical costs (much of it
    paid by Medicare) and $125 billion from lost productivity due to
    illness and premature death. More telling, 570,000 Americans lost their
    lives to the disease last year, according to the American Cancer
    Society. Furthermore, the fact that cancer occurs primarily in
    individuals over the age of 50 means that more of our citizens will
    suffer the terrible burden of this disease in the future due to the
    aging and changing demographics of our population. NCI and its partners
    are committed to making progress toward the goal of eliminating
    suffering and death due to cancer in the next 10 years.
        Thank you, Mr. Chairman. I would be pleased to answer any question
    that the Committee may have.
                                     ______

      Prepared Statement of Dr. Barbara Alving, Acting Director, National
                         Center for Research Resources

        Mr. Chairman and Members of the Committee: I am pleased to present
    the President's budget request for the National Center for Research
    Resources (NCRR) for fiscal year 2006, a sum of $1,100,203,000, which
    reflects a net decrease of $14,887,000 over the comparable fiscal year
    2005 appropriation. Within the total is $162,618,000 for AIDS research.
        I am delighted to have this opportunity to share with you the
    scientific advances achieved by NCRR-supported investigators and the
    future directions for NCRR programs. As the ``research resources''
    component of the National Institutes of Health, NCRR's mission is to
    ensure that scientists have the necessary tools and access to research
    environments to conduct their progressively more complex research on
    human disease. With ready access to essential tools, our nation's top
    scientists may creatively explore promising new research avenues that
    will ultimately enhance human health.
        Because of its cross-disciplinary programs, NCRR supports research
    tools and infrastructure that enable all lines of biomedical inquiry,
    from studies of molecular structures to clinical trials that evaluate
    potential therapies. Most NCRR-supported research resources are shared
    and accessible to scientists nationwide. These shared resources include
    advanced instrumentation and novel technologies, animal models of human
    disease, and electronic networks for collaborations among investigators
    in less populated areas. In addition, through the Institutional
    Development Award program, NCRR provides support to institutions in 23
    states and Puerto Rico to develop new research facilities, equipped
    with state-of-the art research tools.
        NCRR encourages resource sharing because it broadens access to
    essential tools, is cost effective, and leverages precious federal
    research support. Each year, NCRR-funded research resources are used by
    more than 35,000 investigators who receive their primary research
    support from other NIH components, other federal agencies, and the
    private sector. Let me briefly describe just a few of the science
    advances that these researchers achieved over the past year.

             OBESITY STUDIES AIDED BY ANIMAL AND CLINICAL RESOURCES

        Scientists who seek to determine the genetic defects of many human
    diseases are often stymied by the fact that common conditions--from
    obesity to psychiatric disorders--are influenced by multiple genes.
    Therefore, researchers have turned to inbred mice as a model system for
    detecting genetic regions that contribute to complex disease. Using
    unique mouse strains available through an NCRR resource, scientists
    examined genetic factors that affect many complex traits, including
    obesity and anxiety. With this approach about 150 previously
    undiscovered genetic regions were discovered. This effort may narrow
    the search for specific genes that contribute to obesity and also pave
    the way for finding similar genes in humans.
        NCRR's General Clinical Research Centers (GCRCs) provide an ideal
    research environment for studies of obesity, an increasing public
    health concern. Particularly valuable are the GCRCs' highly trained
    staff and state-of-the-art equipment that can analyze a patient's
    metabolism and track consumption of all foods, down to the level of
    micronutrients. At the University of California, Los Angeles,
    researchers depend on the GCRC for their carefully controlled studies
    of the hormones that affect appetite and metabolism. One study found
    that injections of the hormone leptin can reduce body weight by more
    than 50 percent in obese individuals born with leptin deficiency. At
    Yale University's GCRC, scientists evaluated hundreds of overweight
    children and adolescents and found that about half of the severely
    obese have a condition that raises their risk of heart disease and type
    2 diabetes. Ultimately, better understanding of the risk factors and
    potential therapies for obesity could lead to a leaner, healthier
    population.

                      ADVANCES IN TRANSPLANTATION RESEARCH

        As mentioned earlier, the GCRCs continue to have a significant role
    for advancing human health. For instance, the GCRCs enabled pioneering
    clinical studies related to transplantation, from the earliest
    successes with organ transplants in the 1960s to the current
    microtransplants of genes into cells. One recent success, reported in
    the Journal of the American Medical Association this past February,
    showed that islet cells from a single human pancreas can be
    transplanted into up to eight patients with type 1 diabetes, a
    condition in which the pancreatic islet cells do not make insulin. All
    eight transplant recipients achieved normal glucose levels without the
    need for insulin injections. Ongoing advances in transplantation
    illustrate how federally funded efforts--among molecular biologists,
    geneticists, animal researchers, and clinical investigators--lay a
    solid foundation for improving human health through the effort of a
    team of investigators.

                      BIODEFENSE AND TECHNOLOGY RESOURCES

        Besides clinical and comparative medicine resources, NCRR also
    supports biomedical technology centers that develop and provide
    scientists with access to innovative instruments, technologies, and
    computational tools. These technology centers have enabled recent
    advances to help scientists determine how infectious agents, like
    anthrax, induce their deleterious clinical effects. The anthrax
    bacterium is unusual because it produces large amounts of a toxin that
    can kill a patient even after the bacterium itself has been destroyed
    by antibiotics. A research team used x-ray data collected at an NCRR-
    supported synchrotron resource to examine the structures of molecules
    that might disarm the deadly toxin. Synchrotrons are large machines
    (about the size of a football field) that accelerate electrons to
    almost the speed of light to produce intense x-rays with adjustable
    wavelengths that can be exploited to reveal the 3 dimensional
    structures of molecules. Further structural studies may lead to the
    development of effective toxin-blocking therapies for inhalational
    anthrax infections.
        In another study, scientists developed improved techniques for
    identifying microbes by their DNA ``fingerprints''--a critical advance
    in this age of bioterrorism and emerging diseases--and shorten the
    timeframe needed to identify the toxic agent. Using laser technology at
    an NCRR-supported flow cytometry resource, scientists analyzed and
    measured tiny samples of DNA from a Staphylococcus aureus bacterium.
    The analysis can be completed in just 30 minutes, compared to the 24
    hours normally required to analyze DNA. Advanced computational methods
    linked to the new technology may boost efforts to detect and track
    microbial threats and provide sufficient time to alert individuals at
    risk.

                   INFORMATICS AND INTERDISCIPLINARY SCIENCE

        NCRR's shared resources provide a fertile environment for
    interdisciplinary collaboration. Such studies are essential for
    addressing important but complex research problems that scientists
    grapple with today. For instance, NCRR supports a large-scale
    interdisciplinary effort known as the Biomedical Informatics Research
    Network (BIRN). That effort draws on multiple resources to examine
    increasingly complex problems in neuroscience. BIRN is the nation's
    first test bed for online sharing of research resources and expertise,
    and for effective data mining for both basic and clinical research. The
    initial effort focuses on neuroscience, since that discipline holds the
    largest data sets and requires the capacity to transmit large,
    information-rich images of the brain. BIRN will be extended to other
    research areas. Ultimately, the network will enhance the translation of
    basic research to the patient.

                                  NIH ROADMAP

        The NIH Roadmap complements many NCRR programs, and as a result
    NCRR staff members are involved in virtually every Roadmap Working
    Group. NCRR is leading the Exploratory Centers for Interdisciplinary
    Research program. These Centers are developing approaches that will
    allow researchers from very different scientific disciplines to work
    together to solve difficult biomedical or behavioral problems. NCRR is
    also leading the National Technology Centers for Networks and Pathways
    program that aims to develop new technologies to study molecular
    interactions within intact cells. NCRR has a significant role in
    another Roadmap initiative, the National Centers for Biomedical
    Computing, that will provide the infrastructure needed to promote
    productive interactions between computational scientists and biomedical
    researchers.

                   STRATEGIC PLANNING AND FUTURE INITIATIVES

        This past year, NCRR published a new strategic plan for 2004-2008.
    Titled Challenges and Critical Choices, the plan was developed based on
    input from thousands of researchers and administrators for research-
    intensive organizations nationwide. This strategic plan now guides
    NCRR's priorities for programmatic investments. I would like to briefly
    describe just a few of the initiatives that NCRR has launched, or plans
    to launch, to address the plan's recommendations.

    Informatics for Clinical Research
        The scientists who participated in NCRR's strategic planning
    process highlighted cyberspace infrastructure that would significantly
    enhance information sharing, access to and management of vast datasets,
    and transmission of large data objects like brain images as a priority.
    NCRR has initiated an assessment to determine current capabilities and
    future requirements for electronic communication and information
    management across research centers, including the GCRCs, Research
    Centers in Minority Institutions, and biomedical technology research
    centers. One long-term goal is to support collaborations among
    investigators located in less densely populated states.

    Enhance Protection of Clinical Research Subjects
        Another important trend identified during NCRR's strategic planning
    process involves the public's growing concern for the safety of
    participants in clinical research studies. NCRR created a Research
    Subject Advocate (RSA) program to assure appropriate safety monitoring
    of research subjects for GCRC-based studies and to ensure that
    investigators are aware of their responsibilities under State and
    Federal law. Because the RSA program has had such a positive impact,
    NCRR remains committed to strengthening the program.

    Expand Availability of Nonhuman Primate Stem Cells
        Another NCRR initiative will focus on stem cells, which hold the
    potential for treating a variety of disorders. But extensive animal
    studies are needed to identify the molecules, cytokines or other agents
    that modulate stem cell differentiation. NCRR proposes to support
    research to identify these factors and to isolate several different
    embryonic stem cell lines from the rhesus macaque, baboon, and a few
    other nonhuman primate species. Isolated cell lines will be distributed
    to qualified scientists via a national resource, and a companion
    database will track relevant data for each cell line. Information
    gleaned from these studies may be applicable to the study of human stem
    cells.

                                   CONCLUSION

        In closing, as biomedical research becomes more complex,
    specialized research resources are required to address emerging trends
    and build bridges across disciplines. NCRR plays a cross-cutting,
    trans-NIH role in biomedical research, supporting state-of-the-art
    resources that enable collaboration and stimulate scientific discovery.
    These research resources play an essential role in advancing human
    health.
        Thank you, Mr. Chairman. I would be pleased to answer any questions
    that the Committee may have.
                                     ______

    Prepared Statement of Dr. Duane Alexander, Director, National Institute
                     of Child Health and Human Development

        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2006 President's budget request for the National
    Institute of Child Health and Human Development (NICHD). The fiscal
    year 2006 budget includes $1,277,544,000, an increase of $7,223,000
    over the fiscal year 2005 enacted level of $1,270,321, comparable for
    transfers proposed in the President's request.
        With the continued support of this Committee, the National
    Institutes of Health has the unique ability to invest in complex
    medical studies that continue for many years. It is particularly
    satisfying to all of us when an investment in research cures a disease
    or eradicates a condition. With deep satisfaction, we report a major
    medical and public health achievement that the New York Times heralded
    a few weeks ago in a front page headline: U.S. is Close to Eliminating
    AIDS in Infants.
        This progress came in small incremental steps that arose from a
    large ambitious vision: to eliminate mother-to-child HIV transmission.
    Just a decade ago, a pregnant woman with HIV who lived in the United
    States had more than a 25 percent chance of passing the virus on to her
    child. In the early 1990s, the NICHD and the NIAID formed the Pediatric
    AIDS Clinical Trials Group to test promising new anti-HIV treatments.
    One of the first studies showed that the drug AZT administered to the
    mother and newborn infant at specific times could reduce HIV
    transmission from 25 percent to 8 percent. Subsequent research tested a
    drug combination known as highly active anti-retroviral therapy (HAART)
    and showed that the rate of transmission could be reduced even further.
    Today, with an expanded array of anti-HIV drug treatments, the chance
    of a pregnant woman in the United States passing the virus on to her
    child has plummeted to about 1.2 percent.

              COMPOUNDS IN MOTHERS' MILK PROTECT AGAINST DIARRHEA

        Human breast milk is known to protect infants from diarrhea, but
    the responsible components had not been known. Results of a routine
    investigation to understand the purpose of some complex sugar molecules
    found in human breast milk may lead to a way to prevent diarrheal
    diseases from occurring, not just in infants, but in older children and
    adults as well. The molecules, called oligosaccharides, are abundant in
    human breast milk. During the last decade, NIH-funded researchers have
    discovered that oligosaccharides can stop bacteria and viruses from
    binding to the cells in the intestinal wall, preventing diarrheal
    diseases from gaining a foothold.
        Oligosaccharides have been found to combat E. coli 0157, the deadly
    bacterium that can infect ground beef and other common foods. They also
    block the Norwalk virus, which incapacitates thousands of cruise ship
    voyagers every year, as well as rotavirus, one of the most common
    causes of diarrheal diseases in children. Oligosaccharides may also
    provide a means to overcome the problem of bacterial resistance. They
    function differently than do antibiotics, and bacteria do not appear
    able to develop resistance to the oligosaccharides.

                   RESEARCH LEADS TO BETTER HEALTH FOR WOMEN

        Fibroids, or leiomyomas, are painful noncancerous growths that
    develop in the smooth muscle of the uterus. Women with fibroids may
    have painful menstrual periods, pain during intercourse, infertility,
    incontinence, and bowel obstruction. Women with fibroids are also more
    likely to go into labor prematurely and to experience a miscarriage.
    The exact number of women with fibroids is not known, but between 25
    and 40 percent of all U.S. women experience fibroid symptoms. Fibroids
    disproportionately affect African Americans. One study estimated that
    80 percent of African American women have fibroids by age 60. There are
    few effective ways other than hysterectomy to treat these tumors.
    Recently, however, NICHD researchers made some basic discoveries about
    fibroids that may lead to effective non-surgical treatments. In one
    study, researchers used sophisticated gene analysis technology to learn
    that fibroids contained abnormally high levels of a protein known as
    dermatopontin. That study led to another discovery that fibroids are
    largely made up of abnormal strands of collagen; thus, researchers are
    now searching for new drug treatments directed toward the abnormal
    collagen.
        Pregnancy and childbirth place women at higher risk for a disorder
    known as pelvic organ prolapse, which can be painful and disabling, and
    require surgical treatment. Although surgical procedures may correct
    the condition, many women may experience urinary incontinence as a
    result of such treatment, which may require a second surgery to
    correct. From early results of a clinical trial, NICHD-funded
    researchers have learned that performing an incontinence surgical
    procedure during the same operating room session as the prolapse repair
    markedly decreases the chances for incontinence, without adverse
    effects. Such findings not only have implications for improving the
    quality of life for women, but may have implications for helping to
    reduce the cost of care.

                           RESEARCH ENHANCES LEARNING

        After more than 30 years of careful research--using the same
    scientific rigor we use to test a new drug or medical procedure--the
    NICHD has identified the instructional methods that best help children
    learn to read. A recent brain imaging study has shown that these
    scientifically proven methods actually change the brain functioning of
    formerly poor readers so that it resembles the brain functioning of
    good readers.
        Unfortunately, however, many school districts still rely on
    instructional practices that are not based on scientific research.
    According to the National Center for Education Statistics, roughly 37
    percent of the nation's 4th graders read below grade level. In
    collaboration with the Department of Education, NICHD staff is working
    to communicate evidence-based research findings to provide school
    districts around the country with new approaches to teach reading. To
    be competitive in the years ahead, U.S. students will also need a
    thorough grounding in science. A recent study has challenged current
    thinking on the best way to teach science. The traditional belief was
    that students would better remember what they learn if they discovered
    on their own how to conduct an experiment rather than having someone
    teach it to them. In fact, the researchers found just the opposite:
    that students learned faster and retained more information if they were
    given explicit instructions about experimental procedures. The finding
    provides teachers with important information on how best to convey
    scientific concepts to their students.
        Our basic science laboratories continue to produce discoveries of
    potential clinical relevance to learning and mental retardation. NICHD
    scientists discovered that a single protein appears central to the
    formation of the long-term memories underlying all advanced learning.
    Two teams of NICHD scientists have discovered how the protein known by
    the acronym BDNF is produced in the brain and are studying whether
    defects in the BDNF protein system may lead to disorders of learning
    and memory. Other scientists have studied an animal model of the
    defective Rett syndrome gene that causes deterioration of cognitive and
    motor function in girls to learn how the gene causes anatomic and
    functional abnormalities. Studies also continue on the genetic and
    neurobiologic bases of autism.

                   KIDS MAY SAY OTHERWISE, BUT PARENTS MATTER

        Several NICHD studies of child development provide strong evidence
    that parents can exert a direct and positive influence on the decisions
    that children and young adults make. For example, researchers had
    suspected for some time that extensive television viewing at an early
    age might be associated with decreased attention span in children.
    However, they had no data from long-term studies to support this
    observation. So NICHD-funded researchers designed a study to answer an
    important question: do children who watch increasing amounts of TV at 1
    and 3 years of age have increase attention problems at age seven? The
    researchers analyzed data from an ongoing study involving more than
    2,600 children and found that the more television very young children
    watched, the more likely they were at age seven to have attention
    problems. These findings do not mean that early television viewing is
    associated with clinically diagnosed attention-deficit/hyperactivity
    disorder (ADHD). However, the findings support the idea that parents
    could reduce the risk for attention problems by limiting children's
    television viewing in their early years.
        NICHD scientists have also developed a research-based tool that
    parents can use to significantly reduce the risks that young,
    inexperienced drivers face. Insurance companies have known for some
    time that motor vehicle crash rates are higher for teenagers than for
    older drivers and are the highest during the first 1,000 miles and the
    first 6 months of driving. The researchers developed and tested a
    program in which the central feature is a contract between the parent
    and new driver. As part of this contract, the newly licensed driver
    agrees to limit driving at night, driving with other teens in the car,
    driving on high-speed roads, and driving in bad weather. NICHD research
    showed that parents can greatly reduce the risks that new drivers face.

            REHABILITATION NETWORKS SEEK TO IMPROVE QUALITY OF LIFE

        Serious illness and injury may result in life-long impairment. The
    Traumatic Brain Injury Clinical Trials Network will evaluate new
    treatments and rehabilitation techniques for children and adults with
    brain injury. The Pediatric Critical Care Network will evaluate new
    treatments for children who have suffered a serious injury or illness.
    The Network will study the effectiveness of short-term treatment and
    its relationship to the rehabilitation that patients receive and to the
    long-term outcomes.

                   THE BEST PHARMACEUTICALS FOR CHILDREN ACT

        The NICHD, as directed by law, in consultation with the FDA and
    experts in pediatric drug development, has identified and prioritized
    the most important drugs for further study in children. Currently,
    children are being recruited to study lorazepam for use as a sedative
    and anticonvulsant, and nitroprusside for controlling blood pressure of
    children undergoing surgery. In cooperation with the National Cancer
    Institute, data pertaining to the drugs vincristine and dactinomycin
    are being reviewed to provide the first evidence-based look at the
    efficacy, toxicity, and dosing of these two drugs. The evidence from
    this review will provide the basis for subsequent studies that will
    provide specific guidance on the use of these drugs in children. Drugs
    on the current priority list will form the basis of solicitations in
    2006.

                         THE NATIONAL CHILDREN'S STUDY

        NICHD scientists working collaboratively with the NIEHS, the CDC,
    and the EPA continue to make progress in planning the implementation of
    the National Children's Study as directed by Congress in the Children's
    Health Act of 2000. The Study, as currently planned, will involve about
    100,000 children and their families, and can form the basis of child
    health guidance, interventions, and policy for generations to come.
    Funds in the fiscal year 2005 budget are being used to establish four
    Vanguard Centers that will pilot recruitment strategies and the Study
    protocol. A data coordinating center will be established to provide the
    statistical analysis and reporting of the Study results. The protocol
    for this Study has been drafted and 101 sites across the United States
    have been identified to provide a population-based representative
    sample. These steps bring us closer to the point at which the full
    study could be implemented.

                                  NIH ROADMAP

        The NIH Roadmap initiative is providing an important guide to help
    the NICHD achieve its research and programmatic goals. The initiative
    directed to Re-engineering the Clinical Research Enterprise is
    currently helping to develop future leaders in clinical research. The
    NICHD is leading several targeted efforts to enhance the training,
    development, and support of the clinical research teams of the future.
        Mr. Chairman and members of this Committee, I would like to thank
    you for your continued support of our research to improve the health
    and well being of women, children and families, as well as for your
    support in the critical task of developing tomorrow's research leaders.
    I will be pleased to answer any questions.
                                     ______

    Prepared Statement of Dr. Jeremy M. Berg, Director, National Institute
                          of General Medical Sciences

        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2006 President's budget request for the National
    Institute of General Medical Sciences (NIGMS). The fiscal year 2006
    budget includes $1,955,170,000, an increase of $11,103,000 over the
    fiscal year 2005 enacted level of $1,944,067,000 comparable for
    transfers proposed in the President's request.

          UNDERSTANDING DISEASE REQUIRES UNDERSTANDING NORMAL FUNCTION

        As we go about our daily lives, most of us probably forget about
    the biological processes that make our bodies work. Our cells are
    constantly making new components, dividing, moving, and even dying.
    Complex mechanisms underlie each of these processes and elaborate
    networks integrate them to promote normal, healthy function. If any of
    these processes break down, the result can be cancer, diabetes,
    Alzheimer's, or a host of other diseases.
        To improve our understanding of basic biological processes, we need
    to employ a wide range of approaches. These include conducting basic
    research, developing new technologies, and training tomorrow's
    scientists. In essence, this is the core mission of NIGMS. For more
    than 40 years, the Institute has focused on deepening understanding of
    critical life processes and the molecular underpinnings of disease. In
    this way, NIGMS lays the foundation for advances in the diagnosis,
    treatment, and prevention of many different illnesses.

                 PARADIGM-SHIFTING IDEAS AND THEIR APPLICATION

        NIGMS has an impressive track record of investing in research with
    big payoffs. One indication of this success comes from the many
    prestigious awards our grantees receive for their research. In each of
    the last 8 years, at least one Nobel Prize has been given to an NIGMS
    grantee. This year continues the trend: The 2004 Nobel Prize in
    chemistry went to Irwin Rose, Ph.D., a biochemist at the University of
    California, Irvine, whose work has been supported by the Institute for
    several decades. He brings the number of NIGMS-supported Nobel
    laureates to 57.
        Rose shared the prize for his studies on how cells control the
    breakdown of unneeded proteins. The mechanism for this controlled
    breakdown underlies many processes in health and disease and is now the
    focus of literally thousands of research studies. The discoveries
    flowing from this basic research are increasingly being translated into
    new therapies. For example, Alfred Goldberg, Ph.D., an NIGMS grantee at
    Harvard Medical School in Boston, initiated research that led to a new
    drug called Velcade. This drug is used to treat multiple myeloma, a
    deadly type of bone marrow cancer. Velcade works by targeting the
    proteasome--the molecular machine that breaks down unneeded proteins
    that Rose and his coworkers discovered. Velcade is likely to be the
    first of a number of drugs based on the discovery of this process that
    is so fundamental to much of cell biology.
        The path to new approaches for promoting health and preventing and
    treating diseases has several key elements. These include creatively
    exploring a range of biological systems, developing tools for expanding
    knowledge, finding appropriate ways to integrate this knowledge into
    practical applications, and, of course, having a workforce of
    scientists who have the motivation and the knowledge to drive these
    advances.

               FROM CARNIVOROUS SNAILS TO A NOVEL PAIN TREATMENT

        It is tough to make a living as a carnivorous snail. A large family
    of such creatures, called cone snails, relies on extremely potent venom
    to paralyze prey almost instantly. Baldomero Olivera, Ph.D., a
    biologist at the University of Utah in Salt Lake City, has been
    studying cone snails for more than 25 years with NIGMS support,
    carefully separating the venom into its components and studying each
    one.
        Remarkably, the venom components are small proteins that target
    structures within the neuromuscular system with exquisite specificity.
    Because of the roles of their targets and this great specificity, these
    proteins are powerful research tools and show great promise as drugs.
    The first drug to result from this work, Prialt, was approved by the
    FDA in December 2004 to treat the chronic, intractable pain often
    endured by people with cancer, AIDS, or certain neurological disorders.
    One thousand times more powerful than morphine, this new pain
    medication is thought to be non-addictive.
        Other recently discovered pathways are leading to new drugs as
    well. The process of RNA interference, first characterized in
    roundworms by NIGMS grantees, can specifically silence individual
    targeted genes. Harnessing this process has allowed scientists to
    precisely control genes, leading to exciting new research tools and
    promising new ways to treat diseases including HIV, hepatitis, and
    cardiovascular disease. An RNA interference-based drug to treat the
    blinding eye disease of macular degeneration is currently in clinical
    trials.

                          THE SHAPES OF THINGS TO COME

        The human genome is expressed primarily through proteins, the
    molecules that perform virtually all of the body's activities. Based on
    their amino acid sequences, proteins fold into complex shapes that
    determine their functions, including which other molecules they bind to
    form complex assemblies. Powerful techniques have been developed for
    determining protein structures in great detail. Thousands of such
    structures have been determined, providing deep insights into how
    biological systems function in health and disease and driving the
    development of new drugs and other therapies. Much of this work has
    been performed by individual investigators working on individual
    proteins chosen based on their biological context. A productive
    laboratory might determine two to four structures per year. This
    approach continues to be effective, but it is too slow to keep up with
    the vast number of potential protein targets now accessible through
    genomic studies.
        To complement the contributions of individual investigators, NIGMS
    launched the Protein Structure Initiative (PSI) in 2000 with the goal
    of developing technologies and processes to enable researchers to
    quickly, cheaply, and reliably determine the three-dimensional
    structures of proteins. After 4 years, the nine PSI pilot centers can
    produce several structures each week, and the total number of
    structures solved by the PSI centers has now passed the milestone of
    1,000!
        With the second phase of the initiative beginning this summer, the
    PSI will use the tools and methods developed in the pilot phase to
    continue technology development and to determine more protein
    structures, including some that were too complex to tackle during the
    pilot phase. Researchers will use these structures to determine and
    understand protein function, predict the structures of other proteins,
    identify targets for drug development, design molecules to fit those
    targets, and compare proteins from normal and diseased tissues.
        An important activity related to the PSI is the structural biology
    component of the NIH Roadmap for Medical Research, which funded two
    Centers for Innovation in Membrane Protein Production to aid structural
    studies of this major class of proteins. Difficulties inherent in
    studying membrane proteins mean that we know relatively little about
    them, despite the fact that they represent up to a third of all
    proteins and are the targets for a large number of therepeutic drugs.
    NIGMS is actively involved in other Roadmap initiatives, as well,
    including those in the areas of high-risk research (specifically, the
    NIH Director's Pioneer Award), bioinformatics and computational
    biology, molecular libraries and imaging, and interdisciplinary
    research.

                        COMPUTERS MODEL COMPLEX SYSTEMS

        Today's biomedical research has moved beyond describing the parts
    of living systems to focusing on the complex, dynamic interactions of
    those parts. One of the best ways to approach this formidable challenge
    is to use computers to model and manipulate the systems.
        Among the places this is happening are the five NIGMS Systems
    Biology Centers. Multidisciplinary teams of researchers at these
    centers are addressing such fundamental questions as how cells divide,
    differentiate, and communicate and how different kinds of environmental
    stress affect cell and tissue function.
        At the other end of the spectrum, NIGMS-supported researchers are
    investigating how human systems contribute to the spread of infectious
    diseases. The researchers, part of the Institute's Models of Infectious
    Disease Agent Study (MIDAS) initiative, use computational approaches to
    simulate disease outbreaks, whether they occur naturally or result from
    bioterrorism. In much the same way as weather forecasters use computer
    models to predict the landfall of hurricanes, scientists can use the
    MIDAS models to make predictions about potential epidemics. These
    models will assist policymakers, public health workers, and other
    researchers in understanding and responding to new infectious disease
    outbreaks.
        Responding to the medical community's growing concern that avian
    influenza could cause the next flu pandemic, the MIDAS network
    currently is simulating the outbreak of a deadly bird flu strain in a
    hypothetical human community. The computer models incorporate data on
    population density and age structure, distribution of schools,
    locations of hospitals and clinics, travel, and the infectiousness of
    the virus. The models will predict the effects of different strategies
    to contain the spread of infection, such as vaccinating specific groups
    of people or restricting travel. Preliminary results from the avian flu
    modeling project should be available by mid-2005.

                           DIVERSITY DRIVES DISCOVERY

        To continue making rapid progress in biomedical research and
    improving human health, we need to ensure that the pool of biomedical
    scientists reflects the great diversity of our nation. This diversity
    can spark new research questions and offer different approaches to
    answering them. NIGMS promotes this diversity in a number of ways.
        Through our Division of Minority Opportunities in Research, we
    offer programs that encourage and prepare underrepresented minority
    students for research careers. Other programs enhance science curricula
    and faculty research capabilities at institutions with substantial
    minority enrollments.
        We require our institutional training programs to recruit and
    retain underrepresented minority students, as well. And we promote
    diversity of ideas through interdisciplinary training programs and
    through efforts to bring the expertise of researchers in a variety of
    fields, from the physical to the behavioral sciences, to bear on
    biomedical questions. One example is our partnership with the National
    Science Foundation that supports more than 30 research grants at the
    interface of biology and mathematics.

                             EXPANDING THE HORIZON

        Our increasing knowledge of the biological processes that underpin
    health and disease holds great promise for new drugs and better
    diagnostic techniques in the future. A more complete picture of how
    these processes work--and don't work--may lead to new methods for
    preventing illness altogether.
        At the same time, it is important to remember that breakthroughs
    are often based on years of scientific research, with each new result
    building on many previous ones. Each discovery pushes back the frontier
    and reveals intriguing new questions and avenues for future study.
    While we can't always predict what we'll find, we can guarantee that
    the journey will bring us closer to our goal of understanding human
    health and disease.
        Thank you, Mr. Chairman. I would be pleased to answer any questions
    that the Committee may have.
                                     ______

    Prepared Statement of Dr. Francis S. Collins, Director, National Human
                           Genome Research Institute

        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2006 President's budget request for the National Human
    Genome Research Institute (NHGRI). The fiscal year 2006 budget includes
    $490,959,000, an increase of $2,351,000 over the fiscal year 2005
    enacted level of $488,608,000 comparable for transfers proposed in the
    President's request.
        Cable News Network (CNN) recently named the completion of the Human
    Genome Project (HGP) the number one health news story of the past 25
    years. CNN reported, ``Much of the marvel of medicine has to do with
    discovery. Mapping the human genome, the complete sequence of DNA, gave
    scientists a blueprint for building a person, making it the No. 1
    medical story, according to a distinguished panel CNN gathered to rank
    the top 25 medical stories of the past quarter-century.'' As the leader
    of the HGP, the National Human Genome Research Institute (NHGRI) is
    very proud of this recognition, but as CNN also pointed out there is
    still a great deal more to learn.

                           ONGOING NHGRI INITIATIVES

    Analysis of the Completed Human Genome Sequence
        In October 2004, the International Human Genome Sequencing
    Consortium, led in the United States by the NHGRI and the Department of
    Energy, published a description of the finished human genome sequence
    in the journal Nature. An international team worked to convert the
    draft genome, published in 2001, into a highly accurate form. The new
    analysis reduces the estimate of the number of human protein-coding
    genes from 35,000 to only 20,000-25,000--a surprisingly low number for
    our species, considering that only a decade ago most scientists thought
    there would be over 100,000 genes. We now focus on the more difficult
    task of understanding the function of each of these genes.

    Use of Comparative Genomics to Understand the Human Genome
        The availability of the genome sequences of the human, the mouse,
    the rat and a wide variety of other organisms is driving the
    development of an exciting new field of biological research,
    comparative genomics. The NHGRI is funding research comparing the
    finished reference human genome sequence with that of other organisms,
    to identify regions of similarity and difference, thus dramatically
    increasing understanding of the structure and function of human genes
    to enable development of new strategies to combat human disease.

    ENCyclopedia Of DNA Elements (ENCODE) project
        With the goal of identifying the precise location and function of
    all sequence-based functional elements in the human genome, the NHGRI
    launched the ENCyclopedia Of DNA Elements (ENCODE) project in the fall
    of 2003. The project is an international consortium of computational
    and laboratory-based scientists open to all investigators who agree to
    abide by the project's criteria and guidelines for participation. A
    manuscript describing the ENCODE project appeared in the October 22,
    2004 issue of Science, detailing the rationale and strategy behind the
    quest to produce a comprehensive catalog of all parts of the human
    genome crucial to biological function, including all protein-coding
    genes, non-protein-coding genes, regulatory elements involved in the
    control of gene transcription, and DNA sequences that mediate
    chromosomal structure and dynamics. All data generated for the ENCODE
    project are being deposited in free, public databases as soon as they
    are experimentally verified.

    Progress with the HapMap
        All diseases have a hereditary component, but for most common
    diseases like diabetes, heart disease, and mental illness, the gene
    variants responsible for the increased risk have been difficult to
    identify. To solve this problem, an approach to scan large regions of
    chromosomes to find the genetic variants (called SNPs, or single
    nucleotide polymorphisms) that increase or decrease the risk of disease
    is needed. NHGRI has taken a leadership role in the International
    HapMap Consortium and the development of the HapMap (haplotype map), a
    catalog of human genetic variations and how that is organized into
    haplotype ``neighborhoods'' across the gene. Researchers are already
    starting to use the HapMap to find genes and variants that contribute
    to many diseases; it will also be a powerful resource for studying the
    genetic factors contributing to variation in individual response to
    disease, drugs, and vaccines.
        In February 2005, the International HapMap Consortium completed
    phase I of the project, ahead of schedule. Boosted by an additional
    $3.3 million in public-private support, the NHGRI announced plans to
    create an even more powerful map of human genetic variation than
    originally envisioned. The consortium's new goal is an improved version
    of the HapMap about five times denser than the original plan. This
    ``Phase II'' HapMap will test another 4.6 million SNPs from publicly
    available databases and add that information to the map. The HapMap
    will be completed in the fall of 2005.

    Gene Variants May Increase Susceptibility to Type 2 Diabetes
        Understanding the genetic basis of the more common, polygenic
    diseases has traditionally been very difficult. But the tools of
    genomics, especially HapMap, are beginning to reveal many details about
    the risk of common diseases that had previously been unapproachable.
    One disease for which excellent progress has been made towards
    understanding its genetic cause is Type 2 diabetes. Affecting about 17
    million people nationwide, it accounts for 90 to 95 percent of all
    diabetes cases in the United States. This past year, two international
    research teams, including one at NHGRI, each found variants in a gene
    that appears to predispose people to type 2 diabetes, the most common
    form of the disease. Homing in on a wide stretch of chromosome 20, the
    teams identified four genetic variants (SNPs) that are strongly
    associated with type 2 diabetes in Finnish and Ashkenazi Jewish
    populations and that appear to raise the risk of type 2 diabetes by
    about 20 to 30 percent. Translating this discovery into a treatment
    that benefits people with diabetes or those at risk is still years
    away, but this is a major step in that direction.

                                NEW INITIATIVES

    Roadmap--Chemical Genomics
        The Molecular Libraries Roadmap initiative will offer public sector
    researchers access to libraries of novel small organic molecules that
    can be used as chemical probes to study the functions of genes, cells,
    and biochemical pathways. This marriage of chemistry and biology will
    provide new ways to explore the functions of major components of cells
    in health and disease. In June 2004, NHGRI announced the establishment
    of the NIH Chemical Genomics Center, and up to eight pilot extramural
    centers will be funded at academic institutions and other locations
    across the country in the spring of 2005. These will function as an
    integrated network, including a common publicly available database
    (PubChem, already activated in September 2004) which will display the
    results of all screens of chemical compounds.

    Human Cancer Genome Project
        The dramatic drop in costs of DNA sequencing, catalyzed by the
    Human Genome Project, now makes it possible to use sequencing as a
    major tool for medical research. Doctors and research scientists have
    long known that cancer is, essentially, a genetic disease. Inherited
    mutations or acquired genetic alterations can set a normal cell on a
    path of uncontrolled growth and malignancy. It is now conceivable to
    identify the complete universe of genes involved in every type of
    cancer. That is the intent of a bold new NCI/NHGRI proposal for a Human
    Cancer Genome Project. Such a complete inventory of cancer genes will
    provide powerful new ways to prevent, diagnose, and treat every major
    form of the disease.

    The $1,000 Genome Project
        The ability to determine the complete genome sequence of an
    individual could revolutionize medical care. In October 2004, NHGRI
    awarded more than $38 million in grants to spur the development of
    innovative technologies designed to reduce the cost of DNA sequencing
    dramatically. NHGRI's near-term goal is to lower the cost of sequencing
    a mammalian-sized genome to $100,000, which would enable researchers to
    sequence the genomes of hundreds or even thousands of people as part of
    studies to identify genes that contribute to cancer, diabetes, and
    other common diseases. Ultimately, NHGRI's vision is to cut the cost of
    whole-genome sequencing to $1,000 or less, which would enable the
    sequencing of individual genomes as part of medical care. The ability
    to sequence each person's genome cost-effectively could give rise to
    more individualized strategies for diagnosing, treating, and preventing
    disease. Such information could enable doctors to tailor therapies to
    each person's unique genetic profile.

    The U.S. Surgeon General's Family History Initiative
        The U.S. Surgeon General's Family History Initiative was launched
    on November 8, 2004, with the NHGRI as the lead collaborating federal
    agency. The purpose of this national public health campaign is to:
    increase the awareness of the American public and their health
    professionals about the importance of family history in health; provide
    tools to gather, understand, evaluate, and use family history to
    improve health; give health professionals tools to communicate with
    patients about family history; and increase genomic and health
    literacy. A web based and print tool entitled ``My Family Health
    Portrait'' was developed in both English and Spanish to facilitate
    collection of family history data. To date, the initiative has been
    highlighted in more than 1,000 media stories and over 170,000 copies of
    the tool have been distributed via the World Wide Web and in paper
    form. This public health campaign is intended to be an annual event.

    ELSI Centers for Excellence Program
        On August 31, 2004, the NHGRI's Ethical Legal and Social
    Implications (ELSI) research program announced the funding, with
    contributions from the Department of Energy and the National Institute
    of Child Health and Human Development, of four interdisciplinary
    centers as part of its Centers for Excellence in ELSI Research (CEER)
    program, a new initiative to address some of the most pressing ethical,
    legal, and social questions facing individuals, families, and
    communities in the genome era. Each of the centers, based at Duke
    University, Case Western Reserve University, Stanford University, and
    the University of Washington, will assemble a team of experts in
    several disciplines, such as bioethics, law, behavioral and social
    sciences, clinical research, theology, public policy, and genomic
    research.

                            OTHER AREAS OF INTEREST

    Genetic Education for Health Care Professionals
        The NHGRI has developed numerous educational programs to prepare
    health care professionals for the integration of genomics into primary
    health care. A new effort by the NHGRI in this area in 2004 was its
    work with the American Academy of Family Physicians (AAFP) to develop
    the AAFP's 2005 Annual Clinical Focus program, which has Genomic
    Medicine as its theme.

    Genetic Nondiscrimination
        Possibly the greatest impediment to the advancement of genomic
    science and its application to human health is the fear of genetic
    discrimination. The NHGRI has worked for ten years to realize a federal
    solution to this problem. The Secretary's Advisory Committee on
    Genetics Health and Society has also strongly supported the need for
    federal legislation. On February 17, 2005 the Senate passed the Genetic
    Information Nondiscrimination Act of 2005 (S. 306), which would address
    these fears, and the Bill has now been referred to the House. The Bush
    Administration has also issued a Statement of Administrative Policy in
    support of the legislation. This issue remains a high priority for the
    Institute.
        Thank you, Mr. Chairman. I would be pleased to answer any questions
    that the Committee might have.
                                     ______

        Prepared Statement of Dr. Patricia A. Grady, Director, National
                         Institute of Nursing Research

        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2006 President's budget request for the National
    Institute of Nursing Research (NINR). The fiscal year 2006 budget
    includes $138,729,000, an increase of $657,000 over the fiscal year
    2005 enacted level of $138,072,000 comparable for transfers proposed in
    the President's request.
        I appreciate the opportunity to appear before you today to discuss
    the exciting work of the National Institute of Nursing Research (NINR)
    that provides important science to provide necessary improvements in
    the quality of patient care across the continuum of life. Unique within
    the NIH, our mission is structured around the science that connects
    health care providers to patients, their families, and caregivers.
        There are many components to our society's healthcare mosaic. Care
    is delivered through a variety of settings: conventional healthcare
    sites, community-based clinics, and homes. Patients with exceptional
    needs--from newborns, the disabled, individuals at the end-of-life--and
    the underserved, from urban to rural settings, rely on quality care.
    Through our studies, we seek to understand and manage the symptoms of
    acute and chronic illness, and thus, to find effective approaches to
    achieving and sustaining good health.
        Let me now share with you some examples of how our research is
    changing patient care and improving lives.

                  MOTHERS AND THEIR YOUNG CHILDREN WITH ASTHMA

        Asthma, a chronic and sometimes life threatening condition, is
    associated with high health costs related to medications, outpatient
    management, and emergency room visits. Especially for younger children,
    good asthma management requires close vigilance by the parent or
    caregiver. Researchers in one study interviewed working mothers of
    young, inner-city asthmatic children, more than a quarter of whom
    reported that there was a smoker in the house. While most of the
    children were under the care of a doctor and were prescribed
    appropriate asthma medications, many still experienced frequent
    coughing, wheezing, or shortness of breath. The mothers often did not
    give medications for coughing, which can be an early sign of an asthma
    attack. While most were vigilant and strove to provide good asthma
    management, the study demonstrated that many mothers lack sufficient
    information on early asthma symptoms and need additional education
    about asthma in order to provide the best care for their children.

                    HEALTH DISPARITIES IN RURAL COMMUNITIES

        The health care of rural populations is a concern because of
    poverty, lack of services and/or health vulnerability of the
    population. NINR's recently funded Rural Nursing and Health Care
    Research Center provides an interdisciplinary research infrastructure
    to conduct and disseminate nursing research to address the needs of
    rural populations. NINR has funded researchers who are making advances
    with technological interventions for the chronically ill rural
    populations. The Women to Women project is a computer-based
    communication intervention that is testing a program of health
    information and social support for women. The program provides
    educational tools for self-management skills and studies the risks of
    isolation and chronic illness. This project has influenced health
    outcomes by creating a more informed and self-managing patient
    population. The program may ultimately serve as a model to deliver
    support and education to remote or vulnerable populations.

                           CARING FOR THE CAREGIVERS

        Dementia-related conditions cause a progressive decline in memory,
    cognition, and physical function, and affect nearly 10 percent of
    persons over 65 years of age. The behavior of the patient with dementia
    can range from forgetfulness to dangerous and aggressive activities.
    Family caregivers often identify the management of this behavior as a
    major source of distress and burden.
        The Savvy Caregiver Program, an educational program for caregivers,
    increased the skill, knowledge, and confidence of caregivers. In
    addition, most caregivers reported a decreased sense of burden and
    improved ability to deal with dementia-related behavior of the patient.
    The caregivers underscored their belief in the benefits of caregiving,
    and stated they would recommend the program to others.
        When family caregivers cannot manage the patient with dementia at
    home, they often must place the person in a long term care facility.
    The Family Involvement in Care program was developed to help family
    members contribute to the care of the institutionalized patient. This
    project tested a program for the nurses and staff on the impact of
    dementia for the family, and on ways to support a continued family
    presence. Family members reported more positive feedback to the
    facility, while the staff participants reported positive outcomes
    regarding the family caregiving role.

                      RESEARCH ON CARE AT THE END OF LIFE

        The end-of-life process includes numerous challenges: physical,
    emotional, spiritual, and financial. There also are challenges in
    health care systems exacerbated by the lack of continuity among
    caregivers, disruption of social support networks, unshared clinical
    information, and multiple physical locations for care. Family members
    experience role changes, stress, and ultimately, bereavement as their
    loved one traverses life's continuum.
        The NINR is charged with leading the Institutes and Centers for
    advancing a trans-NIH research agenda on end-of-life care. In this
    role, we support a broad range of studies designed to improve the
    management of symptoms associated with the end of life; elucidate the
    broad issues that affect many families across the nation such as
    communication among patient, family, and care providers; enhance coping
    with terminal illness; and examine cultural and ethnic influences on
    end-of-life care.
        In one NINR study, researchers interviewed patients with terminal
    cancer and found that spiritual well-being helped reduce depression,
    hopelessness, thoughts of suicide, and the desire to hasten death. The
    investigators concluded that palliative care clinicians should assess
    the spiritual beliefs and needs of their terminal patients to help them
    cope with despair and achieve a sense of peace and meaning in their
    life.
        In December 2004, NINR cosponsored an NIH state-of-the-science
    conference on end-of-life. Nearly one thousand people from around the
    world came to NIH to review the existing knowledge base on end-of-life
    and to recommend opportunities for future research. These
    recommendations will feature prominently in NINR's forthcoming research
    plans in this area.

          PALLIATIVE AND END-OF-LIFE CARE IN RURAL AND FRONTIER AREAS

        Residents living in rural or frontier areas typically have limited
    access to health care services, particularly at end-of-life. In fiscal
    year 2006, NINR will initiate studies focused on understanding the
    scope of the problems associated with limited access to care in rural
    areas. These studies will examine ways to improve end-of-life care
    through the use of technology; develop new methods to use existing
    networks and services; design culturally appropriate interventions for
    palliative care; and identify possible alternative settings and methods
    for providing care and supporting family caregivers.

                       BUILDING NURSING RESEARCH CAPACITY

        As our nation is experiencing a shortage of nurses, we are also
    experiencing a shortfall in the number of nurse scientists. NINR is
    building research capacity with several innovative initiatives,
    collaborating with universities nationwide to rapidly develop
    baccalaureate-to-doctoral fast-track programs. The Graduate Partnership
    Program (GPP) in Biobehavioral Research, a new pilot training program,
    partners schools of nursing with the NIH intramural program to provide
    cutting-edge, mentored research training for outstanding doctoral
    students.
        NINR is also supporting Centers to stimulate research and research
    training opportunities. One example, the Nursing Partnership Centers to
    Reduce Health Disparities, together with the National Center on
    Minority Health and Health Disparities, partners research-intensive
    universities with minority-serving institutions.

                            NINR AND THE NIH ROADMAP

        NINR has identified two key areas of science within the NIH
    Roadmap, Interdisciplinary Research Teams of the Future and Re-
    engineering the Clinical Research Enterprise, and integrated them
    within the nursing research agenda. NINR and its investigators have
    extensive experience in conducting interdisciplinary research projects.
    Currently, more than one-half of NINR-funded studies appear in non-
    nursing journals. This shows the promise of future interdisciplinary
    collaborations and the value of nursing research findings by other
    disciplines. In the area of improving the clinical research enterprise,
    most of NINR's research is clinical in nature and research questions
    are evaluated from the clinical researcher's perspective. Investigators
    translate research findings into the clinical practice of healthcare
    providers and develop partnerships to speed new scientific knowledge
    into mainstream health care.

                                   CONCLUSION

        In conclusion, NINR strives to improve the quality of life and
    quality of health through every stage of life, especially for the most
    vulnerable in our society. We are committed to training the next
    generation of nurse researchers, and to continuing to fund rigorous and
    innovative programs of research to enhance the health of our nation.
        Thank you, Mr. Chairman. I will be pleased to answer any questions
    that the Committee might have.
                                     ______

        Prepared Statement of Dr. Richard J. Hodes, Director, National
                               Institute on Aging

        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2006 President's budget request for the National
    Institute on Aging (NIA). The fiscal year 2006 budget includes
    $1,057,203,000, an increase of $5,213,000, or 0.5 percent over fiscal
    year 2005 enacted level of $1,051,990,000 comparable for transfers
    proposed in the President's request.
        Thank you for the opportunity to participate in today's hearing. I
    am Dr. Richard Hodes, Director of the National Institute on Aging, and
    I am pleased to be here today to tell you about our progress making and
    communicating scientific discoveries that will improve the health and
    well-being of older Americans.
        There are today approximately 35 million Americans ages 65 and
    over, according to the U.S. Bureau of the Census, and this number is
    expected to rise dramatically in the coming decades. The mission of the
    National Institute on Aging (NIA) is to improve the health and well-
    being of these older Americans through research. In support of its
    mission, the Institute conducts and supports an extensive program of
    research on all aspects of aging, from the basic cellular and molecular
    changes that occur as we age, to the prevention and treatment of common
    age-related conditions, to the behavioral and social aspects of growing
    older, including the demographic and economic implications of an aging
    society. In addition, the NIA is the lead federal agency for research
    related to the all-important effort to prevent and treat Alzheimer's
    disease (AD). Finally, our education and outreach programs provide
    vital information to older people across the Nation on a wide variety
    of topics, including living with chronic conditions, maintaining
    optimal health, and caregiving.

               ALZHEIMER'S DISEASE AND THE NEUROSCIENCE OF AGING

        AD is a devastating condition with a profound impact on
    individuals, families, the health care system, and society as a whole.
    Approximately 4.5 million Americans are currently battling AD, with
    annual costs for the disease estimated to exceed $100 billion.\1\
    Moreover, the rapid aging of the American population threatens to
    increase this burden significantly in the coming decades: By the year
    2050, the number of Americans with AD could rise to some 13.2 million,
    an almost three-fold increase.\2\
    ---------------------------------------------------------------------------
        \1\ Data from the Alzheimer's Association. See also Ernst, RL; Hay,
    JW. ``The U.S. Economic and Social Costs of Alzheimer's Disease
    Revisited.'' American Journal of Public Health 1994; 84(8): 1261-1264.
    This study cites figures based on 1991 data, which were updated in the
    journal's press release to 1994 figures.
        \2\ Hebert, LE et al. ``Alzheimer Disease in the U.S. Population:
    Prevalence Estimates Using the 2000 Census.'' Archives of Neurology
    August 2003; 60 (8): 1119-1122.
    ---------------------------------------------------------------------------
        These statistics lend an urgency to the NIA's efforts to better
    understand, prevent, and treat AD, and in the past year, we have made
    several important steps forward. For example, a priority for the NIA is
    to identify risk factors for AD, as interventions that impact the
    effect of a risk or preventative factor could potentially delay the
    onset of the disease or prevent it altogether. Results from several
    recent studies have associated diabetes, which affects about one in
    five persons over age 60 years,\3\ with increased risk of cognitive
    impairment, including AD, raising the possibility that prevention
    strategies for diabetes may also have major consequences for preventing
    or delaying AD.
    ---------------------------------------------------------------------------
        \3\ See http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm.
    Statistics are taken from the 1999-2001 National Health Interview
    Survey and 1999-2000 National Health and Nutrition Examination Survey
    (estimates projected to year 2002).
    ---------------------------------------------------------------------------
        Evidence is also mounting that lifestyle choices may affect risk of
    AD. In one recent study, older dogs on a regimen of regular physical
    exercise and mental stimulation and a diet fortified with plenty of
    fruits, vegetables, and vitamins performed better on cognitive tests
    and were better able to learn new tasks than dogs in a ``control
    group.'' Although the results of this study need to be replicated in
    humans, they do provide evidence that diet and mental exercise may
    protect against late-life cognitive decline, and that they may work
    more effectively in combination than by themselves.
        An area of some controversy has been the effects of hormonal
    influences on cognitive aging in women, with some studies demonstrating
    a decreased risk for AD among users of hormone therapy and others,
    notably the Women's Health Initiative Memory Study (WHIMS), showing
    that post-menopausal women on certain regimens were actually at higher
    risk for cognitive decline. The risks and benefits of hormone therapy
    remain under study. One new avenue of inquiry is the use of selective
    estrogen receptor modulators (SERMs) to prevent cognitive decline.
    SERMs mimic estrogen's actions in some tissues but block the action of
    the body's naturally occurring estrogen in others, offering the
    benefits of traditional hormone therapy with fewer potential health
    risks. In a recent study, the SERM raloxifene (Evista), frequently
    prescribed for the prevention and treatment of osteoporosis, appeared
    to reduce the risk of cognitive impairment in postmenopausal women.
    More research is needed, but this is a promising area of research.
        The first NIH AD prevention trial, comparing the effects of vitamin
    E and donepezil (Aricept) in preventing AD in people diagnosed with
    mild cognitive impairment (MCI), often a precursor condition to AD,
    recently concluded. Preliminary data indicate that people with MCI
    taking donepezil were at reduced risk of progressing to AD for the
    first 18 months of the 3-year study when compared with their
    counterparts on placebo. The reduced risk of progressing from MCI to a
    diagnosis of AD disappeared after 18 months, and by the end of the
    study, the probability of progressing to AD was the same in the two
    groups.
        NIA is currently supporting over 20 additional AD clinical trials,
    including large-scale prevention trials, which are testing agents such
    as anti-inflammatory drugs, statins, homocysteine-lowering vitamins,
    and anti-oxidants for their effects on slowing progress of the disease,
    delaying AD's onset, or preventing the disease altogether. Trials are
    also assessing interventions for the behavioral symptoms (agitation,
    aggression, and sleep disorders) of people with AD. The Institute also
    supports the development of new agents for AD prevention and treatment,
    including chemical compounds to validate new drug targets, an activity
    with relevance to the ``Molecular Libraries'' area of the NIH Roadmap.
        This year, we have moved forward with two major AD initiatives. The
    Alzheimer's Disease Neuroimaging Initiative, a longitudinal,
    prospective, natural history study of normal aging, mild cognitive
    impairment, and early AD to evaluate neuroimaging techniques such as
    magnetic resonance imaging (MRI) and positron emission tomography
    (PET), was funded, with funding also identified for several ancillary
    studies. This ambitious initiative is being implemented jointly with
    several other NIH Institutes, academic institutions, and industry
    partners, and exemplifies the potential for scientific discovery that
    is the goal of the NIH Roadmap component on Public-Private
    Partnerships.
        The NIA is accelerating the pace of Alzheimer(s disease genetics
    research with its AD Genetics Initiative, a major new program to speed
    the creation of a large repository of DNA and cell lines from families
    with multiple AD cases. The goal of this initiative is to develop the
    resources necessary for identifying the remaining late-onset AD (LOAD)
    risk factor genes, associated environmental factors, and the
    interactions of genes and the environment. To aid recruiting efforts,
    the NIA Alzheimer's Disease Education and Referral Center worked
    closely with the Alzheimer's Association as well as several academic
    partners to publicize the initiative.
        In addition to AD, the NIA supports research on other neurological
    diseases, including Parkinson's disease, frontotemporal dementia, and
    prion diseases. For example, NIA investigators, along with researchers
    from the National Institute of Neurological Disorders and Stroke, were
    part of an international research team that identified a mutation that
    is believed to be the most common genetic cause of Parkinson's disease
    identified to date. This discovery could lead to the development of a
    test to detect the mutation in individuals at risk.

                          OTHER AGING-RELATED RESEARCH

        Diseases of aging continue to affect many older men and women,
    seriously compromising their quality of life. Diseases and conditions
    currently under study at the NIA include:
        Anemia.--Recently, NIA investigators found an overall prevalence of
    anemia of 11 percent in men and 10.2 percent in women ages 65 years and
    older, with prevalence increasing dramatically over age 85. The
    American Society of Hematology (ASH) has worked closely with several
    NIH institutes to establish a research agenda on anemia in the elderly.
    An ASH workshop, ``Clinical Implications of Anemia in the Elderly,''
    was held in March 2004 to establish a research agenda on anemia in the
    elderly; a report of this workshop will be published in the journal
    Blood in spring 2005. Program staff from NIA and several other NIH
    Institutes participated in the ASH workshop and will work
    collaboratively to identify research priorities. In addition, the NIA
    is developing an initiative to stimulate a broad range of research on
    anemia in the elderly that will inform efforts to decrease the
    associated functional impairment, morbidity and decreased survival.
        Obesity.--According to the National Health and Nutrition
    Examination Survey, some 64 percent of U.S. adults are either
    overweight or obese. Excess weight and obesity are linked with an array
    of conditions, including diabetes, osteoarthritis, and cardiovascular
    disease. As we age, we tend to gain fat, which may interfere with the
    work of tissues in which it accumulates. For example, marrow in most
    bones becomes partially or wholly replaced by adipose (fat) cells, and
    fat accumulates around and infiltrates the bundles of muscle fibers in
    muscles of the limbs and trunk. The accumulation of fat in the muscle
    appears to be doubly dangerous, interfering with both mechanical
    function of the muscles and insulin sensitivity. The NIA is planning an
    initiative to stimulate research exploring adipogenesis in aging--i.e.,
    the origin of the increased propensity to form fat cells, and its
    impact on tissues and systems. This area of research has the potential
    to broadly impact our understanding of both the decline in function of
    individual tissues in the musculoskeletal system, and the frequently
    seen changes in glucose metabolism and insulin sensitivity with age.
        Elder Abuse and Mistreatment.--Many older Americans are vulnerable
    to mistreatment, including physical and psychological abuse, neglect,
    and financial exploitation. However, the scope of the problem remains
    unknown. The National Research Council (NRC), at the request of the
    NIA, established a Panel to review risk and prevalence of elder abuse
    and neglect. The Panel's 2003 report, Elder Mistreatment. Abuse,
    Neglect, and Exploitation in an Aging America, outlines a number of key
    priorities, including the development of operational definitions of
    elder mistreatment and the development of reliable and valid measures
    of prevalence. To that end, the NIA is planning a pilot program to
    develop the tools to accurately assess the prevalence of elder abuse, a
    necessary first step in developing interventions.
        A number of the NIH Roadmap initiatives are particularly relevant
    to aging research. For example, small molecule development, by
    providing chemical compounds to validate new drug targets, is crucial
    to the development of drugs for a variety of age-related diseases,
    degenerative conditions, and disabilities. Another Roadmap initiative
    has established a network of investigators to improve the measurement
    of patient-reported outcomes, and ongoing projects of particular
    relevance to the aged population are addressing pain, fatigue,
    arthritis, psychiatric symptoms, including depression, and social
    functioning.

                      HEALTH COMMUNICATIONS AND PROMOTION

        Last year, the NIH launched NIHSeniorHealth.gov, a unique web site
    developed by NIA and the National Library of Medicine and geared toward
    the health needs of older adults. In its first year, the site was
    extremely successful, attracting some 380,000 unique visitors and
    garnering over three million page views. It was the only web site to
    receive an ``Industry Innovators Award'' from the International Council
    on Active Aging. A Spanish-language version of the site is currently
    under development.
        Meals on Wheels Initiative.--During a 2002 Congressional hearing,
    it was recommended that NIA and the Administration on Aging (AoA) work
    together to disseminate research-based consumer education materials to
    the thousands of seniors who participate in the Meals-on-Wheels (MOW)
    program. In participation with AoA, NIA conducted focus groups with the
    MOW Association of America to identify the types of information of
    greatest interest to MOW's clients and the best ways to deliver such
    information. Now, a new booklet entitled ``Take Your Medicines the
    Right Way--Everyday!''is being made available to MOW providers for
    their clients free of charge. The booklet is in easy-to-read language
    and covers important steps to help ensure safe and effective medication
    use.

                                   DEMOGRAPHY

        As the percentage of Americans over age 65 increases, profound
    societal changes will likely occur. NIA-supported researchers are
    exploring the changing demographic, social, and economic
    characteristics of the older population. The results of this research
    often have important implications for public policy. A major source of
    demographic data on aging is the Health and Retirement Study, a
    biennial survey of more than 22,000 Americans over age 50, which
    provides data for researchers, policy analysts, and program planners
    who are making major policy decisions that affect retirement, health
    insurance, saving and economic well-being. In 2004, the NIA added a
    cohort of ``Early Baby Boomers'' to this study; this will provide
    crucial information on the savings, retirement, and health behaviors of
    tens of millions of Americans now approaching retirement age.
        Thank you for the opportunity to testify before this Subcommittee.
    I would be happy to answer any questions you may have.
                                     ______

     Prepared Statement of Dr. Sharon H. Hrynkow, Acting Director, Fogarty
                              International Center

        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2006 President's Budget for the Fogarty International
    Center (FIC). The fiscal year 2006 budget includes $67,048,000, which
    reflects an increase of $416,000 over the fiscal year 2005 enacted
    level of $66,632,000 comparable for transfers proposed in the
    President's request.
        Many years ago, President John F. Kennedy noted that ``A rising
    tide lifts all the boats. And a partnership, by definition, serves both
    partners, without domination or unfair advantage.'' These words serve
    to remind us of the importance of working in partnership with those
    around the world, on equal footing, and for the common good.
    Congressman John E. Fogarty, for whom our Center is named, also shared
    this belief and worked tirelessly to champion improved health of
    Americans in a healthier world--through international health research
    and training programs.
        Today, the vision of Congressman Fogarty continues to inspire the
    Center in building international partnerships on behalf of the National
    Institutes of Health (NIH) and in supporting research and training
    programs to advance the objectives of global health. FIC's unique
    mission and initiatives add value, complement NIH international
    programs and build scientific capacity around the world for the benefit
    of Americans and the global community.
        I welcome this opportunity to discuss briefly FIC's progress over
    the past year as well as our proposed plans for fiscal year 2006.
    Developed with the support and guidance of the Administration and this
    Committee, the Fogarty programs reflect our nation's enduring
    commitment to global health as well as vibrant, and equal,
    international collaborations.

                          GLOBAL BURDENS OF ILL HEALTH

        The health challenges we face as Americans and as members of a
    global community are many. HIV/AIDS and tuberculosis continue to rise
    at alarming rates. SARS, West Nile Virus, and avian flu are constant
    threats to global health and economies. At the same time, as chronic
    diseases such as cancer, cardiovascular disease, and mental health
    disorders increase year after year, taking enormous tolls in human
    suffering and economic costs, the development and deployment of more
    effective preventive and treatment measures is urgent.
        The Fogarty response to these challenges is to support a range of
    critical research and training programs, each designed to tackle
    specific health problems shared by United States and foreign
    populations. We work in partnership with universities in the United
    States, low- and middle-income nations, and our fellow Institutes at
    the NIH, the Centers for Disease Control and Prevention, the World
    Health Organization, and others to effect change. Fogarty supports over
    20 research and training programs in more than 100 countries, involving
    more than 5,000 scientists in the United States and abroad. HIV/AIDS,
    TB, maternal and child health, environmental health and bioethics are
    just a few of the priority program areas in which Fogarty and its
    partners are making an impact.

                           IMPACT OF FOGARTY PROGRAMS

        I want to share with you two examples to highlight the impact of
    Fogarty programs worldwide. The first is a genealogy of sorts of one
    scientist's career path and support by Fogarty. Dr. Lee Riley of the
    University of California at Berkeley traces his professional roots to
    Dr. Warren D. Johnson, Jr. of the Weill Medical College of Cornell
    University. Both have dedicated decades of their professional careers
    to understanding, preventing, and treating infectious diseases in the
    slums of Brazil. It all started in 1988 when Dr. Johnson received FIC
    support to train AIDS scientists in Brazil. When Dr. Riley joined the
    Cornell faculty in 1990, Dr. Johnson brought him into the AIDS training
    effort and allowed Dr. Riley to initiate additional training activities
    on tuberculosis diagnostics and pathogenesis. When Dr. Riley moved to
    the University of California at Berkeley in 1996, he competed
    successfully for his own training program in Brazil through Fogarty's
    International Training and Research in Emerging Infectious Diseases
    Program (ITREID). Dr. Johnson received a similar ITREID program grant
    at Cornell, enabling the two to coordinate and synergize their training
    activities. Dr. Riley's group ultimately expanded the ITREID program to
    other countries in Latin America as well as to Eastern Europe, and Dr.
    Riley competed successfully for a new FIC-supported grant on Global
    Infectious Disease Training and Research in Brazil.
        The results and impact of these 17 yearlong partnerships have been
    enormous. In terms of people and publications, thirty Brazilian
    investigators have been trained in the United States, 29 of whom are
    still active researchers in Brazil; 28 articles have been published in
    top scientific journals; 12 Ph.D. and 3 Masters degrees in public
    health have been conferred; and, a large number of allied health
    professionals, many of whom are or were residents of slums, have
    received project-related training. Just one of the trainees who has
    returned to Brazil, Dr. Albert Ko, has trained over 50 local staff--
    both laboratory and field--over the last eight years, and he has now
    received his own FIC training award. Other trainees are applying for
    and are receiving funds from NIH and other research agencies.
        Critically, the wealth of knowledge generated has been enormous.
    New understandings have emerged of the causes and treatments of
    leptospirosis, a disease that impacts primarily young people. Patterns
    of the spread of tuberculosis in crowded situations have been
    uncovered, and prevention strategies deployed. Training of health
    scientists from Brazil through the FIC AIDS training programs led to a
    major research grant from the National Institute of Allergy and
    Infectious Diseases for the study of the pathogenesis of leishmaniasis
    in Brazil and for a subsequent Fogarty award in infectious disease
    training. Training through the FIC AIDS training programs has helped
    Brazil evaluate the effectiveness of antiretroviral therapy programs
    that have served as a model and inspiration to other developing
    countries. The partnerships have generated millions of dollars of
    additional support from Brazil, Spain, Mexico, and other nations to
    sustain the research and training activities. And, the relationships
    and partnerships that have been built over time are the ones that will
    allow future studies to move ahead expeditiously.
        The second example is from a research project involving a 1996
    pilot program in Orizaba, Mexico working to evaluate the impact of
    Directly Observed Therapy (Short-Course) (DOTS) in populations with
    drug-resistant tuberculosis. DOTS is the WHO recommended TB treatment
    regimen whereby TB patients are monitored daily to ensure that
    medications are taken properly. In this region, 21 percent of the new
    cases were resistant to at least one anti-tuberculosis drug and 3
    percent were multi-drug resistant (MDR) over a five-year period. The
    data collected demonstrated that DOTS could rapidly reduce transmission
    and the incidence of both drug-susceptible and drug-resistant
    tuberculosis. The case rates of multi-drug resistant tuberculosis were
    also reduced; however, the fatality rate was highest (12 percent) for
    patients infected with resistant strains. In a developing country with
    a moderate rate of drug-resistant tuberculosis, DOTS can rapidly reduce
    the transmission of both susceptible and resistant organisms.
    Additional studies are now under way to expand on these initial
    findings.

                          FISCAL YEAR 2006 INITIATIVES

        FIC will continue to support the NIH Roadmap for Medical Research
    in the 21st Century. Working with partners across NIH and universities
    around the world, FIC will foster interdisciplinary programs in
    clinical research training, identify novel technologies to combat
    global health threats, and expand efforts to bring experts from
    multiple disciplines together to advance NIH Roadmap goals. In keeping
    with the Roadmap, FIC will work in fiscal year 2006 to bring new
    partners into the global health enterprise. FIC will support the
    Framework Programs for Global Health to link multiple schools within
    the same university (or coupled universities) around the topic of
    global health, bringing business, journalism, social science,
    engineering, medicine, law, public health and other disciplines into
    the global health arena in the university setting. A second goal will
    be to energize the next generation of global health leaders through
    development of undergraduate and graduate curricula on global health.
    This effort will propel global health efforts forward in new ways in
    the United States and abroad.
        FIC will enhance its two main programs to address HIV/AIDS and
    related TB challenges. Fogarty's AIDS International Research and
    Training Program builds capacity in resource poor nations to tackle the
    AIDS problem through science and evidence-based policies. Working
    through 25 U.S. universities, educational programs support post-
    doctoral, doctoral, Masters level work, and training for allied health
    professionals, including nurses, to advance research on vaccine
    development and microbicide development, to identify groups at high-
    risk for exposure and to help support the development of interventions
    that make sense at the local and community levels. Nearly 2,000
    developing country researchers from over 100 countries have been
    trained in the United States, many at senior levels, and more than
    50,000 through in-country workshops and courses. More than 80 percent
    of those trained in the United States through this program returned
    home to pursue research and health efforts locally. And, recognizing
    the need for clinical and health systems researchers for AIDS and TB,
    FIC launched a unique International Clinical, Operational and Health
    Services Research Training Award program to meet these needs. Today,
    under this program, experts in Uganda, Haiti, Russia, and China are
    working with U.S. partners to advance AIDS prevention and treatment
    strategies through targeted training efforts and to monitor the
    effectiveness of AIDS drug delivery paradigms. These programs support
    the goals of the President's Emergency Plan for AIDS Relief and the
    Global Fund and will lead to useful insights about effective drug
    delivery approaches in resource poor nations.
        As a third emphasis area, FIC will expand in fiscal year 2006 its
    pilot program to support NIH Alumni Associations abroad. These
    Associations will serve an important role to junior scientists as they
    return home through support of networking activities in which to share
    information and expertise, and other activities. At the same time, they
    will allow U.S. scientists to maintain collaborative ties. Building on
    efforts in Brazil, Mexico, South Africa, India and China, FIC will
    expand this effort to include Central and Eastern Europe, Russia and
    Thailand.
        As a fourth emphasis area in 2006, FIC will expand efforts in the
    neurosciences. With the exception of sub-Saharan Africa, brain
    disorders are the leading contributor to the years lived with
    disability in all regions of the world. More than 150 million people
    suffer from depression at any point in time and nearly one million
    commit suicide each year. Worldwide, about 25 million people suffer
    from schizophrenia and 38 million from epilepsy. FIC, in partnership
    with the National Institute of Neurological Disorders and Stroke and
    other NIH Institutes, will continue its efforts to develop new
    knowledge and technologies to enhance the understanding of brain
    disorders in resource poor settings around the world. Much of the
    research funded by this program could have implications for how certain
    brain disorders are studied, diagnosed, and treated in the United
    States.

                                   CONCLUSION

        The global health challenges we face are many, but the
    international partnerships supported by Fogarty and its partners are a
    bedrock upon which scientific progress will be made to the benefit of
    the American people and the global community.
        Thank you, Mr. Chairman. I would be pleased to answer any questions
    that the Committee may have.
                                     ______

    Prepared Statement of Dr. Thomas R. Insel, Director, National Institute
                                of Mental Health

        Mr. Chairman, and members of the Committee, I am pleased to present
    the fiscal year 2006 President's budget request for the National
    Institute of Mental Health (NIMH). The fiscal year 2006 budget includes
    $1,417,692,000, which reflects an increase of $5,759,000 over the 2005
    enacted level of $1,411,933,000 comparable for transfers proposed in
    the President's request. In my statement, I will call to your attention
    our Nation's immense burden of mental and behavioral disorders and
    include a brief review of our research activities and accomplishments.

                            BURDEN OF MENTAL ILLNESS

        The mission of the National Institute of Mental Health (NIMH) is to
    reduce the public health burden of mental and behavioral disorders. New
    scientific discoveries and powerful new tools are revealing the
    mechanisms involved in the pathophysiology of mental disorders. This is
    a vital step in the development of more effective strategies to manage,
    treat, and even prevent these debilitating disorders.
        The report of the President's New Freedom Commission: Achieving the
    Promise--Transforming Mental Health Care in America defined the
    challenge. The burden of these disorders is staggering, in terms of
    both morbidity and mortality. Mental illness represents 4 of the top 6
    sources of disability from medical causes for Americans ages 15-44
    according to the World Health Organization; suicide accounts for more
    deaths each year than either homicide or AIDS. Recent estimates in the
    President's report put the economic costs of treating mental disorders
    at $150 billion, with elements of these costs increasing beyond 20
    percent per year. The report called for a transformation of mental
    health care, with recovery as a goal. NIMH is working closely with the
    Substance Abuse and Mental Health Services Administration (SAMHSA) as
    it seeks to carry out this mandate.

                                PRIORITY SETTING

        This past year NIMH searched for creative ways in which to optimize
    its impact on public health; the Institute and its stakeholders
    endeavored to reevaluate priorities for funding research. To help with
    this process, two workgroups of the National Advisory Mental Health
    Council were formed: one to review the NIMH extramural clinical
    treatment portfolio and one to review the basic sciences research
    portfolio.
        The goal of the clinical treatment workgroup was to help NIMH focus
    strategically in its support of therapeutics and interventions
    research. The workgroup's report describes clinical areas where more
    study is essential, and urges increased innovation and a sharpened
    focus on amplifying the impact of clinical trials on clinical practice.
    The report also cites the need to expand core resources and clinical
    trials infrastructure for NIMH to enhance its treatment development
    capacity.
        The workgroup reviewing the basic sciences research portfolio
    outlined specific tools and areas of research particularly ripe for
    increased investment, such as the pathophysiology of mental disorders
    and the translation of basic science discoveries into biomarkers,
    diagnostic tests, and new treatments.
        Translation of basic science to clinical issues and practice is now
    a major focus of the Institute. This past year, NIMH reorganized its
    extramural programs into five research divisions (from three) to focus
    on: basic science, translational research for adults, translational
    research for children and adolescents, behavioral effects on health
    (including HIV/AIDS spread and prevention), and psychiatric services
    and treatments. A key aim of the reorganization is accelerating
    translation of the best ideas in neuroscience and behavioral research
    into the clinics and out into the community.
        Rapid advances in mental health research are revealing the
    biological and environmental components of major mental illness. We now
    recognize that mental disorders are brain disorders, and we now have
    the tools to identify the brain circuits involved. Of note is recent
    research on improved detection of disease with biomarkers and
    development of personalized treatments.

               REVEALING THE BIOLOGICAL BASIS OF MENTAL DISORDERS

        A major goal for NIMH is to identify the biological basis of mental
    disorders to more precisely pinpoint targets for prevention and
    treatment. This means understanding the neural basis of the illness at
    all levels, from molecular to behavioral. For instance, imaging studies
    suggest that ischemia (restriction of blood flow in the brain due to a
    narrowed or blocked artery) may significantly contribute to the
    development of a form of depression. In a recent clinical trial, more
    than half of elderly depressed participants met the criteria for this
    newly recognized form of depression called ``ischemic depression.''
    This realization should help improve diagnosis, and more effectively
    guide treatment for those with late-life depression.
        A recent NIMH study shows that in people with panic disorder, a
    type of receptor for serotonin (a mood-regulating neurotransmitter) is
    reduced by nearly a third in several structures of the brain that
    mediate anxiety. The finding is the first in living humans to show that
    this specific receptor, which is pivotal to the action of anti-anxiety
    medications, may be abnormal in the disorder and may help explain how
    genes might influence vulnerability for panic and anxiety disorders.
        A recent translational study on post-traumatic stress disorder
    (PTSD) was the first to demonstrate in humans the importance of a
    particular brain region in ``fear extinction''--the process by which a
    previously learned fear is extinguished by a new form of learning,
    rather than the forgetting of the original fear. The brain region is
    associated not with emotion, but with the regulation of higher
    cognitive functions. This will provide important contributions to the
    understanding and treatment of PTSD and other anxiety disorders.
        Several studies on depression have suggested that the formation of
    new neurons (neurogenesis) might be hindered in those with the
    disorder. In addition, animal studies have demonstrated that
    antidepressant medications are likely effective because they help
    increase neurogenesis. Several genes have been implicated in the
    susceptibility to schizophrenia and depression. In the past year, we
    have learned that common genetic variations bias the way the brain
    works, even in people who have not developed a major mental disorder.
    For instance, a gene variant that is especially common in people with
    depression is associated with a higher level of brain activation in
    response to threat or stress. A variant associated with schizophrenia
    appears to increase the amount of activity in the frontal lobe needed
    to perform complex attentional tasks. These kinds of studies reveal how
    subtle genetic variations may increase vulnerability to mental illness.
    Ultimately, this may provide a strategy for early detection and
    prevention of a psychotic or depressive episode based on identifying
    individuals at genetic highest risk, just as we routinely intervene in
    those with high blood pressure and high cholesterol to prevent a heart
    attack.
        Autism continues to be an increasing priority for NIH. We are just
    beginning to see the pay-offs of cross-Institute investments in several
    new centers and projects. Previous studies show that on average, autism
    is not diagnosed in children until after the age of 6, a relatively
    late age considering that early intervention is critical for the best
    treatment response. Thus, NIMH research will help develop new tools for
    detecting autism early, before age two. In addition, NIMH is part of a
    public/private research consortium focusing on the study of infant
    siblings of children with autism, to help identify early features and
    distinguishing characteristics of autism. NIMH and other NIH institutes
    are collaborating with voluntary and private funding organizations and
    government agencies internationally to develop a new research
    initiative ($21.5 million over 5 years) to identify specific gene
    variants that produce susceptibility to autism.

                            TREATMENTS FOR RECOVERY

        The first of several large, NIMH-funded clinical studies testing
    various treatment options for those with serious mental illnesses was
    completed last summer: a 13-site trial aimed at defining the most
    effective and safe treatment for children and adolescents with major
    depressive disorder. Depression is an important risk factor for
    suicide, the third leading cause of death among adolescents; it is also
    a major risk factor for long-term psychosocial impairment in adulthood.
    There has been much debate about whether a class of antidepressant
    medications, selective serotonin re-uptake inhibitors (SSRIs) can
    actually increase suicidal thinking. At present, fluoxetine (Prozac) is
    the only FDA-approved medication for depression in children and
    adolescents, and there have been conflicting results regarding its
    benefits and risks. The goal of the NIMH trial was to clarify the
    usefulness of treating adolescent depression with a type of
    psychotherapy called cognitive behavior therapy (CBT), or fluoxetine,
    or both. Results of the first 12 weeks found that a combination of
    fluoxetine and CBT was the most effective treatment (71 percent
    response rate). Of the other three treatment groups, fluoxetine alone,
    (60.6 percent response), but not CBT alone (43.2 percent response) was
    significantly better than placebo (34.8 percent response). Suicidal
    thinking, which was present in 29 percent of the participants at the
    beginning of the study, improved significantly in all four treatment
    groups, with those receiving medication and therapy showing the
    greatest reduction (below 8 percent). Soon we will know the
    effectiveness of these treatments over a six-month period from
    treatment initiation. It is critical for physicians and
    psychotherapists to closely monitor their young patients on
    antidepressant medications for signs of hurtful or suicidal behavior,
    particularly during the early phases of treatment.
         A central focus of NIMH treatment research has been finding a more
    tailored, individual approach to therapy. To personalize treatments, we
    need to know predictors of treatment response. Recent studies have
    begun to reveal some predictors that will help clinicians optimize
    care. For instance, studies of people with major depressive disorder
    reveal that standard antidepressant medication may be less helpful in
    those with a history of trauma, or specific genetic variations, or
    specific patterns of brain activation as seen on imaging scans. These
    same patients may respond well to cognitive behavior therapy.
    Similarly, patients with schizophrenia who have poor attentional
    processing and other cognitive deficits may report less satisfaction
    with anti-psychotic medications, which were not designed to treat these
    features of the illness. Ongoing research seeks to find markers that
    will guide individual treatment to optimize recovery.
        Other large trials to be completed within the next year will answer
    urgent questions about the choice of treatments in people with bipolar
    disorder, schizophrenia and Alzheimer's, and treatment-resistant major
    depression. NIMH continues its strong commitment to public
    dissemination of findings from these clinical trials by fostering
    partnerships with national and state organizations via the Outreach
    Partnership Program. Through this program, NIMH works with the National
    Institute on Drug Abuse and SAMHSA to bridge the gap between research
    and clinical practice.

                      BLUEPRINT FOR NEUROSCIENCE RESEARCH

        The NIH Blueprint for Neuroscience is a framework to enhance
    cooperation among the 15 NIH Institutes and Centers that have common
    interests in the nervous system. By pooling resources and expertise,
    the Institutes and Centers can take advantage of economies of scale,
    confront challenges too large for any single Institute, and develop
    research tools and infrastructure that will serve the entire
    neuroscience community. The Blueprint is developing a primary set of
    initiatives including a gateway to existing databases that permits more
    effective searches; training enhancement for basic neuroscientists; and
    expansion of ongoing pediatric imaging, gene microarray, and gene
    expression database efforts.

                                  NIH ROADMAP

        NIMH has assumed a lead role on the Molecular Libraries and Imaging
    initiative of the NIH Roadmap, whose goal is to provide organic
    compounds called ``small molecules'' to scientists to use as tools to
    improve our understanding of biological pathways in health and disease.
    The potential of scientific discoveries of clinical relevance is
    enormous. The NIMH mission can be advanced by the identification of
    even one novel small molecule with biological activity in the brain, as
    it could provide invaluable information about brain circuits involved
    in mental illness and those that are altered by treatment.
                                     ______

    Prepared Statement of Dr. Stephen I. Katz, Director, National Institute
               of Arthritis and Musculoskeletal and Skin Diseases

        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2006 President's budget request for the National
    Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
    The fiscal year 2006 budget includes $513,063,000, an increase of
    $1,906,000 over the comparable fiscal year 2005 enacted level of
    $511,157,000 comparable for transfers proposed in the President's
    request.
        Improving daily life is the driving force for the research that we
    support and conduct at the NIAMS. Virtually every home in America is
    touched by diseases affecting bones, joints, muscles, and skin. We are
    committed to improving our understanding, diagnosis, treatment, and
    prevention of these diseases and disorders that are typically costly,
    chronic, and disabling, many of which disproportionately affect women
    and minority populations. I am delighted to share highlights of our
    research progress as well as our plans.

                      THE NIH ROADMAP FOR MEDICAL RESEARCH

        The NIAMS is pleased to partner with other NIH components in the
    many dimensions of the NIH Roadmap, and the Institute has
    responsibility for the management of an initiative for a patient-
    reported outcomes measurement information system--or PROMIS--network.
    The goal of this initiative is to develop ways to measure patient-
    reported symptoms such as pain and fatigue and aspects of health-
    related quality of life across a wide variety of chronic diseases and
    conditions. The PROMIS initiative will develop a publicly available
    computerized adaptive test for the clinical research community. Many
    diseases that compromise daily life involve pain, fatigue, and other
    difficult-to-measure quality of life outcomes, and the development of a
    test to measure changes in these symptoms will be of benefit to
    patients and their health care providers.

                              RESEARCH IN CHILDREN

        When arthritis and other rheumatic diseases affect children, they
    can significantly compromise a child's ability to enjoy an active life.
    NIAMS-supported researchers have launched a state-of-the-art genomics
    project, and the goal of this project is to take full advantage of the
    tremendous progress that has been realized in genetics and genomics,
    and to uncover gene expression patterns (groups of genes that are
    ``turned on'' or ``turned off'') that contribute to the development of
    pediatric arthritis. The NIAMS and a chapter of the Arthritis
    Foundation and the Schmidlapp Trust are supporting this study of
    children newly diagnosed with a variety of pediatric diseases such as
    juvenile rheumatoid arthritis, juvenile ankylosing spondylitis (or
    spinal arthritis) and other related immune disorders. Identifying the
    gene expression patterns for different types of arthritis in children
    will help to improve diagnosis as well as to predict the severity of
    disease for affected children.
        In other studies supported by the NIAMS, the promise of genetic
    studies was underscored by the identification of a gene variant that
    increases susceptibility to juvenile arthritis. The NIAMS and the
    Arthritis Research Campaign funded researchers from around the world
    who worked collaboratively in collecting DNA samples from children with
    juvenile rheumatoid arthritis and their parents. Research findings
    suggest that there may be distinct genetic profiles for the disease
    that result in differences in age of onset as well as disease severity.

                             BIOMARKERS OF DISEASE

        Progress in identifying the onset and progression of disease is a
    challenge in many chronic diseases, and the NIAMS has taken the lead in
    three initiatives to address this challenge: the first is the
    Osteoarthritis Initiative--a public-private partnership that the NIAMS,
    the National Institute on Aging, several other NIH components, and
    three pharmaceutical companies support that is working to develop
    clinical research resources for the discovery and evaluation of
    biomarkers and surrogate endpoints for clinical trials on
    osteoarthritis (the most common form of arthritis). Data and images
    collected will be available to researchers around the world to speed
    the pace of research in biomarker identification, and this consortium
    is expected to serve as a model for initiatives in the future that
    involve public and private partnerships. We have already enrolled 1,900
    individuals to participate in this Initiative. The second initiative is
    the creation of the Osteoarthritis Biomarkers Network involving
    institutions in the United States and Sweden. This Network facilitates
    the sharing of clinical, biological, and human resources to more
    rapidly and more effectively identify biomarkers for osteoarthritis. In
    the third biomarker initiative, the NIAMS supports the Autoimmune
    Biomarkers Collaborative Network which includes efforts to identify and
    validate biomarkers for lupus--a serious and potentially fatal
    autoimmune disease that occurs with greater frequency and intensity in
    African American women, and that affects many organ systems of the
    body.

                     ARTHRITIS AND OTHER RHEUMATIC DISEASES

        Rheumatoid arthritis is an autoimmune disease, and affected
    individuals often must be treated with powerful drugs that may help to
    keep the disease better controlled, but also suppress the immune
    system--leaving patients particularly vulnerable to infection. NIAMS-
    supported researchers have identified a potential treatment that will
    suppress the abnormal, autoimmune response that causes the rheumatoid
    arthritis, but does not diminish the patient's ability to fight
    bacteria and viruses. The treatment is a synthetic peptide (a chain of
    amino acids) called dnaJP1--a particular section of a protein that has
    the same characteristic amino acid sequence as that found in patients
    with rheumatoid arthritis. In initial studies a synthetic version of
    the dnaJP1 peptide was given to patients with rheumatoid arthritis with
    the goal of blocking the immune response, and the immune system
    responses were normal in these treated patients. The NIAMS partnered
    with the National Institute of Allergy and Infectious Diseases, the
    Royal Netherlands Academy of Arts and Sciences, and the Dutch
    Organization for Scientific Research in funding this study. A new
    larger study will be undertaken to pursue studies of this promising
    synthetic peptide for people with rheumatoid arthritis.
        Fibromyalgia is a disease that affects many systems of the body,
    affects women far more commonly than men, and is characterized by low
    pain thresholds at specific tender points in the body. NIAMS-supported
    researchers have furthered our understanding of fibromyalgia in recent
    studies that determined that fibromyalgia was strongly aggregated in
    families, and that the number of tender points as well as total muscle
    pain scores were strongly associated with fibromyalgia in families. In
    addition, there was an increase in the presence of mood disorders in
    relatives of fibromyalgia patients. This aggregation of fibromyalgia in
    families suggests that genetic factors may play an important role in
    this disease. The NIAMS supported a workshop in November 2004 that
    reviewed the state of the science and a view to future studies in
    fibromyalgia.

                       BONE AND MUSCULOSKELETAL DISEASES

        Osteoporosis is characterized by bone thinning that results in
    increased susceptibility to fracture. A particular clinical challenge
    has been that often the first indication of osteoporosis is when a
    person (most often a woman) has a bone fracture, and by then the bone
    has already thinned. Better methods are needed to screen for
    osteoporosis and for those who are at high risk for fractures.
    Researchers have recently learned that bony regions of conventional
    dental x-rays may be useful in evaluating both the current micro-
    architecture of bone as well as following changes in bone over time.
    Bone quality plays a critical role in osteoporosis and other bone
    diseases, and the NIAMS has partnered with the American Society for
    Bone and Mineral Research in sponsoring a meeting in May 2005 to
    evaluate the current status of assessment methods to serve as
    surrogates for fracture and bone fragility, as well as to determine the
    next steps that must be taken to validate these methods and incorporate
    them into clinical trials. In other studies with relevance for
    osteoporosis, basic scientists have identified a particular gene
    (Alox15) that is strongly associated with changes in bone mineral
    density--a measure of vulnerability for osteoporosis. Researchers had
    previously identified the involvement of Alox15 in fat metabolism, so
    the identification of its role in bone links metabolic pathways and
    bone changes, and also provides a new drug target for osteoporosis.

                                MUSCLE DISEASES

        One of the most active and productive areas within the Institute's
    research portfolio is in the muscular dystrophies--a group of genetic
    diseases characterized by progressive weakness and degeneration of the
    skeletal or voluntary muscles which control movement. NIAMS research
    has made progress in defining the genetic mutations and in overcoming
    the current barriers to effective gene therapy of Duchenne muscular
    dystrophy, Facioscapulohumeral dystrophy, and other muscle diseases.
    For example, scientists supported by the NIAMS and the Muscular
    Dystrophy Association recently reported that a particular method of
    gene therapy was able to reach all damaged muscles in a muscular
    dystrophy (MD) mouse, with implications for delivering genetic therapy
    for MD and perhaps other diseases of the muscle or heart. Previous work
    showed that MD could be prevented from occurring in a mouse model of
    the disease by replacing the gene for dystrophin, which is defective in
    people with the Duchenne form of the disease with a corrected copy of
    the gene. However, until now, no one had found a way to deliver a new
    gene to all muscles of an adult animal, including muscles that had
    already developed MD.
        The NIAMS has teamed with the National Institute of Neurological
    Disorders and Stroke (NINDS) and the National Institute of Child Health
    and Human Development (NICHD) to bring a strong focus to basic and
    clinical studies of MD. Activities include the efforts related to the
    new Muscular Dystrophy Coordinating Committee (MDCC), and the Muscular
    Dystrophy Research and Education Plan for the NIH that was developed by
    the MDCC and released in September 2004. In addition, in fiscal year
    2003, the NIAMS, along with NINDS and NICHD, each funded a Muscular
    Dystrophy Cooperative Research Center for which additional funding was
    provided by the Muscular Dystrophy Association. In fiscal year 2004,
    the three institutes re-issued the solicitation for centers--now known
    as Senator Paul D. Wellstone Muscular Dystrophy Cooperative Research
    Centers, and expect to fund two to three additional meritorious centers
    in fiscal year 2005.
        The NIAMS, NINDS, NICHD and the Centers for Disease Control and
    Prevention sponsored a workshop on the burden of muscle diseases in
    January 2005. The participants in this workshop identified existing
    data on the costs and scope of muscle diseases, with a focus on the
    muscular dystrophies, and recommended strategies for developing new
    information sources.

                                 SKIN DISEASES

        Skin diseases significantly compromise daily life for millions of
    Americans, both physically and psychologically. Researchers supported
    by the NIAMS have made great progress in our understanding of basic
    skin biology as well as understanding the bases for skin diseases.
        A particular area of focus in the NIAMS portfolio is on the roles
    of genes in skin diseases, and scientists have advanced our
    understanding in a number of areas, including identifying two genes on
    chromosome 17 which are associated with psoriasis. Other studies have
    identified susceptibility genes for keloids, which are an abnormal form
    of scarring that disproportionately affects people of color.
    Investigators studying the physiologic basis for keloid formation were
    able to determine that a blood vessel growth factor was likely to be
    associated with keloid formation. This suggests that it may be possible
    to suppress keloid formation by topical application of an inhibitor of
    this molecule. In a third area of genetics research, investigators have
    identified a new mouse model of alopecia areata that has allowed
    genetic susceptibility studies to be undertaken, and two new regions on
    chromosomes 8 and 15 were identified. The availability of this new
    animal model will allow better identification of the genetic basis of
    alopecia areata as well as provide a basis for testing potential
    interventions.

                                   CONCLUSION

        Significant progress has been made in our understanding of
    fundamental life processes and how they go awry in diseases of bone,
    joints, muscles, and skin. We are proud of the advances that scientists
    supported by the NIAMS have achieved, and we are excited about
    initiatives that we have launched. Our goal remains, as always, to
    improve the health of the American public--to reduce the burden of
    disease and to enrich the quality of life for all Americans.
        I will be happy to answer any questions that you may have.
                                     ______

    Prepared Statement of Dr. Ting-Kai Li, Director, National Institute on
                          Alcohol Abuse and Alcoholism

        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2006 President's budget request for the National
    Institute on Alcohol Abuse and Alcoholism (NIAAA). The fiscal year 2006
    budget includes $440,333,000, which reflects an increase of $2,056,000
    over the fiscal year 2005 enacted level of $438,277,000 comparable for
    transfers proposed in the President's request. The Centers for Disease
    Control and Prevention last year ranked alcohol the number-three
    preventable cause of death in the country. This finding echoed a report
    issued by the World Health Organization, which listed alcohol as the
    third leading preventable cause of healthy years lost to death and
    disability in developed nations during 2002. The high rate of death and
    disability associated with alcohol is the result not only of injury,
    but also of organ damage, including brain damage. Alcohol's biological
    actions are widespread in the body, and, when used in excess, it has
    the potential to contribute to conditions such as cancer and liver
    disease. Every age group is at risk of alcohol-related problems, from
    fetuses exposed to alcohol in the womb to the elderly. In the United
    States, the estimated annual cost of alcohol-use disorders (alcohol
    abuse and alcohol dependence), including indirect costs, such as lost
    productivity, is $185 billion.\1\
    ---------------------------------------------------------------------------
        \1\ Harwood, H.; Fountain, D.; and Livermore, G. (2000). The
    Economic Costs of Alcohol and Drug Abuse in the United States 1992
    (updated for 1998). Report prepared for the National Institute on Drug
    Abuse and the National Institute on Alcohol Abuse and Alcoholism,
    National Institutes of Health, Department of Health and Human Services.
    NIH Publication No. 98-4327. Rockville, MD: National Institutes of
    Health. NIAAA's mission is to develop prevention and treatment
    interventions that reduce alcohol-use disorders and their consequences.
    To achieve this goal, we must understand the underlying biological,
    behavioral, and environmental factors and identify populations at risk.
    NIAAA research initiatives in four areas, in particular, are essential
    to this effort: medication development, neuroscience, metabolism, and
    youth.
    ---------------------------------------------------------------------------
                             MEDICATION DEVELOPMENT

        Development of more widely effective medications for alcohol-use
    disorders and organ damage is among NIAAA's highest priorities; it is
    among the 28 research outcome goals listed in the NIH Government
    Performance and Results Act report. Medications help prevent or reduce
    drinking by acting on one or more of the many brain systems through
    which alcohol exerts its actions. For example, some medications reduce
    craving for alcohol. We are testing promising compounds for treatment
    of alcohol-use disorders, by themselves and in combination with
    behavioral therapies, and for treatment of liver damage.
        Recent advances in science and technology have enabled remarkable
    progress in our understanding of neurobiological mechanisms that
    underlie behavior, and are revealing new molecular targets for
    medications for alcohol-use disorders. Likewise, advances in our
    understanding of organ injury are providing new opportunities for
    developing medications. These advances are reflected in unprecedented
    progress in NIAAA's medication development initiative.
        A special challenge for our initiative is to develop strategies
    that will increase translation of promising medications identified by
    NIAAA research into clinical applications. The pharmaceutical industry
    has been reluctant to develop medications for alcoholism, and the
    medical community has been reticent to use new pharmacotherapeutic
    modalities as an adjunct to traditional behavioral therapies for the
    treatment of this disease. For example, only 3 to 13 percent of
    patients treated for alcoholism receive a prescription for the
    medication naltrexone, although it has yielded positive results in
    NIAAA-funded studies published in medical journals. We need to increase
    the likelihood that compounds we identify as effective and safe will
    reach the market and that they will reach patients who can benefit from
    them. Research is underway to identify barriers and strategies to
    remove them.
        Our recently established collaboration with the Food and Drug
    Administration (FDA) will help to expedite progress. Together, NIAAA
    and FDA are developing standards for clinical trials of medications to
    be tested as alcoholism treatments. This will help ensure that NIAAA-
    supported trials are in line with regulatory requirements, enabling
    them to proceed.
        Our two highest priorities for accelerating our medication program
    are (1) to develop animal models and human research paradigms that can
    predict the clinical success of potential medications. Having these
    predictive models in place will prevent spending time and money on more
    elaborate testing of compounds that would ultimately fail to be
    effective. (2) Another priority is to establish a network of sites for
    early stages of human testing of medications, to reveal whether or not
    a drug should be pursued in larger, more expensive trials. Medications
    in this system will be on a fast track, in which scientific elements of
    safety testing, etc., remain, but elimination of unnecessary
    administrative roadblocks will expedite the process.

                                IN THE PIPELINE

        Human trials of two particularly promising medications are
    underway. Among the studies being conducted is a collaboration with the
    National Institute on Drug Abuse (NIDA), to test the antiseizure drug
    topiramate's effectiveness in treating people addicted to both alcohol
    and cocaine. Antiseizure drugs act on neurotransmitter systems that
    modulate brain-cell activity, to restore their natural balance. Alcohol
    causes an imbalance in the glutamate and GABA neurotransmitter systems
    (among others) and topiramate's actions on these receptors are thought
    to ease some of the symptoms of alcohol withdrawal. The drug rimonabant
    is directed at a different neurotransmitter system (the cannabinoid
    system) and has shown considerable promise in animal studies. Several
    other kinds of medications that have shown promise in research settings
    are in various phases of clinical studies, including several
    collaborations with other NIH Institutes.
        Some populations are at particular risk, and we also are conducting
    studies specific to them. We are testing medications in youth, who have
    high rates of alcohol abuse. This group poses special challenges, since
    the biological changes that occur in the brain during adolescence might
    compromise the pharmacologic actions of medications used for adults.
        People with co-occurring alcoholism and psychiatric conditions are
    another high-risk group. Our studies of this population include
    collaborations with the National Institute of Mental Health. In a
    recent trial, a drug already used as an anticonvulsant and to treat
    bipolar disorder showed promise in treating alcoholism in bipolar
    people, who are generally resistant to current medications for
    alcoholism.
        A collaboration with the National Cancer Institute and NIDA is
    helping researchers to understand the biological interactions that
    occur between alcohol and nicotine, and to develop treatments for
    alcoholic smokers. Studies suggest that addiction to alcohol and
    nicotine involves some common underlying mechanisms.
        In addition to developing medications to treat alcohol-use
    disorders themselves, we are developing treatments for alcoholic liver
    disease. Alcohol is among the leading causes of death from liver
    disease in the United States.
        Pharmaceutical companies put aside many of the medications they
    develop. Even though they may be safe, they may not be optimally
    effective for treating the diseases or conditions for which they were
    developed. These medications are potentially useful for treatment of
    other diseases, and some act on neurotransmitters that we have
    identified as promising targets for treatment of alcoholism. We are
    encouraging pharmaceutical companies to collaborate with us in
    developing these compounds as potential alcoholism treatments.

                          NEUROSCIENCE AND METABOLISM

        The biology of the brain contributes to how we make decisions--to
    the choices we make in life and the behaviors in which they result.
    Neuroscience research is essential for understanding the biological
    basis of alcohol-related behaviors and for identifying molecular
    targets for therapeutic compounds that can alter alcohol's actions in
    the brain. Many different biological systems in the brain influence how
    people respond to alcohol, and chronic, heavy exposure results in brain
    adaptations that form the underpinnings of alcoholism.
        NIAAA-funded scientists are making important discoveries about
    genes and proteins active in these brain systems, whose variant forms
    increase or decrease the risk of alcohol-use disorders. For example,
    recent studies suggest that a gene that produces an appetite-regulating
    protein fragment, neuropeptide Y, also affects tolerance to alcohol, a
    predictor of alcoholism and a factor in its development.
        In 2006, NIAAA will take part in the NIH Blueprint for
    Neuroscience, a collaboration of 15 Institutes. We are particularly
    interested in the Blueprint's cross-training programs for the next
    generation of researchers and clinicians in neuroscience. One component
    trains physicians and scientists to work together toward translating
    neuroscience findings into clinical practice; others provide training
    in computer and neuroimaging technologies that offer unprecedented
    research capabilities. The Blueprint's project to target all of the
    genes in the mouse genome, to discover which of them are critical
    players in health or diseases of the nervous system, will benefit NIAAA
    research.
        Metabolism also has a profound effect on people's responses to
    alcohol. Variations in the genes and proteins involved in alcohol
    metabolism can, like those involved in brain function, increase or
    decrease risk of alcoholism. NIAAA's metabolism initiative is making
    progress in identifying these gene/protein variations and their impact
    on alcohol-related behaviors, particularly in regard to enzymes in
    alcohol-metabolism pathways. The NIH Roadmap Initiative on National
    Technology Centers for Networks and Pathways is contributing valuable
    information to the effort. Like our neuroscience research, our
    metabolism research is helping us to identify potential targets for
    therapeutic compounds.

                                 YOUTH AT RISK

        Last year, we reported that new epidemiology data called for a
    major scaling up of efforts to prevent underage drinking. The data
    revealed that youth is the age of greatest risk of alcoholism; people
    18-to-25 years old have much higher rates of alcoholism than any other
    age group in the Nation. Previous studies had shown the extent to which
    youth engage in risky patterns of drinking, such as occasionally or
    frequently drinking too much, too fast. Alcohol is the largest
    contributor to unintentional injury, the leading cause of death of
    Americans under age 21. People who begin drinking earlier in
    adolescence have a much higher risk of alcoholism as adults, as
    compared with late starters. Children are beginning to drink at earlier
    ages, and youth from secondary-school age to college age have
    substantial rates of risky drinking. In the military, more than 26
    percent of underage personnel engage in ``binge drinking'' (five or
    more drinks in a row), according to a recent Department of Defense
    report. These and other epidemiology data indicated to us that (1) the
    problem of underage drinking required renewed emphasis and coordination
    in the research and service communities, and (2) we should approach
    alcoholism as having a developmental trajectory that begins in
    childhood and adolescence. In a recent report, Reducing Underage
    Drinking: A Collective Responsibility, the Institute of Medicine called
    for strategies to ameliorate these problems. Last year, NIAAA announced
    the addition of a major new initiative to its ongoing research on
    youth.

                                YOUTH INITIATIVE

        Research shows that brain development and maturation occur over a
    longer period than previously thought. A key question we are asking is:
    What brain systems differ in adolescents and adults such that youth
    tend to binge drink? The brain receives and sends chemical messages
    that influence when an individual has ``had enough'' and stops
    drinking. Are the brain systems that regulate these ``stop mechanisms''
    not yet mature in the adolescent brain? Does alcohol alter their
    development? A collaboration with NIDA is stimulating studies on
    consequences of alcohol exposure and drug abuse on development of the
    brain and behavior.
        NIAAA has formed a steering committee that includes both scientists
    and policy and communication experts. The former chairman of the IOM
    committee on underage drinking is a member, as are two of the 60
    current and former governors' spouses leading a national NIAAA-
    sponsored prevention campaign. In addition, the NIAAA sits on the newly
    established Interagency Committee on Prevention of Underage Drinking.
    This Committee cuts across agencies, from research to service,
    including the Substance Abuse and Mental Health Services
    Administration, in a major coordination of effort.
        Our initiative also is reaching out to health-care systems and
    communities. An area in critical need of attention is the response of
    health care systems to underage drinking. NIAAA's youth initiative is
    beginning to address this need, in part, with a project called Underage
    Drinking: Building Health Care System Responses. Rural academic health
    centers will use existing services and clienteles to conduct the
    studies.
        The youth initiative is responding to crisis levels of risky
    drinking on college campuses, as well. It includes fast-track approval
    of grant applications in response to campuses that request help, a
    recommendation issued in the NIAAA Task Force on College Drinking--a
    collaboration between scientists and college presidents. Seven approved
    and funded projects are underway; another application is nearing
    approval, and others are under review. The Task Force is about to
    release an updated report, which will reflect the latest research
    findings. Another new program under the youth initiative, the
    Mississippi River Delta Project, is examining whether a prevention
    strategy recommended for college students by the Task Force is
    effective for rural adolescents.
        One major question that must be addressed regarding underage
    drinking and its consequences is whether enforcement of existing laws
    can reduce these problems by reducing youths' access to alcohol. We
    recently began collaborating with the Office of Juvenile Justice and
    Delinquency Prevention to address this question in rural communities.
    NIAAA's role in this joint effort is to provide the research required
    for evaluation of the effectiveness of the 3-year program. Four
    projects are underway; three more are nearing approval.
        The leadership of the youth initiative is discussing collaborations
    with other potential partners. In Spring 2005, we will meet with
    leaders in the radio and television media about the effects of alcohol
    portrayal on youth behaviors. Navy leaders have requested a meeting
    with NIAAA, also to be held in Spring 2005, to discuss prevention and
    treatment strategies. We have begun discussions with the Department of
    Agriculture about the possibility of conducting research and outreach
    through the 4-H Club organization.

                               AT THE CROSSROADS

        The results of our research will be useful to the public to the
    extent that clinicians and communities apply them. We are at a
    crossroads, in which we are able to identify new medications, for
    example, while the pharmaceutical and medical communities are
    relatively unresponsive to new findings in alcohol research, and
    prevention and treatment are not reimbursed adequately by private
    insurers.
        At this juncture, a high priority for our Institute is to develop
    strategies that will increase the likelihood that clinicians,
    communities, and health-care systems will adopt findings from our
    investigations. Efforts are underway. Thank you Mr. Chairman. I would
    be pleased to answer any questions that the Committee may have.
                                     ______

    Prepared Statement of Dr. Story C. Landis, Director, National Institute
                      of Neurological Disorders and Stroke

        Mr. Chairman and Members of the Committee I am Story Landis,
    Director of the National Institute of Neurological Disorders and Stroke
    (NINDS). I am pleased to present the fiscal year 2006 President's
    budget request for NINDS. The fiscal year 2006 budget includes
    $1,550,260,000, an increase of $10,812,000 over the fiscal year 2005
    enacted level of $1,539,448,000 comparable for transfers proposed in
    the President's request.
        The mission of the NINDS is to reduce the burden of neurological
    disorders by finding ways to prevent or to treat these diseases. This
    mission is extraordinarily important and extraordinarily difficult. It
    is important because the burden of neurological disorders is immense,
    affecting all segments of society. Diseases of the nervous system kill
    people of all ages, disrupt essential bodily functions, cause pain and
    discomfort, and disturb all aspects of human ability, from perception
    and movement through emotions, memory, language, and thinking. It is
    difficult because hundreds of diseases affect the brain, spinal cord,
    and nerves of the body, each presenting unique challenges. Compounding
    the challenge, the brain and spinal cord are difficult to access,
    sensitive to intervention, reluctant to regenerate following damage,
    intricate in structure, and elusive in their normal workings.
        Despite these challenges, we are making progress. Prevention of
    stroke and of nervous system birth defects is having a major impact on
    public health. Better drugs and surgical treatments help relieve
    symptoms for people with Alzheimer's disease, Parkinson disease,
    epilepsy, chronic pain, multiple sclerosis, and other diseases.
    Improvements in genetic testing and brain imaging also enhance
    physicians' ability to diagnose disease and guide therapy for nervous
    system disorders.
        To continue this progress, the NINDS supports basic studies to
    understand the nervous system in health and disease, translational
    research to move from the laboratory toward the clinic, and clinical
    research, including clinical trials to test the safety and efficacy of
    treatments and preventive interventions. The Institute supports most
    research through extramural grants and contracts to physicians and
    scientists throughout the country. NINDS intramural investigators also
    conduct research on the NIH campus in Bethesda, Maryland.
        To complement investigator-initiated research, the Institute
    directs initiatives to public health needs, unusual scientific
    opportunities, or issues that Congress highlights as critical. NINDS
    initiatives for fiscal year 2006 focus on tuberous sclerosis, Rett
    syndrome, muscular dystrophy, neuro-AIDS, transmissible spongiform
    encephalopathies (TSEs), stroke, and Parkinson disease, as well as on
    cross-cutting issues including counterterrorism, neurological
    emergencies, and stem cells. Increasingly, NINDS initiatives and other
    programs are in cooperation with other components of the NIH.

                               CLINICAL RESEARCH

        The NINDS currently supports more than 1,000 research projects that
    involve human subjects, with more than 300,000 people expected to
    participate. For example, epidemiological studies are examining risk
    factors for stroke with special attention to Blacks and Hispanics;
    genetic studies have recently helped identify genes related to
    Parkinson disease, ALS, dystonia, Joubert syndrome, and cerebrovascular
    disease; and brain imaging research is revealing how the brain develops
    throughout childhood and adapts after damage. Among the findings this
    year are brain imaging data that will identify which stroke patients
    might benefit from emergency treatments to unblock blood vessels and
    preliminary indications that vitamin D might help prevent multiple
    sclerosis in women, a finding which researchers are following up.
        Of the NINDS clinical research studies, approximately 125, with
    more than 25,000 expected participants, are clinical trials of
    interventions to prevent or treat neurological disorders. Projects
    range from planning and pilot trials to large multi-center trials. In
    notable results this year, a small intramural clinical trial of
    multiple sclerosis patients who did not respond to interferon, the
    standard therapy, found that administering the genetically engineered
    antibody daclizumab improved outcome substantially. An extramural
    clinical trial found that ultrasound may improve the effectiveness of
    t-PA (tissue plasminogen activator) in breaking up clots and restoring
    blood flow to the brain. T-PA has been the only FDA-approved therapy
    for acute ischemic stroke since NINDS clinical trials demonstrated its
    effectiveness in the 1990's.
        In other clinical trials activities this year, the innovative
    Neuroprotection Exploratory Trials in Parkinson Disease (NET-PD)
    program is selecting drugs that show promise for slowing the course of
    Parkinson disease and testing them through a clinical trials network.
    From 59 drug candidates proposed by 42 scientists from 13 countries, 4
    drugs were selected for testing in phase II clinical trials, with
    results expected in the next few months. If results warrant, larger
    trials will follow quickly. To enhance drug selection in the future,
    the NINDS is establishing a contract animal testing facility. The NINDS
    Pilot Studies Network (NPTUNE) is also underway to expedite pilot
    trials of new treatments for rare neurological disorders, for which the
    lack of clinical trials infrastructure often blocks moving therapies
    forward. NPTUNE chose testing of phenylbutyrate for spinal muscular
    atrophy (SMA) as the first trial. Development of the Clinical Research
    Collaboration (CRC) has also begun, which will extend the reach of the
    NIH into more communities across the United States. The CRC will engage
    hundreds of community practice and academic neurologists to speed
    trials; minimize costs; make trials more accessible to patients;
    recruit a diverse spectrum of participants; facilitate trials of rare
    diseases; and improve transfer of research results to clinical practice
    in community settings. Complementing the CRC, the NINDS is building a
    network to develop emergency treatments for neurological disorders.
    Stroke, seizures, and traumatic injury are just a few of the
    neurological disorders that often require emergency treatment. This
    program brings together specialists in emergency medicine with experts
    in neurological disease and in clinical trials. Finally, the NINDS is
    fully engaged in Roadmap initiatives to address clinical research and
    trials issues that cut across all of medical science.

                             TRANSLATIONAL RESEARCH

        Translational research encompasses the many steps that move basic
    research findings to a therapy that is ready for testing in clinical
    trials. In 2002, the NINDS began a comprehensive translational research
    program that can apply to all diseases within its mission. The program
    solicits investigator-initiated proposals, evaluates them according to
    peer review criteria tailored to the needs of translational research,
    and monitors progress with milestone-driven funding, as is common in
    industry. The first major project in this program, the Parkinson's Gene
    Therapy Study Group, met critical milestones this year with the
    creation of a stable colony of parkinsonian non-human primates for
    testing therapies and the development of modified viral vectors that
    can deliver therapeutic genes under tight control.
        Complementing the broad translational research program and relevant
    Roadmap initiatives in areas such as molecular libraries are several
    specific NINDS efforts. In one such program, the Institute, working
    with academia and voluntary disease organizations, formed a consortium
    of 26 laboratories to screen a set of 1,040 known drugs with laboratory
    tests for potential use against neurodegenerative diseases. Most of the
    drugs in this set have been approved by the U.S. Food and Drug
    Administration (FDA) for other uses, and so might move more quickly
    toward clinical trials. Several drugs from this program have shown
    promise against neurodegeneration and moved forward to testing in more
    definitive mouse models of human diseases. One drug, ceftriaxone, has
    already proceeded to testing in a clinical trial for ALS early this
    fall.
        Because of the state of the science and the impact of SMA on
    children and families, the NINDS chose this disease as the focus of an
    innovative approach to expedite therapy development. The SMA Project
    uses a performance-based contract mechanism to accelerate all steps
    from recognition of a research need, through solicitation, review, and
    funding of targeted research subprojects. In its first year, the
    Project quickly developed detailed plans for SMA drug development and
    solicited targeted research subprojects. A September 2004 workshop
    engaged SMA researchers, clinicians, and voluntary health organizations
    on clinical trials. As the Project proceeds, the NINDS is evaluating
    whether the approach might be applied to other disorders. The NINDS
    continues to support teams of researchers focused on developing
    therapies for neurological diseases through several other programs.
    These programs emphasize basic, translational, or clinical research, as
    appropriate to the state of science for each disorder. Examples include
    the Senator Paul D. Wellstone Muscular Dystrophy Cooperative Research
    Centers, the Morris K. Udall Centers of Parkinson's Disease Research,
    the Facilities of Research Excellence in Spinal Cord Injury, and the
    Specialized Programs of Translational Research in Acute Stroke.

                                 BASIC RESEARCH

        Preventing and treating neurological disorders relies on
    understanding the normal workings of the nervous system and what goes
    wrong in disease. The emerging new modalities for combating disease
    highlight this: Stem cells and growth factors arose from fundamental
    studies of nervous system development. Deep brain stimulation, which
    shows promise for Parkinson, dystonia, Tourette syndrome, and other
    diseases, relies upon research techniques developed to monitor the
    activity of single nerve cells in the brain, and on basic knowledge of
    anatomical circuits that control movement. Studies of how the brain
    learns are leading to behavioral therapies that may enhance ``brain
    plasticity'' to repair damage and giving new insights into what causes
    chronic pain, epilepsy, and dystonias. Most current drugs for nervous
    system diseases target molecules identified for their role in normal
    brain function. Gene therapy, new understanding of the molecular basis
    of diseases, diagnostic tests, and animal models for testing therapies
    are among the many fruits of fundamental studies in neurogenetics.
        Basic neuroscience research is continuing to advance rapidly, and
    Roadmap initiatives in areas such as protein structure, computational
    biology, and nanomedicine will help to accelerate that pace. Among the
    many basic neuroscience findings this year are studies that give
    insights into what controls stem cells in the brain and how they might
    be used therapeutically, the role of estrogen in autoimmune disease,
    strategies to transfer therapeutic genes into muscles to treat
    dystrophies, insights into the molecular targets of nicotine, better
    understanding of how genes and experience interact in brain
    development, and a new approach to silencing harmful genes in diseases
    such as Huntington's and spinocerebellar ataxias.

                  THE NIH BLUEPRINT FOR NEUROSCIENCE RESEARCH

        Over the last several years, the NIH Institutes and Centers that
    have an interest in the nervous system have increasingly joined forces,
    driven by advances in neuroscience that have revealed common issues
    that intersect their unique missions. The NIH Blueprint for
    Neuroscience is a framework to enhance that cooperation. Just as the
    NIH Roadmap addresses the roadblocks that hamper progress across all of
    medical science, the NIH Blueprint for Neuroscience takes on challenges
    in neuroscience that are best met collectively. By pooling resources
    and expertise, the 15 NIH Institutes and Centers that make up the
    Blueprint can take advantage of economies of scale, confront challenges
    too large for any single Institute, and develop research tools and
    infrastructure that will serve the entire neuroscience community. The
    Blueprint is developing an initial set of initiatives focused on tools,
    resources, and training that can have a quick and substantial impact
    because each builds on existing programs. These initiatives include an
    inventory of neuroscience tools funded by the NIH and other government
    agencies, enhancement of training in the neurobiology of disease for
    basic neuroscientists, and expansion of ongoing pediatric imaging, gene
    microarray, and gene expression database efforts. For fiscal year 2006,
    Blueprint initiatives focus on genetically engineered mouse strains to
    study the nervous system, neuroscience training programs, and
    specialized ``core'' resources that can be shared across many
    laboratories.
        Thank you, Mr. Chairman. I would be pleased answer questions from
    the Committee.
                                     ______

      Prepared Statement of Dr. Donald A.B. Lindberg, Director, National
                              Library of Medicine

        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2006 President's budget request for the National
    Library of Medicine (NLM). The fiscal year 2006 includes $318,091,000,
    an increase of $2,945,000 over the fiscal year 2005 enacted level of
    $315,146,000 comparable for transfers proposed in the President's
    request.
        In a world that is increasingly digital, the National Library of
    Medicine plays a pivotal role in facilitating research, supporting safe
    and effective health care, and promoting healthy behavior. In addition
    to maintaining the largest physical collection of health science
    literature in the world, the Library builds and makes freely available
    immense databases of scientific information, identifies and organizes
    free Web-based consumer health information produced by the NIH
    institutes and other authoritative sources, and connects all of these
    resources in novel ways that increase their value to scientists, health
    care practitioners, and the general public. Each day, almost a million
    people access the National Library of Medicine's digital resources. By
    making the results of research--from DNA sequences to published
    scientific articles to patient and consumer health information--readily
    available, the Library magnifies the positive impact of NIH's
    investment in the creation of new knowledge.
        The Library is a key player in a number of important NIH and HHS
    initiatives that have current implications for the scientific
    community, health care providers, and the general public. These are
    described later, but briefly they are: the new policy to encourage the
    depositing of peer-reviewed articles supported by NIH grant in an
    archive maintained by the Library; the creation of PubChem, a new
    resource for scientists that is part of the NIH Roadmap Initiative; the
    movement to widen the registration of clinical trials in
    ClinicalTrials.gov, an NIH/NLM database; and the dissemination of
    standard vocabulary for electronic health records and research data
    within NLM's Unified Medical Language System (UMLS).

              INFORMATION FOR SCIENTISTS AND HEALTH PROFESSIONALS

        The Library's services have never been more central to the
    scientific enterprise. No scientist would think of embarking on an
    experiment without a careful review of the literature. Researchers rely
    on NLM databases for this. They search the Medline/PubMed collection of
    15 million journal article records, or perhaps utilize the GenBank
    collection of 40 million DNA sequences and associated molecular data.
    Research articles and biological databases are interlinked through
    NLM's Entrez retrieval system that provides seamless searching of a
    vast information space all from a user's desktop computer.
        The original role of the Library, to provide access to the
    published literature of the health sciences, remains the foundation of
    NLM's services, and the physical collection continues to expand
    steadily. Medline/PubMed is a Web-accessible database that now contains
    more than 15 million references and abstracts to articles in biomedical
    journals from the 1950s to the present. For most of the records now
    being entered, it is possible to link from the reference to the full
    text of the article. More than half a million records, from journals in
    many languages, are added each year. Medline/PubMed is free on the Web
    and in fiscal year 2004 there were 678 million searches done on the
    system.
        PubMedCentral, which was created by NLM's National Center for
    Biotechnology Information (NCBI), is a database that is a key in one of
    the special NIH initiatives mentioned earlier--archiving the full text
    of articles that represent work supported by the NIH. Today's
    technology has led to research that frequently generates an enormous
    amount of data that is associated with the publication of an article.
    To maximize the usefulness of such articles, the full text needs to be
    stored, with ancillary data, and with links to associated resources, in
    a data repository such as PubMedCentral. Under a new NIH policy, peer-
    reviewed research articles are submitted electronically to
    PubMedCentral. There are now more than 350,000 current and
    retrospective articles available free of charge in this archive.
        NLM's NCBI also hosts over 40 databases providing researchers and
    students with easy access to molecular biology information--sequences,
    genome maps, 3-D protein structures, and gene functions. The
    integration of all these data coupled with Web-based analysis tools
    offers a virtual desktop laboratory to the 50,000 researchers and
    students who visit daily over the Internet.
        With the completion of the NIH genome project, an important new
    opportunity to explore the interactions of chemical substances with
    biological systems has opened. The Molecular Libraries component of the
    NIH Roadmap aims to exploit this opportunity by developing chemical
    probes that modulate biological processes. A new database created by
    the NCBI, called PubChem (the second major initiative noted earlier),
    integrates data from a variety of sources to enable researchers to link
    diverse information about chemicals and biological processes. For
    example, PubChem links chemicals to PubMed, so that users may
    investigate the relationship of screening-center results and biological
    activities reported in the biomedical literature. As such, PubChem is a
    research tool for expediting discovery of the biological basis of
    disease and the development of new therapeutic approaches.
        A new information system was introduced by NLM in 2004: the
    Wireless Information System for Emergency Responders (WISER). Available
    for downloading over the Internet, the system uses a hand-held PDA
    device to provide on-the-spot information for emergency personnel who
    first respond to situations where hazardous materials have been
    released into the environment. WISER extracts data from NLM's extensive
    electronic file of peer-reviewed hazardous substances information and
    makes it instantly and conveniently available.

                      INFORMATION SERVICES FOR THE PUBLIC

        The Library was first prompted to create information services for
    the general public in 1997, when it became apparent that consumers were
    in fact using the Medline/PubMed database of the scientific medical
    literature heavily. The following year the NLM Board of Regents
    formally recommended that the Library expand its mandate to include
    serving the public. Since that time, NLM has created a series of highly
    successful Web-based information services aimed at consumers.
        Foremost among these is MedlinePlus.gov. This service, begun in
    1998, has become a much-consulted information resource for the public,
    patients, and their families. Some 6 million people use MedlinePlus
    each month, viewing more than 60 million pages of health information
    written especially for consumers. Much of the data comes from the NIH
    institutes, a reliable source of authoritative health information for
    the public. Other HHS health agencies, professional societies,
    voluntary health agencies, and academic organizations are also sources
    of the information carried on MedlinePlus. Many users come to the site
    for access to extensive information on prescription and over-the-
    counter medications, a medical encyclopedia, directories of physicians
    and hospitals, and ``health tutorials'' on common medical topics and
    procedures.
        With help from the medical library community and from the National
    Institutes of Health, MedlinePlus continues to expand its coverage. A
    ``Go Local'' function has been introduced so that users of MedlinePlus
    can link directly to organizations and agencies in their locality to
    request needed health services. North Carolina and Missouri are now
    connected locally, and more states will soon be joining Go Local.
    Another popular service is MedlinePlus en espanol. This was introduced
    in 2002 and has grown rapidly to reach virtual parity with the English
    version. Both English and Spanish language MedlinePlus scored the
    highest marks of any Federal Web site in a recent evaluation by the
    American Customer Satisfaction Index.
        One popular feature of MedlinePlus is the ability to link from any
    of the health topics to the database, ClinicalTrials.gov. In the past,
    information about clinical research was not readily available to the
    public. Patients typically learned about studies only from their
    doctors. ClinicalTrials.gov, which now contains extensive information
    on more than 12,000 studies, is a one-stop Web site for patients,
    families, and members of the public. Each record includes the locations
    of a study, its design and purpose, criteria for participation, contact
    information, and further information about the disease and intervention
    under study. One of the special NIH initiatives mentioned at the
    beginning of this statement is about the need for a broad registry to
    track all trials and their results. Because ClinicalTrials.gov provides
    an established system for collecting, organizing, and displaying study
    information, expansion of its role is being considered.
        In addition to MedlinePlus and ClinicalTrials.gov, the Library in
    recent years has introduced a number of specialized information
    resources for different segments of the public. NIHSeniorHealth.gov,
    for example, created with the National Institute on Aging, has
    information in a format that is especially usable by seniors on topics
    they are concerned with, such as Alzheimer's, arthritis, hearing loss,
    exercise for older adults, and so forth. There are other information
    resources created by NLM especially for people living with AIDS,
    American Indians, those living in the Arctic, and Asian Americans.
        The public will also find useful NLM databases that contain health
    and safety information about the content of everyday household
    products, consumer information about genetic conditions and the genes
    or chromosomes responsible for those conditions, and the potential
    environmental hazards in ordinary communities (``Tox Town''). The
    newest database of interest to the public is TOXMAP, a system that
    allows the user to specify a chemical, or a location, and to create a
    map that shows the distribution of that chemical in a geographic area.
        The usage of the Library's databases, both those for scientists and
    for the public, continues to climb. NLM pursues a number of outreach
    projects to spread the word that these resources are available to
    everyone, free and without registration. The more than 5,000 member
    institutions of the National Network of Libraries of Medicine are
    valued partners in this endeavor. They hold workshops at public
    libraries and other community organizations, demonstrate NLM databases
    to the public, and exhibit at meetings and conventions on behalf of
    NLM, thus providing the personal element that can be so important to
    reaching populations affected by health disparities. Another special
    outreach project is the ``Information Rx'' program, a collaboration
    with the American College of Physicians (ACP) Foundation. This is a
    project to encourage physicians to make information referrals to
    MedlinePlus. Since patients trust their physicians to recommend good
    health information, the idea is to promote MedlinePlus as the ``Web
    site your doctor prescribes.'' NLM is also now working with the
    American Medical Association Foundation in a similar project for its
    members.

          RESEARCH TO IMPROVE INFORMATION PRODUCTS AND INFRASTRUCTURE

        In addition to the work of the National Center for Biotechnology
    Information, described earlier, NLM also sponsors research and
    development through the Lister Hill National Center for Biomedical
    Communications. This organization conducts advanced communications
    research projects in such areas as high-quality imagery, medical
    language processing, high-speed access to biomedical information,
    developing intelligent database systems, multimedia visualization, data
    mining, and machine-assisted indexing. One prominent area of research
    has been the Visible Human Project. The project consists of two
    enormous (50 gigabytes) data sets, one male and one female, of
    anatomical MRI, CT, and photographic cryosection images. These data
    sets are available through a free license agreement. More than 2,000
    individuals and institutions in 47 countries have licensed the data and
    are using them in a wide range of educational, diagnostic, treatment
    planning, virtual reality, artistic, and industrial applications. An
    ``Insight Toolkit'' makes available a variety of open source image
    processing algorithms for computing segmentation and registration of
    medical data. The Visible Human Web site is one of the most popular of
    NLM's Web offerings.
        Another initiative of the Lister Hill Center is the Scalable
    Information Infrastructure program. Its purpose is to encourage,
    through 3-year research contract awards, the development of health-
    related applications of scalable, network aware, wireless, geographic
    information systems, and identification technologies in a networked
    environment. The initiative focuses on situations that require, or will
    greatly benefit from the application of these technologies in health
    care, medical decision-making, public health, large-scale health
    emergencies, health education, etc.
        The Library has a program of grant assistance for research,
    training and fellowships, medical library assistance, improving access
    to information, and publications. For more than 30 years NLM has
    supported medical informatics research and the training of medical
    informaticians at universities across the nation. NLM funding has been
    instrumental in the development of pioneering electronic health record
    systems now considered models for the nation and for the training of
    generations of leaders in the field of informatics. Today the training
    programs also emphasize opportunities for training in bioinformatics,
    the field of biomedical computing for the large datasets characteristic
    of modern research. At present, NLM provides 18 grants to biomedical
    informatics training at 26 universities, supporting 250 trainees. A new
    initiative to expand the scope of these training programs is a
    collaboration between the NLM and the Robert Wood Johnson Foundation
    that is establishing public health training tracks at several of these
    sites. In this post 9/11 era the sophisticated use of public health
    information--whether for timely detection of disease outbreaks or rapid
    dissemination of information to clinicians and the public in an
    emergency--is a subject of great importance.
        An important contribution of NLM to the infrastructure of medicine
    is the Unified Medical Language System. This project develops and
    distributes multi-purpose electronic ``Knowledge Sources'' and
    associated lexical programs for system developers. The purpose of these
    UMLS databases and programs is to help computer systems behave as if
    they ``understand'' the meaning of the language of biomedicine and
    health. The UMLS Metathesaurus, the heart of the UMLS Knowledge
    Sources, contains more than 1 million concepts and 4.5 million unique
    concept names from more than 100 different biomedical vocabularies and
    classifications, including the three principal clinical vocabulary
    standards: SNOMED CT (Systematized Nomenclature of Medicine-Clinical
    Terms), LOINC (Logical Observation Identifiers, Names, Codes), and the
    RxNorm clinical drug vocabulary. NLM has been instrumental in making
    these standards freely available through U.S.-wide licensing contract
    support, or direct development.
        These resources are especially important to the Federal
    government's plans to achieve always-current, always-available
    electronic health records (EHRs) for most Americans within a decade.
    The lack of common, readily available electronic medical terminology
    standards has been a major obstacle to the widespread deployment and
    effective use of EHRs. NLM is playing an important role in remedying
    this situation with the national licensing of SNOMED CT and its uniform
    distribution with other clinical and administrative standards within
    the UMLS. It is now possible for software vendors, health care
    providers, hospitals, insurance companies, public health departments,
    medical research facilities, and others to incorporate uniform
    terminology into their information systems much more readily. This is
    an important step toward establishing interoperable electronic health
    records that can be made available wherever and whenever patients need
    treatment. In addition to improving the safety and quality of health
    care, standard electronic health data will assist in detecting and
    responding to public health emergencies and provide one of the key
    building blocks for a cost-effective national research infrastructure.
        In summary, the National Library of Medicine has a central part to
    play on today's health care scene. It continues to be a freely
    accessible archive of the world's published biomedical literature and
    collection of genomic data, relied on by scientists and health
    professionals around the world. Millions of people view the Library as
    a source of trusted consumer health information and access the
    MedlinePlus and other NLM resources for the public. And the U.S. health
    care system, as it evolves to take advantage of new information
    technologies, will rely on infrastructure advances made by the NLM in
    the area of standard and widely shared terminology.
        Thank you, Mr. Chairman. I would be pleased to answer any questions
    that the Committee may have.
                                     ______

      Prepared Statement of Elizabeth G. Nabel, M.D., Director, National
                        Heart, Lung, and Blood Institute

        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2006 President's Budget request for the National Heart,
    Lung, and Blood Institute (NHLBI). The fiscal year 2006 budget includes
    $2,951,270,000, an increase of $10,069,000 over the fiscal year 2005
    enacted level of $2,941,201,000 comparable for transfers proposed in
    the President's request. I come to you with pride on behalf of the NIH
    component that is responsible for much of the gain in life expectancy
    that we have enjoyed over the past three decades in the United States,
    as shown in this chart. At the same time, however, I come with deep
    concern because the diseases under NHLBI responsibility still comprise
    three of the four leading causes of death in this country--heart
    disease, stroke, and chronic obstructive pulmonary disease (COPD).
    Clearly, we have come a long way, but we have far to go.

                      A VISION FOR THE FUTURE OF THE NHLBI

        As the NHLBI's first new director in 22 years, I would like to take
    this opportunity to share with the Committee my vision for the
    Institute. This vision is based upon a fundamental set of values--
    excellence, integrity, innovation, respect, and compassion--that will
    permeate all activities in the NHLBI. I believe that scientific
    discovery provides the basis for progress and that the NHLBI is
    uniquely positioned to catalyze changes that must be made to transform
    our new scientific knowledge into tangible benefits for the people of
    this country. Within this framework, let me articulate four themes that
    will guide priority setting of our research agenda.

                              THEME ONE: DISCOVERY

        The first theme--stimulating basic discoveries of the causes of
    diseases--is vital to developing new, critically needed treatments.
    Basic research provides the foundation of the NHLBI portfolio and has
    been one of its great strengths. The typical model of investigation--
    research conducted by single investigators or small groups of
    investigators on projects of their own inspiration--accounts for most
    of the unanticipated and major scientific discoveries in this country.
    I believe strongly that we must protect and nurture investigator-
    initiated research. The NHLBI will continue to invest in the most
    talented scientists conducting the highest caliber research. Innovation
    and creativity using the most advanced biomedical technologies will be
    our goal.
        We have an exciting opportunity to support emerging new scientific
    fields. Major strides are being made in computer sciences,
    bioengineering, material sciences, chemistry, and other areas of study
    that vastly benefit medical research, and the pace of discovery in
    these disciplines should be accelerated. One approach is to develop
    funding mechanisms (e.g., for support of high-risk research) that
    encourage innovative thinkers to turn their attention to the major
    current challenges in heart, lung, and blood diseases.
        Another objective is to generate large, publicly available sets of
    reagents and data that could function as a ``tool kit'' for NHLBI
    investigators. Gene sequences and maps, cell lines, knockouts and
    knockdowns of genes in selected animals, reference sets of proteins,
    protein affinity reagents, and libraries of small molecules are
    examples of resources that will provide our investigators with the
    technologies required for innovative discoveries.

                             THEME TWO: TRANSLATION

        Our second task is to speed translation to clinical applications so
    that people can benefit as quickly as possible from the basic research
    enterprise. Clinical research, and more specifically, translational
    research (``bench to bedside'') are vital to our mission, so that we
    can translate basic discoveries into the reality of better health for
    our country.
        The NHLBI must further develop the infrastructure for clinical
    research so that it serves the evolving field of scientific discovery
    and provides a foundation for evidence-based clinical decision-making.
    Clinical research is critical to ensuring that new products and
    techniques are safe and effective before they are widely applied.
    However, clinical research is often time-consuming and inefficient, and
    is increasingly burdened by regulatory hurdles. Our challenge is to
    expand clinical research to complement the exciting basic science
    discoveries, while making it more efficient and cost-effective.
        We intend to develop a translational research agenda supported by
    clinical trials, clinical networks, and clinical workforce training.
    Key components will focus on increasing interactions between basic and
    clinical investigators and easing the movement of new tools from
    laboratories to clinics. We will build upon our rich experience with
    clinical trials and networks to develop new partnerships among
    organized patient communities, community-based physicians, and academic
    researchers. We will work on improving bioinformatics and clinical
    databases, standards for clinical research protocols, measures of
    clinical outcomes, and quality assessment. Translational research
    requires the expertise of many fields and should include analysis of
    health education, outcomes, health-care delivery, and health-care
    economics. This focus fits well with the Re-engineering the Clinical
    Research Enterprise of the Roadmap.
        The NHLBI must cultivate a cadre of clinical researchers who have
    skills commensurate with the complexity and needs of our research
    enterprise. Clinicians must be trained to work in the
    interdisciplinary, team-oriented environments that characterize today's
    research efforts. We further anticipate that specific training will be
    required in an array of disciplines important to clinical research,
    including genetics, epidemiology, biostatistics, and behavioral
    medicine.
        At the core of this vision is the need to develop new partnerships
    of research with organized patient communities, community-based health
    care providers, and academic researchers. We will rely on our
    partnerships to facilitate the conduct of this clinical research, to
    train our clinical investigators, and most important, to achieve our
    common goals of improved health for the public.

                           THEME THREE: INTERACTIONS

        The third theme is facilitating communication between scientists
    and physicians so that new ideas can be generated, shared, and
    advanced.
        Today's science is far more complex than that of yesteryear.
    Research, whether basic or clinical, is now commonly done by teams of
    scientists wherein each individual brings specific talents and
    expertise to the overall effort. We will stimulate and facilitate the
    conduct of interdisciplinary research, so that advances can be made
    more quickly. Principal-investigator status will be granted not to just
    one investigator, as is the norm, but to all key members of the
    research team. Integrated reviews of grants will take into account the
    melding of various disciplines to address the problem at hand, and
    interdisciplinary teams will be encouraged to evolve in both directed
    and unexpected ways.
        An essential component of our efforts in research collaboration
    will be community-based clinical trials, which enhance the conduct of
    clinical research at academic medical centers. An outstanding example
    is our ALLHAT (Antihypertensive and Lipid-Lowering to Prevent Heart
    Attack Trial), in which physicians from many types of medical
    settings--a total of 623 sites in 47 states, Puerto Rico, the United
    States Virgin Islands, and Canada--successfully enrolled over 42,000
    patients and followed them for 6 years. The physicians participated
    because they believed in the importance of the scientific questions
    being addressed with regard to patient care and because of the direct
    benefits of participation to their patients, including free
    medications. These community-based physicians conducted the trial at
    very high standards--follow up was over 97 percent. As part of our plan
    to disseminate the ALLHAT results, participating community physicians
    are now working with other doctors in their local communities to treat
    patients with high blood pressure.

                           THEME FOUR: COMMUNICATION

        Our fourth task is to effectively communicate our research advances
    to the public to improve understanding of new, promising science.
        The NHLBI has an outstanding history of outreach in the areas of
    high blood pressure, cholesterol, asthma, heart attack, obesity, sleep
    disorders, and women's cardiovascular health, and new efforts are under
    way with respect to COPD and peripheral arterial disease. I
    wholeheartedly support these programs that serve the mission of our
    Institute and the Nation. Education of our patients and the public
    regarding prevention and treatment of heart, lung, blood, and sleep
    disorders is one of my highest priorities.
        We will continue to work collaboratively with our colleagues in the
    DHHS, including the CDC and the FDA, to support prevention and control
    programs. We also have an unprecedented opportunity to build upon our
    partnerships with professional organizations, who have a large stake in
    developing and implementing practice guidelines and monitoring their
    effectiveness, and with patient advocacy groups. One of our most
    gratifying partnership programs has been The Heart Truth, which is
    successfully raising awareness nationwide that heart disease is the
    leading cause of death among American women. The ``reach'' of this
    campaign continues to expand as we forge additional fruitful
    partnerships with entities in the public and private sectors.
        Disparities in health status constitute a significant global issue.
    Research is essential to understand the diverse contributions of
    genetics, health behavior, diet, socioeconomic status, culture, and
    environmental exposures in the genesis of health disparities in heart,
    lung, and blood diseases and to formulate, evaluate, and disseminate
    well-conceived, focused intervention programs. This work will
    necessarily entail a vigorous effort to increase the representation of
    minorities in the ranks of NHLBI researchers. We are also cognizant of
    the need to improve and expand programs to prevent, manage, and treat
    diseases and conditions that disproportionately affect U.S. minority
    and underserved populations, such as cardiovascular disease and asthma,
    and to evaluate the effectiveness of our research, treatment, and
    education programs. A full resolution of the health disparities problem
    will occur only through committed and sustained efforts by many in our
    government, health centers, and society.

                                    SUMMMARY

        The realization of this vision will require the efforts of many. We
    are engaged in a special form of public service, that is, the promotion
    of patient and public health. I will work diligently to preserve public
    trust in the Institute, the NIH, and the biomedical research
    enterprise, and to ensure that the NHLBI serves the public with the
    highest level of integrity. This trust is essential for meeting our
    common goals of making important new scientific discoveries and
    translating them to improve health in this country.
        Thank you, Mr. Chairman. I would be pleased to answer any questions
    that the Committee may have.
                                     ______

     Prepared Statement of Dr. Kenneth Olden, Director, National Institute
                        of Environmental Health Sciences

        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2006 President's budget request for the National
    Institute of Environmental Health Sciences (NIEHS). The fiscal year
    2006 budget includes $647,608,000, an increase of $3,103,000 over the
    fiscal year 2005 enacted level of $644,505,000 comparable for transfers
    proposed in the President's request.

                                  INTRODUCTION

        ``Genetics loads the gun, but environment pulls the trigger.''----
    Judith Stern, University of California, Davis
        The Nation needs better information to promulgate evidence-based
    environmental health regulatory policies and to prevent or cure most
    chronic diseases. This paucity of information has an enormous impact on
    the world's economy, both in terms of costs associated with health care
    and with regulatory compliance. In large measure, this situation exists
    because we still do not understand what role the environment plays in
    human health and disease. The application of knowledge and technologies
    developed through the pursuit of the Human Genome Project offers great
    promise for elucidating mechanisms of gene-environment interactions in
    the development of complex diseases.
        For years, the environment was considered to have a minor role in
    the etiology of human illness. But, in recent years, the thinking has
    shifted in favor of gene-environment interactions. For example, recent
    studies show that no more than one-third of the cancer burden can be
    attributed to the action of genes alone (Verkasala, et al., 1999, Int.
    J. Cancer 83:743-749; Lichlenstein, et al., 2000, NEJM 343:78-85), only
    15 percent of Parkinson's Disease (Tanner et al., 1999, JAMA, 281:341-
    346), and about a third of autoimmune diseases (Powell, et al., 1999,
    Env. Health Pers. 107 (Suppl. 5), 667-672). A more recent study
    reported that 90 percent of individuals with severe heart disease have
    at least one or more of four classic risk factors captured in the
    current definition of the environment (Khat et al., 2003, JAMA 290:899-
    904). Because of these and other findings, it is now generally accepted
    that more informative, cost-effective, high-throughput methods for
    assessing and predicting risk resulting from environmental exposures
    will need to be developed. Otherwise, we will not be able to prevent or
    cure most chronic diseases, and the costs associated with health care
    and environmental regulatory compliancy will continue to escalate.
        Starting in 1997, NIEHS developed several new research initiatives
    to respond to this urgent need. Such programs include: the
    Environmental Genome-Project (Kaiser, 1997, Science 278:569-570; Brown
    and Hartwell, 1998, Nat. Genet. 18:91-93), the National Center for
    Toxicogenomics (Kaiser, 2003, Science 300:563), and the Mouse
    Sequencing Project (Nature 432: 5, 2004). While the results from these
    three initiatives will provide information relevant to most chronic
    diseases, other research programs have been developed to address
    specific diseases such as breast cancer, Parkinson Disease, and autism.
    Today, I will briefly describe several of these initiatives and their
    implications for human health and disease.

         GENETIC DIFFERENCES IN SUSCEPTIBILITY TO DRUGS AND ENVIRONMENT

        Individuals vary, often significantly, in their response to
    environmental agents. This variability provides a high ``background
    noise'' when scientists examine human populations to identify
    environmental links to disease, often masking important environmental
    contributors to disease risk. Fortunately, the Human Genome Project
    created tools that can help identify the genetic variations in
    environmental response genes that can lead to such wide differences in
    disease susceptibility. NIEHS developed the Environmental Genome
    Project (EGP) to catalogue these genetic variants (polymorphisms) and
    to identify the ones that play a role in human susceptibility to
    environmental agents. This information is already being used in
    epidemiological studies to better pinpoint environmental contributors
    to disease. Also, several important variants have been discovered that
    are associated with risk for chronic illnesses such as leukemia,
    cardiovascular disease, and neuronal dysfunction.

                ANIMAL MODELS PREDISPOSED TO ENVIRONMENTAL RISK

        The usefulness of the susceptibility data generated in the EGP is
    enhanced by the availability of animal models with the exact sequence
    variations discovered by resequencing of the human environmental
    response genes. Therefore, NIEHS developed a university-based Mouse
    Genomics Centers Consortium to create mice with such variations and
    provide them to the scientific community. To date, approximately 20
    well-characterized mouse models have been developed. These models
    represent a variety of disease endpoints, including: Werner's syndrome
    (aging disorder), diabetes, mammary cancer, gastrointestinal and
    bladder cancer, prostate cancer, and skin cancer.

                  EFFORT TO IMPROVE RELEVANCE OF ANIMAL MODELS

        Environmental health scientists often use mice to predict how
    environmental agents might affect people. Although mouse studies can
    indicate the potential of an exposure to cause cancer and other
    diseases, there is no way to precisely extrapolate these study results
    to the risk in humans. Information on the similarities and differences
    in homologous genes between human and mouse is important to improve
    accuracy in predicting human risk. While laboratory mice might look
    alike, the 100 different strains used in medical research differ
    significantly in their behavior, physiology and susceptibility to drugs
    and environmental agents (e.g., carcinogens), and scientists are eager
    to discover the differences in the genetic sequences that underlie
    these traits, with the goal of finding counterparts in humans. NIEHS
    initiated a mouse sequencing project to decipher the genomes of the 15
    mouse strains used most frequently in research to predict human risk.
    Such data will improve environmental risk assessment decisions and will
    help researchers in choosing the most appropriate strain for studying
    toxicity.

                         SISTER STUDY OF BREAST CANCER

        A unique study exploring gene-environment interactions in breast
    cancer development has begun nationwide recruitment. It will look at
    how genes, activities of daily life, and environmental exposures affect
    breast cancer risk. To get the information quickly, this study is
    recruiting 50,000 symptom-free women who have a sister that had breast
    cancer. These women are at increased risk of breast cancer, share many
    genes with their affected sibling, and would have experienced many of
    the same exposures. For these reasons, it is expected that a sufficient
    number of women will develop breast cancer within 10 years and their
    genes and exposures can be compared with those of women in the study
    who did not develop the cancer. A broad range of exposures will be
    examined, including personal care and household products, workplace
    exposures, and dietary factors, along with genetic analysis. The
    principal investigator has the active support of the American Cancer
    Society, Sisters Network, Inc., the Susan G. Komen Breast Cancer
    Foundation, and the Y-ME Breast Cancer Organization.

                              PARKINSON'S DISEASE

        A major impediment in Parkinson's Disease (PD) research has been
    the lack of rapid communication between epidemiologists, laboratory
    researchers, and clinicians which prevents the type of
    multidisciplinary approach this field needs. To encourage advances in
    this important area of study, NIEHS developed a multidisciplinary
    Collaborative Centers Program for Parkinson's Disease Environmental
    Research. This multi-institutional approach is designed to accelerate
    the identification of genetic and environmental factors leading to PD.
    Collectively, the three centers have expertise in basic neurosciences,
    human genetics, clinical research, and epidemiology, as well as long-
    standing interactions with patient groups. Accomplishments to date
    include: efforts to discover new PD susceptibility genes; development
    of a registry in California to track the disease; development of mouse
    models with specific alterations in genes suspected of playing a role
    in PD, and efforts to develop a primate model of PD that exhibits the
    most prominent clinical features of the disease.

                                     AUTISM

        Autism is a devastating behavioral disorder that most likely arises
    from underlying genetic susceptibilities interacting with specific
    environmental exposures during pre- or post-natal development. A number
    of people have suspected that the mercury-containing compound
    thimerosal, used to preserve childhood vaccines, could be an
    environmental trigger for autism development, based on the established
    neurotoxicity of higher doses of mercury. Extensive epidemiological
    studies, however, have failed to provide any association between
    vaccines and autism. It is possible, however, that only a subset of
    children are susceptible to mercury effects, perhaps when coupled with
    an immunological challenge. Preliminary animal studies have provided an
    intriguing clue to possible susceptibilities that NIEHS is now
    pursuing. In these studies, different mouse strains were exposed to
    thimerosal at ages and doses that corresponded to the standard protocol
    for childhood vaccinations. Only the immunologically deficient strain
    of mouse exhibited a response. In these mice, behavioral effects were
    reported and morphological changes were observed in the brain. However,
    this study did not have sufficient power to be definitive. Fortunately,
    the NIEHS already had two Children's Environmental Health and Disease
    Prevention Research Centers devoted to autism. Thus, the Institute
    provided a supplement to one of these Centers to do more extensive
    testing of thimerosal in autoimmune-prone (SJL) mice. This Center has
    expertise in evaluating critical social behaviors, as well as the
    ability to conduct state-of-the-art stereology to measure brain effects
    such as volume changes and changes in cell number occur. This more
    extensive look at thimerosal-immune co-contributors to brain damage may
    provide better insight into this disorder than previous studies have.
    In addition, the same Center is recruiting a cohort of 700 autistic
    children, and appropriate control subjects, to further examine the role
    of gene-environment interactions in the etiology of autism.

                       OBESITY AND THE BUILT ENVIRONMENT

        Obesity is a major contributor to human disease and rising health
    care costs. NIEHS is collaborating with the Robert Wood Johnson
    Foundation to examine how community design influences physical
    activity. This so-called Active Living Design Program is working with
    local governments to influence city planning and land use decisions.
    The program's impact on physical activity, obesity, and other health
    indicators will be assessed. The Institute is also encouraging research
    to evaluate the role of ``in utero,'' neonatal, and pre-puberty
    exposures to environmental estrogens and other compounds in the onset
    and development of obesity, as well as examining gene-environment
    interactions that favor weight gain.

                                 NANOTECHNOLOGY

        Nanotechnology is an exciting area of research with broad
    implications for multiple industries, including medicine and
    communication. For example, nanoscale devices have the potential to
    deliver therapeutic and imaging agents to specific cells and tissues in
    ways not presently possible. However, when bulk material is converted
    to ultrafine nanoparticles, its physical, chemical, and biological
    properties can be altered in ways that might adversely affect health.
    So, while many laboratories are focused on exploiting the rich
    potential of these agents, there is little activity to assess their
    toxicological properties. NIEHS, under the auspices of the National
    Toxicology Program (NTP), has initiated a program to evaluate the
    toxicological properties of the major classes of nanoscale materials
    and will investigate fundamental questions such as: How are nanoscale
    materials absorbed, distributed in the body, and taken up by cells? Are
    there novel toxicological interactions? What are the appropriate
    detection and quantification methods for nanoscale particles?

                 NIH ROADMAP AND ENVIRONMENTAL HEALTH RESEARCH

        The ability to investigate and understand issues in environmental
    health requires collaboration between many scientific disciplines:
    epidemiology, toxicology, molecular biology, clinical sciences, and
    many others. Thus, Roadmap initiatives such as the Interdisciplinary
    Research Planning Centers will greatly enhance NIEHS' work. Examples
    include: the use of geographic/spatial methodologies to address
    combined genetic, social, and environmental factors on child health and
    development, and an effort to redefine computational genomics with
    emphasis on gene-environment interactions in alcoholism,
    atherosclerosis and breast cancer. Both projects have strong ties to
    other significant NIEHS-funded programs at the same institutions.
        Thank you for the opportunity to comment on the important work
    supported by the NIEHS. I will be happy to answer any questions you
    might have.
                                     ______

      Prepared Statement of Dr. John Ruffin, Director, National Center on
                     Minority Health and Health Disparities

        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2006 President's budget request for the National Center
    on Minority Health and Health Disparities (NCMHD). The fiscal year 2006
    budget includes $197,379,000, an increase of $1,220,000 over the fiscal
    year 2005 enacted level of $196,159,000 comparable for transfers
    proposed in the President's request.
        The NCMHD has just entered its fourth year of operation. Much has
    been accomplished during this time. However, much remains to be done.
    Racial and ethnic minorities and other health disparity populations
    continue to suffer a disproportionate burden of illness, disability and
    premature death. Health disparities cover a broad spectrum of health
    conditions and diseases that include cancer, mental illness, infectious
    diseases, autoimmune diseases, endocrine diseases, vascular diseases,
    infant mortality, diabetes, HIV/AIDS, obesity and nutritional
    deficiencies. There are many factors that contribute to health
    disparities such as genes, biology, culture, race, environment,
    socioeconomics, and health behavior. Due to the interaction of these
    complex factors, the elimination of health disparities requires a
    multifaceted approach.

                     NIH HEALTH DISPARITIES STRATEGIC PLAN

        The Congress has charged the NCMHD to lead the Federal effort in
    health disparities research, research capacity building, and outreach.
    The NCMHD guides the NIH efforts in collaboration with NIH Director,
    the other NIH Institutes and Centers, and the NCMHD's Advisory Council
    in revising the NIH Health Disparities Strategic Plan annually. The
    plan represents the trans-NIH health disparities vision and strategy to
    eliminate health disparities through research, research infrastructure,
    capacity building, and community outreach.
        The NIH Institutes and Centers (ICs) are committed to educating
    minority patient populations on disease management and quality care.
    Several of the ICs plan to increase the number of culturally relevant
    health educational materials and to develop and expand linkages with
    minority organizations and professional societies to increase
    dissemination of research advances to minority-serving institutions,
    and racial and ethnic minority and health disparity communities. For
    example, the National Institute of Allergy and Infectious Diseases
    (NIAID) will produce a series of low-literacy fact sheets on sexually
    transmitted infections, HIV/AIDS, and tuberculosis. The NINDS expanded
    its health education program, Know Stroke. Know the Signs. Act in
    Time., to populations at high risk for stroke--African Americans,
    Hispanics, and seniors--in communities that have the health care
    systems in place to treat them. The National Center for Complementary
    and Alternative Medicine (NCCAM) will employ multimedia technology,
    such as web chats, teleconferences, and minority-focused media to
    disseminate information about complementary and alternative medicine.
        The National Cancer Institute (NCI) is achieving significant
    progress toward understanding and addressing the needs of the Hawaiian
    and Pacific Basin populations through a five-year cooperative agreement
    with Papa Ola Lokahi, a Native Hawaiian owned-and-operated community-
    based health organization. Through this agreement, the NCI funds a
    variety of culturally competent cancer awareness, research, and
    training activities.
        The National Heart, Lung and Blood Institute (NHLBI) is initiating
    a new program to address the substantial and growing burden of
    Cardiovascular Disease (CVD) in American Indians and Alaska natives.
    This initiative will develop and test culturally appropriate
    interventions to promote the adoption of lifestyles and behaviors that
    are known to reduce biological and CVD risk factors, such as high blood
    pressure and cholesterol levels, obesity, glucose intolerance, and
    diabetes.

                        NCMHD HEALTH DISPARITIES IMPACT

        In addition to developing the NIH Strategic Plan, the NCMHD has
    focused attention on the pressing need to establish its programs. The
    national reach of the NCMHD extends to more than 100 institutions and
    more than 500 individuals that have received awards to train for health
    professions careers, conduct health disparities research, build
    research capacity and advance outreach efforts.
        The NCMHD Health Disparities Centers of Excellence (Project EXPORT)
    program currently funds seventy-one institutions in 29 states engaged
    in multidisciplinary research. Priority research focus areas include
    cancer, cardiovascular disease, stroke, diabetes and the health of
    mothers and their infants.
        Communities nationwide in states such as Alabama, New York,
    Pittsburgh, Montana and Hawaii are being encouraged and equipped for
    participation in clinical studies and for partnering in the conduct of
    evidence-based disease prevention and intervention activities. The
    Clemson University-Voorhees College Project EXPORT partnership has
    three studies focused on obesity. Using a network of community-based
    partners, each study examines diet and/or physical activity levels of
    rural residents or students. The objectives of the studies are to
    identify the socio-cultural factors influencing choices and determine
    how environmental effects and knowledge of nutrition and physical
    activity impact choices about diet and exercise.
        Culturally competent health care is an essential component in
    defeating health disparities and requires a distinct sense of urgency.
    In a recent study on cultural competence among physicians treating
    Mexican Americans who have diabetes, supported by a NCMHD-Center of
    Excellence, scientists determined that physicians can increase cultural
    competence and effective care by becoming self-aware of their
    knowledge, views, and attitudes about cultures and ethnic groups, and
    by engaging in culture-focused educational activities. Recognizing that
    culturally appropriate actions can be predicted, based on a provider's
    awareness that culture is relevant to medical care and that negative
    preconceptions can hinder the effectiveness of health care delivery, is
    an important finding for improving cultural competence and reducing
    health disparities.
        The NCMHD Research Endowment Program, unique within the NIH, is
    best described as inclusive and diverse. Fourteen institutions receive
    NCMHD endowment funds to enhance research capacity and infrastructure
    for research and training. The activities of the institutions involve
    strengthening teaching programs in the biomedical and behavioral
    sciences; establishing endowed chairs and programs; obtaining state-of-
    the-art equipment for instruction and research; and enhancing the
    recruitment and retention of student and faculty from health disparity
    populations. A NCMHD Endowment Program award to the University of
    Kansas has enabled the university to develop a K-12 pipeline to recruit
    students through summer programs; retain and graduate 95 percent of
    underrepresented minority medical students; increase underrepresented
    minority faculty members from 24 to 39; and provide opportunities for
    48 underrepresented minority students to participate in health
    disparity research over the summer.
        The NCMHD supports two loan repayment programs--the Health
    Disparities Research Loan Repayment Program (HDR) and the Extramural
    Clinical Research Loan Repayment Program for Individuals from
    Disadvantaged Backgrounds (ECR), to promote a diverse and strong
    scientific workforce by alleviating the financial barriers that often
    discourage many talented health professionals from health disparity,
    medically underserved and disadvantaged communities from pursuing a
    research career.
        The NCMHD funds are supporting the deployment of 466 emergent
    researchers to 42 states and the District of Columbia to conduct health
    disparities research. These programs are the foundation for developing
    a lasting relationship with talented and committed health disparities
    scholars. Fifty-six percent of the awardees in the HDR program are
    members of a health disparity population. The loan repayment programs
    exemplify the multidisciplinary approach needed to address health
    disparities. For example, epidemiology, pharmacology, linguistics,
    etiology, ethnography, health policy, and behavioral science are among
    the program's research disciplines. Research includes: identifying
    barriers to health care access; race and long-term diabetes self
    management in an HMO; a comparison of androgen receptor for
    polymorphism in African American and Caucasian women with breast
    cancer; and reducing HIV/STI risk in young adult minority populations.
        The number of participating institutions in the Research
    Infrastructure in Minority Institutions (RIMI) Program has tripled
    since 2001. Program accomplishments include faculty seminar series on
    health disparities research; research on the health and developmental
    impact of methamphetamine production in New Mexico children, and the
    establishment of a Natural Toxins Research Center. The NCMHD will
    continue to build upon the RIMI program by exploring partnerships among
    tribal colleges, community/junior colleges, and non-research intensive
    four-year institutions with major research-intensive colleges and
    universities.
        The Minority Health and Health Disparities International Research
    Training Program (MHIRT) positions the NCMHD in collaboration with the
    NIH Fogarty International Center, to extend its health disparities
    research and training capacity across borders. The MHIRT program
    enables students and faculty from health disparity populations to
    participate in international research training opportunities in
    countries such as South Africa, Sweden, Italy, Mexico, Bulgaria,
    Thailand, Trinidad, China, Australia, Brazil, and Senegal. Research
    efforts include cancer epidemiology, reproductive biology,
    parasitology, malaria, ethnopharmacology and neurobiology.

              COMMUNITY-BASED PARTICIPATORY RESEARCH AND OUTREACH

        The NCMHD recently established an Office of Community-Based
    Participatory Research and Outreach, and launched a new program that
    will support collaborative partnerships between academic institutions
    and community-based organizations for research studies looking at the
    interface of physical and psychological environments and their health
    impacts on communities of color and the medically underserved;
    methodology research looking at effective methods of measuring racism
    and community level outcomes; evaluation of outcomes; and impact of the
    research. This program will build on the NCMHD existing community-based
    research and outreach initiatives through its Project EXPORT program.

                        FEDERAL RESEARCH COLLABORATIONS

        In addition to its core programs, the NCMHD has continued to fund a
    broad range of collaborations with the other NIH Institutes and
    Centers, the Department of Health and Human Services, and other Federal
    agencies. Recently, the NCMHD launched a new initiative to support
    research relevant to the Mississippi Delta Region and its medically
    underserved populations. This endeavor involved the collaboration of
    eight NIH Institutes and Centers with the NCMHD supporting
    approximately $8 million in research projects.

                                   CONCLUSION

        Working with our many research partners, the top priority of the
    NCMHD is to build a solid and diverse national biomedical research
    enterprise of individuals, institutions, and communities dedicated to
    eliminating health disparities. The NCMHD will sustain and expand its
    primary strategies. Research capacity building will extend beyond
    academia to involve community and faith-based organizations,
    individuals, and business at local and grassroots levels. Training and
    the diversification of the health, scientific, and technological
    workforce will remain key areas of focus in developing innovative
    projects. Prevention, treatment, cultural competency, and health care
    delivery for urban and rural communities will be approached more
    aggressively. We will continue to strive for an America in which all
    populations will have an equal opportunity to live long, healthy, and
    productive lives.
                                     ______

        Prepared Statement of Dr. Paul Sieving, Director, National Eye
                                   Institute

        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2006 President's budget request for the National Eye
    Institute (NEI). This budget includes $673,491,000, an increase of
    $4,421,000 over the fiscal year 2005 enacted level of $669,070,000
    million comparable for transfers proposed in the President's request.
    As the Director of the NEI it is my privilege to report on the progress
    laboratory and clinical scientists are making in combating blindness
    and visual impairment and about the unique opportunities that exist in
    the field of vision research.

                        GLAUCOMA AND OPTIC NEUROPATHIES

        Glaucoma is a group of eye disorders that causes optic nerve damage
    that can lead to severe visual impairment or blindness. Elevated
    intraocular pressure (IOP) is frequently, but not always, associated
    with glaucoma. Glaucoma is a major public health problem and published
    studies find it is the most common cause of visual impairment and
    blindness in African Americans.
        The prevalence of glaucoma is three times higher in African
    Americans than in non-Hispanic whites.\1\ Additionally, the risk of
    visual impairment is much higher and the age of onset is earlier than
    in Whites. An NEI-supported follow-up study to the Ocular Hypertension
    Treatment Study (OHTS) found that early treatment of elevated IOP
    reduces the risk of developing glaucoma in African Americans. Of the
    participants in the treatment arm of the study, 8.4 percent developed
    glaucoma whereas 16.1 percent in the observation group developed the
    disease. Additionally, the OHTS follow-up study found that certain
    biological characteristics of the eye including corneal thickness are
    helpful in predicting who will likely develop glaucoma and who will
    benefit from therapy. This study provides important treatment and
    prognostic information for clinicians in caring for this at risk
    population.
    ---------------------------------------------------------------------------
        \1\ The Eye Diseases Prevalence Research Group: Prevalence of open-
    angle glaucoma among adults in the United States. Arch Ophthalmol
    122:532-538, 2004.
    ---------------------------------------------------------------------------
                                RETINAL DISEASES

        Retinal diseases are a diverse set of sight-threatening conditions
    that include age-related macular degeneration, diabetic retinopathy,
    retinopathy of prematurity, retinitis pigmentosa, Usher's syndrome,
    ocular albinism, retinal detachment, uveitis (inflammation) and cancer
    (choroidal melanoma and retinoblastoma). This year, NEI supported
    laboratory researchers made great strides in developing therapies for
    these diseases. For example, a recent NEI study found that eye
    injections of bone marrow stem cells from adult animals prevented
    vision loss in two rodent models of retinitis pigmentosa (RP). These
    findings raise the possibility of a therapy in which patients could
    receive an injection of their own bone marrow stem cells to preserve
    vitally important central vision.
        Age-related macular degeneration (AMD) is a leading cause of
    blindness and visual disability in older age Americans. The inability
    to prevent the development of AMD and its complications is largely due
    to an imprecise understanding of the pathologic mechanisms of the
    disease. Genetic and environmental factors have previously been
    implicated in the disease. A recent NEI supported study in animal
    models has found evidence that inflammation may also play a role. These
    animal models suggest that the immune system contributes to the disease
    and offer new insights into possible mechanisms of the disease. The
    availability of animal models of the disease will also allow for the
    testing of new intervention strategies.

                                CORNEAL DISEASES

        The cornea is the transparent tissue at the front of the eye.
    Corneal disease and injuries are the leading cause of visits to eye
    care professionals, and are some of the most painful ocular disorders.
        The epithelial cells of the cornea form a surface barrier that
    protects the underlying tissues from the external environment. When
    this layer is damaged, the epithelial cells normally respond quickly to
    close the wound and reform the barrier. In some cases, however, this
    response is defective, leading to the formation of persistent and
    painful corneal ulcers. Development of more effective treatments for
    this condition has been hampered by the limited information about the
    cellular and biochemical events that regulate corneal wound closure.
    This year, scientists at the NEI discovered that an enzyme called Cdk5
    plays a central role in regulating the migration of epithelial cells to
    close corneal wounds. More importantly they discovered that drugs which
    inhibit Cdk5 promote cell migration and wound closure. These findings
    suggest a new therapeutic approach for treating persistent corneal
    ulcers and other conditions that impair wound healing. Animal studies
    are in progress to determine whether inhibitors of Cdk5 can safely be
    used in the eye to enhance wound healing.

                                    CATARACT

        Cataract, an opacity of the lens of the eye, interferes with vision
    and is the leading cause of blindness in developing countries. It is
    also a major public health problem in this country. Throughout life,
    the lens carries out a process of continued growth with epithelial
    cells dividing and differentiating into fiber cells. As epithelial
    cells differentiate into fiber cells they become denuded of certain
    cell components so they will not interfere with vision or cause
    cataracts. NEI supported scientists have recently discovered that the
    epithelial cells ``borrow'' enzymes involved in programmed cell death,
    or apoptosis, to mediate the destruction of these cell parts. Apoptosis
    is a normal biologic process that guides an orderly destruction of
    cells that are no longer functional or needed. This study defines a
    critical step in how fiber cells are formed and will spark further
    investigation into whether alterations in apoptotic enzymes play a role
    in cataract formation.

                  STRABISMUS, AMBLYOPIA AND VISUAL PROCESSING

        Developmental disorders such as strabismus (misalignment of the
    eyes) and amblyopia (commonly known as ``lazy eye'') are among the most
    common eye conditions that affect the vision of children. In addition,
    published data estimates that more than 3 million Americans suffer from
    visual processing disorders not correctable by glasses or contact
    lenses.
        It is estimated that 20 percent of preschool children ages 3-4 have
    a treatable eye condition.\2\ While many states are developing
    guidelines for preschool screening programs, none of the commonly used
    vision tests have been evaluated in a research-based environment to
    establish their effectiveness. Initial results from the NEI-sponsored
    Vision in Preschoolers (VIP) Study found that 11 commonly used
    screening tests vary widely in identifying children with symptoms of
    common childhood eye conditions such as amblyopia, strabismus, and
    significant refractive error. When the best tests are used by highly
    skilled personnel in a controlled setting, approximately two-thirds of
    children with one or more of the targeted disorders were identified.
    These better tests were able to detect 90 percent of children with the
    most severe visual impairments. The ongoing VIP study will continue to
    provide state and local agencies with data to select the most effective
    vision screening exams that are currently available. The VIP study will
    also help ensure that more children are detected and treated at an
    early stage when therapy is most effective.
    ---------------------------------------------------------------------------
        \2\ Comparison of preschool vision screening tests as administered
    by licensed eye care professionals in the Vision in Preschoolers Study.
    Ophthalmology 111(4): 637-50, 2004.
    ---------------------------------------------------------------------------
        A fundamental issue in neuroscience has been the inability of nerve
    cells to regenerate. If researchers could develop therapies that
    overcome this limitation, the deleterious effects of many neurologic
    diseases and central nervous system (CNS) injuries might be reversed or
    greatly improved. NEI-supported researchers provoked nerve cell
    regeneration in rodents by activating a nerve cell's natural growth
    capacity and using gene therapy to suppress the effects of growth-
    inhibiting factors. Although vision was not restored, this combined
    approach stimulated nerve cell regeneration three times greater than
    prior attempts. Regeneration of the mature CNS would provide an
    opportunity to treat blindness and other neurologic diseases.

                               HEALTH DISPARITIES

        Census 2000 data indicate that 12.5 percent of residents in the
    United States, or 35 million people, are Latino. Based on these data,
    it is estimated that by the year 2025, 61.4 million Latinos will live
    in this country, making this the fastest growing minority population.
    However, there is little available data to ascertain the prevalence and
    severity of major eye diseases in this population. Results from the
    NEI-sponsored Los Angeles Latino Eye Study (LALES) suggest that Latinos
    have some of the highest rates of visual impairment and blindness in
    the United States. The prevalence of visual impairment and blindness in
    Hispanics increased with age and women were more frequently affected
    than men. From a socio-economic perspective, Latinos who were
    unemployed, divorced or widowed, or less educated had increased rates
    of visual impairment and blindness. The prevalence statistics, coupled
    with the socio-economic data from LALES concerning the factors that
    negatively influence access to health care, will aid the NEI, through
    its public education programs, to devise strategies that better target
    these at-risk populations.

                                  NIH ROADMAP

        A major theme of the NIH Roadmap, Re-engineering the Clinical
    Research Enterprise, is aimed at accelerating and strengthening the
    clinical research process. This Roadmap theme is consonant with the
    NEI's own goal of supporting the highest quality clinical research. The
    NEI and vision research community have anticipated these opportunities
    by creating networks such as the Pediatric Eye Disease Investigator
    Group (PEDIG) and the newly launched Diabetic Retinopathy Clinical
    Research Network. Continuation and expansion of these initiatives
    should facilitate and hasten the translation of research discoveries
    from the laboratory to the clinic for the benefit of those afflicted
    with a range of eye disorders and diseases.

                           NIH NEUROSCIENCE BLUEPRINT

        The NIH Neuroscience Blueprint was launched in 2004 to further
    enhance cooperation among 15 NIH Institutes and Centers that support
    research on the nervous system. Blueprint participants are developing
    an initial set of initiatives focused on tools, resources, and training
    that can have a quick and substantial impact because each builds on
    existing programs. Among the Blueprint initiatives for fiscal year
    2006, NEI will participate in the systematic development of genetically
    engineered mouse strains for research on the nervous system and
    training in neuroimaging and computational biology. NEI will also
    participate with other Institutes in an initiative to provide
    specialized neuroscience resources such as animal model, imaging, gene
    sequencing and screening facilities.
        Mr. Chairman, this concludes my prepared statement. I would be
    pleased to respond to any questions you or other members of the
    committee may have.
                                     ______

        Prepared Statement of Dr. Allen M. Spiegel, Director, National
            Institute of Diabetes and Digestive and Kidney Diseases

        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2006 President's budget request for the National
    Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) a sum
    of $1,872,146,000, which includes $150,000,000 for the Special
    Appropriation for Research on Type 1 Diabetes through Sec. 330B of the
    Public Health Service Act. The NIDDK transfers some of these funds to
    other institutes of the NIH and to the Centers for Disease Control and
    Prevention (CDC). Adjusted for mandatory funds, this is an increase of
    $8,562,000 over the fiscal year 2005 enacted level of $1,863,584,000
    comparable for transfers proposed in the President's request.
        I appreciate the opportunity to testify on behalf of the NIDDK. Our
    Institute supports research to combat a wide range of debilitating
    chronic health problems, including diabetes and other endocrine and
    metabolic diseases; digestive diseases; kidney and urologic diseases;
    blood diseases; and obesity. Through vigorous support of investigator-
    initiated research and Institute-initiated efforts, the NIDDK will
    continue to elucidate the fundamental biology underlying health and
    disease and to explore new strategies for disease diagnosis, treatment,
    and ultimately, prevention.

               FROM THE LABORATORY BENCH TO THE PATIENT'S BEDSIDE

        In recent years, ever-advancing technologies have led to an
    explosion of biomedical knowledge. It is imperative that scientists
    harness new discoveries to improve medical care. Thus, in addition to
    supporting critical basic and clinical research, the NIDDK is also
    bolstering ``translational'' research, to accelerate the progression of
    scientific discovery from basic to clinical studies to directly benefit
    patients. In one stage of translational research, insights gained at
    the laboratory ``bench'' spur the design of new strategies for
    prevention or intervention, which investigators then test in clinical
    studies--at the patient ``bedside.'' In a second stage of translational
    research, investigators explore ways to bring successful interventions
    and lifesaving knowledge from the clinical research setting into the
    realm of healthcare practice.
        With the goal of directing NIDDK translational research investments
    to enhance efforts on multiple diseases, I established a Trans-NIDDK
    Translational Research Working Group to identify research obstacles and
    opportunities. The Working Group charted the progression from basic to
    clinical research to medical practice for a number of health conditions
    to identify common themes for future research. These analyses were
    considered by NIDDK's National Advisory Council; external advice was
    also received at other scientific meetings.
        By way of example, translational research relating to the
    assessment of blood sugar (glucose) levels has greatly benefited
    diabetes care. Scientists discovered that levels of a variant of the
    red blood cell protein hemoglobin, called hemoglobin A1c (HbA1c),
    correlate with blood sugar levels. In the 1990s, a landmark NIDDK-
    supported clinical trial demonstrated that people with type 1 diabetes
    can reduce the risk of eye, kidney, and nerve complications by lowering
    their HbA1c levels through intensive treatment of blood sugar. As a
    result of this research, target levels for HbA1c were set, thus
    improving patient care by encouraging medical practitioners to use a
    combination of methods to better control blood sugar. This research
    further led to the FDA's acceptance of the HbA1c level as an end-point
    sufficiently robust to define clinical benefit in clinical trials.
    ``Biomarkers,'' such as the level of HbA1c, can facilitate clinical
    trials and thus stimulate the development of new therapeutic agents.
    Many new drugs for diabetes have now been FDA-approved based on HbA1c
    as an outcome.
        In another example of successful bench-to-bedside research, NIDDK-
    supported investigators elucidated the biological defect responsible
    for the devastating inherited metabolic disease, MPS I; discovered a
    naturally-occurring dog model for the disease; and tested a potential
    therapy in dogs. Following clinical testing, this therapeutic agent is
    now produced by industry and available on the market to treat this
    disease. These two examples illustrate the critical role of NIH
    investment in research from bench-to-bedside. Both also spanned several
    decades from the initial basic research discoveries to clinical
    application. Thus, a critical goal of NIDDK's new translational
    research efforts is to accelerate this process.
        In one planned translational research effort, the NIDDK will pursue
    the development of new biomarkers. Examples of diseases or conditions
    for which such biomarkers would be valuable include acute kidney
    failure, liver and kidney fibrosis, type 1 diabetes, and insulin
    resistance--which is associated with type 2 diabetes. The NIDDK will
    also foster research on biomarkers for interstitial cystitis, including
    the evaluation of a potential diagnostic marker that emerged from prior
    NIDDK-funded research.
        Among other translational research efforts, the NIDDK will
    strengthen research to bring new non-invasive imaging techniques from
    the laboratory to the clinical setting to enhance clinical research on
    liver, pancreatic, kidney, and urologic diseases. The Institute will
    also encourage the development of new animal models suitable for
    preclinical testing of diagnostic, preventive, or therapeutic
    interventions for diseases within NIDDK's mission. Although a wealth of
    information about human biology has been and continues to be gleaned
    from studies of mice and other animals, in many cases existing animal
    models are insufficient for preclinical testing. Other translational
    research efforts are capitalizing on fundamental knowledge about how
    proteins assume their proper structures. This approach, informed by a
    recent NIDDK-sponsored conference, will help propel the search for
    therapies for cystic fibrosis and certain liver and kidney diseases,
    which are caused by defects in protein ``folding'' or ``processing.''
    Translational research promoted by the NIH Roadmap will synergize with
    these NIDDK efforts to accelerate progress.
        Insights gained from clinical observations can open new avenues for
    basic research studies, which, in turn, will spur new clinical research
    endeavors. Several NIDDK initiatives are fostering increased
    collaboration between basic and clinical researchers, including support
    for ancillary studies to major ongoing NIDDK clinical trials. Such
    studies will also maximize the Institute's investment in these trials.
    As part of our new efforts to enhance our research centers programs,
    the NIDDK will encourage basic and clinical research partnerships to
    take advantage of the opportunities of research centers.
        In addition to the bench-to-bedside research just described, the
    NIDDK is pursuing strategies to best translate successful clinical
    research results from patient study volunteers to the public. These
    efforts include, for example, translating the results of the Diabetes
    Prevention Program (DPP) clinical trial, which demonstrated that people
    at high risk for type 2 diabetes can dramatically reduce risk of
    disease onset through modest weight loss and exercise. To promote these
    positive findings, the NIDDK launched its campaign, ``Small Steps. Big
    Rewards. Prevent Type 2 Diabetes,'' with tailored messages and
    materials developed for ethnic groups at high risk for type 2 diabetes,
    older adults, and a general audience. In parallel, the Institute is
    supporting research demonstration and dissemination projects to explore
    new strategies for effectively translating the DPP results, from
    clinical trial to community. This research includes testing programs
    that target different age groups and minority populations.
        New translation efforts to combat kidney disease are building upon
    the recent finding that even modestly-impaired kidney function
    increases risk of cardiovascular disease and premature death. Avoiding
    these devastating outcomes requires early awareness of kidney disease
    and appropriate treatment. Critically important is detection of
    deterioration in the kidneys' filtering capacity, the glomerular
    filtration rate (GFR). While GFR is difficult to measure directly, it
    can be estimated from routinely measured serum creatinine. The NIDDK's
    National Kidney Disease Education Program (NKDEP) is thus encouraging
    laboratories that measure serum creatinine to provide clinicians with
    GFR values. The NKDEP recently launched an education campaign
    emphasizing the importance of early detection and treatment, and
    targeting this message to primary care providers and those at high risk
    for kidney disease.

              EXAMPLES OF BASIC AND CLINICAL RESEARCH ENHANCEMENTS

        Underscoring a growing health crisis among our Nation's children,
    this past year an NIDDK-supported pilot study of middle school students
    uncovered high levels of the ``metabolic syndrome,'' which is a cluster
    of health problems associated with obesity and increased risk for
    diabetes and cardiovascular disease. To address the health threats
    posed by obesity, we developed and published a Strategic Plan for NIH
    Obesity Research. Informed by extensive input from scientific and lay
    experts, the Strategic Plan was developed by the NIH Obesity Research
    Task Force. Since its inception by the NIH Director, I have had the
    privilege of co-chairing the Task Force with the NHLBI Director, with
    the aims of synergizing and accelerating obesity research across the
    NIH. Consistent with the goals of the Strategic Plan, the NIDDK is
    pursuing a multifaceted obesity research agenda, from basic molecular
    investigations to novel intervention studies to translational research.
    For example, the NIDDK is spearheading a new trans-NIH initiative to
    study how factors such as maternal weight during pregnancy can lead to
    obesity in offspring. This research has important implications for
    public health.
        In the area of digestive diseases, the Action Plan for Liver
    Disease Research has now been published. It was developed through
    NIDDK-led efforts with broad external input from the research,
    professional, and patient-advocacy communities. Examples of the many
    areas addressed by the Action Plan include developing or improving
    therapies for hepatitis C; developing tools for early liver cancer
    detection; and research on living donor liver transplantation. The
    Action Plan will direct new liver disease research; the NIDDK will also
    continue major ongoing clinical studies on hepatitis C; biliary
    atresia, a disease that strikes children; and non-alcoholic
    steatohepatitis, a fatty liver disease.
        The Action Plan for Liver Disease Research is part of a larger
    planning process for research on digestive diseases, which have an
    enormous burden on the U.S. population. For inflammatory bowel disease,
    external advice received in previous planning efforts will continue to
    inform the NIDDK research agenda. New planning efforts will aim to
    strengthen research on irritable bowel syndrome and other functional
    gastrointestinal disorders, which are debilitating and highly prevalent
    but not well understood. Following focused planning efforts relevant to
    gastroparesis, the NIDDK will establish a new clinical research
    consortium to study this debilitating syndrome of nausea, vomiting,
    bloating, and other symptoms which complicates diabetes and other
    diseases.
        In the areas of kidney and urologic diseases, in addition to the
    efforts described earlier, the NIDDK will encourage partnerships to
    pursue promising new therapies for polycystic kidney disease, and will
    launch a new clinical intervention study of children with
    vesicoureteral reflux, a bladder condition which can impair kidney
    function.
        I have highlighted today examples of NIDDK's many and diverse
    research plans and efforts. These reflect our strong commitment to
    improving human health.
        Thank you, Mr. Chairman. I would be pleased to answer any questions
    that the Committee may have.
                                     ______

    Prepared Statement of Dr. Stephen E. Straus, Director, National Center
                   for Complementary and Alternative Medicine

        Mr. Chairman and Members of the Committee: I am pleased to present
    the fiscal year 2006 President's budget request for the National Center
    for Complementary and Alternative Medicine (NCCAM). The fiscal year
    2006 budget includes $122,692,000, an increase of $587,000 over the
    fiscal year 2005 enacted level of $122,105,000 comparable for transfers
    proposed in the President's request.
        In 2004 NCCAM celebrated its first 5 years by reflecting on its
    contributions to the science of complementary and alternative medicine
    (CAM) and crafting a second strategic plan that articulates the
    Center's plans for 2005-2009. The plan is a collaborative effort that
    was developed with extensive input solicited from the public, CAM
    practitioners, and experienced scientific investigators; it articulates
    NCCAM's agenda for researching CAM healing practices, training CAM
    researchers, and conducting outreach.
        It is noteworthy that an independent analysis released in January
    2005 of the major scientific and policy issues surrounding CAM use,
    which was undertaken by conventional and CAM investigators for the
    Institute of Medicine (IOM) of the National Academies, identified many
    of the same research and training priorities as had NCCAM in its
    strategic planning process. The IOM report emphasized that evidence-
    based science must inform all health care practices, both conventional
    and CAM.
        In accord with the philosophy articulated by the IOM, scientific
    rigor has been and will remain the foundation upon which NCCAM advances
    its research agenda. In its first 5 years, NCCAM funded more than 1,200
    projects at some 260 CAM and conventional research institutions. The
    results of these projects are being published in leading medical
    journals, affording the public and their health care providers better
    data on which to base decisions on CAM use. The following are a few
    highlights of NCCAM's recent scientific advances, ongoing activities,
    and plans that illustrate the Center's progress and future directions.

                       UNDERSTANDING WHO USES CAM AND WHY

        Understanding who uses CAM and why they do so informs NCCAM's
    research goals, initiatives, and collaborations. In 2004, NCCAM
    reported results based on survey data collected in partnership with the
    Centers for Disease Control and Prevention from more than 31,000
    Americans. The data revealed that 62 percent of survey respondents used
    CAM in 2002. Back pain was the single most common reason respondents
    used CAM, followed by respiratory infections. To track trends in CAM
    use, NCCAM and the CDC have agreed to undertake a followup survey in
    2007. Additional NCCAM-funded survey analyses are also under way to
    examine in greater detail CAM use in diverse minority populations.

                     DETERMINING THE EFFECTS OF ACUPUNCTURE

        Acupuncture is among the top ten most popular CAM practices in the
    United States. In spite of its venerable traditions as a therapeutic
    practice in Asia, scientific research on acupuncture and how it might
    work is a relatively recent phenomenon. The recent report on the
    efficacy of acupuncture for osteoarthritis demonstrates the power and
    promise of the research strategies developed and implemented by NCCAM.
        More than 20 million Americans have osteoarthritis, a frequent
    cause of pain and disability among aging adults. In 2004, NCCAM-funded
    investigators, building on the results of previous smaller studies,
    reported the results of the largest randomized, controlled Phase III
    clinical trial of acupuncture ever conducted. This study of 570
    patients demonstrates that acupuncture is an effective complement to
    conventional treatments in patients with osteoarthritis of the knee.

                          EXPLORING MIND-BODY MEDICINE

        Recognizing the important role of social and behavioral factors in
    illness and health, NCCAM's new strategic plan describes further growth
    in the Center's investments on mind-body medicine for a range of
    diseases. One such study already under way is a clinical trial
    examining the use of meditation to achieve weight loss and enhance
    overall health and well-being among obese men and women. Also, in 2004
    NCCAM funded a mind-body center as part of its research centers
    program.
        To further stimulate the field of mind-body medicine research,
    NCCAM is co-funding an initiative with the NIH Office of Behavioral and
    Social Sciences Research to encourage interdisciplinary collaborations
    to elucidate processes underlying mind-body interactions and health and
    to develop health promotion and disease prevention and treatment
    interventions.

                  INVESTIGATING DIETARY SUPPLEMENTS AND FOODS

        As reported in the NCCAM/CDC survey, herbal products are among the
    most popular CAM therapies. Although many believe these products to be
    safe because they are ``natural'' or have been used for centuries, few
    of these products have undergone sufficient study of their safety and
    effectiveness. Research on botanicals is a priority area, and NCCAM
    funds numerous studies ranging from basic laboratory investigations to
    large Phase III clinical trials, to gather data on the nature, safety,
    and efficacy of popular herbal remedies.
        For example, NCCAM supports several interrelated studies of
    cranberries for preventing urinary tract infections (UTIs), which
    afflicts approximately 25 percent of women at least once in their
    lifetime. These include Phase II clinical trials to identify the
    optimal cranberry formulation, dose, and treatment duration in studies
    on UTI prevention as well as other smaller studies on the basic
    mechanisms, pharmacokinetics, and renal clearance of cranberry's major
    chemical components.
        Another priority for NCCAM's dietary supplement research portfolio
    is chronic liver disease, which claimed the lives of more than 20,000
    Americans in 2002 and disproportionately affects minorities. Through
    the Small Business and Innovative Research program, NCCAM supports
    development of a standardized milk thistle product, the most promising
    CAM therapy for liver disease. In collaboration with the National
    Institute of Diabetes and Digestive and Kidney Diseases, NCCAM will
    undertake early phase studies of safety and tolerability of milk
    thistle to determine if a Phase III trial is likely to be successful,
    and if so, the optimal research design for its implementation.
        NCCAM grantees are also examining the potential therapeutic
    properties of foods such as soy--especially as it relates to
    alleviating menopausal symptoms and promoting bone health. Last year
    NCCAM-supported scientists reported that in a study of pain induced by
    bone cancer, soy-fed mice experienced less pain than those in a control
    group. A better understanding of how dietary constituents and plant-
    based nutrients moderate pain may yield further treatments to help
    patients with chronic pain.
        Benefiting NCCAM's botanical research agenda is its partnership
    with the NIH Office of Dietary Supplements (ODS). This year NCCAM and
    ODS have renewed their partnership in funding Botanical Research
    Centers to promote interdisciplinary collaborative studies on dietary
    supplements.

               MEETING THE DIVERSE NEEDS OF SELECTED POPULATIONS

        NCCAM has a broad-based research portfolio, reflecting the
    diversity of individuals who use CAM for help in managing an array of
    diseases and conditions. For example, understanding how racial and
    ethnic minorities use CAM is a focus of the Center's research agenda in
    health disparities. Initiatives are under way to examine the interplay
    of race, ethnicity, age, gender, and locale to understand how they
    affect minorities' use of CAM to manage chronic illnesses such as
    diabetes or asthma. Examining these practices will help direct future
    research to answer why specific populations use certain CAM practices--
    for cultural reasons, because of access issues, for economic reasons,
    or for effectiveness--which in turn will help health care providers
    better meet the needs of these groups.
        Diseases and conditions predominately affecting the elderly are
    major targets of ongoing investments. For example, NCCAM is supporting
    the largest randomized Phase III clinical trial to date of Ginkgo
    biloba to prevent dementia in the elderly. Cardiovascular disease
    (CVD), the leading cause of death in the United States, is also a
    research priority for NCCAM. Investigations are ongoing of the ability
    of green and black tea extracts (Camellia sinensis) to reduce
    cholesterol absorption and biosynthesis in postmenopausal women and
    patients at high risk for CVD.
        In 2004, NCCAM grantees reported results from a clinical trial in
    children affected with upper respiratory infections (URI). In the
    trial, over 400 healthy 2- to 11-year-olds received a placebo or an
    echinacea product, an herbal identified by the NCCAM/CDC survey as
    widely used, to determine objectively whether it would reduce the
    severity of URIs over the 4-month study period. The researchers
    observed no differences between the two groups in the duration,
    severity, number of days with fever, and rate of adverse events except
    for an increased incidence of rashes in children receiving echinacea.
    Given the widespread use of this product, NCCAM is following up on this
    research, focusing on prevention of infection, which is how echinacea
    is usually taken, and studying the mechanisms by which echinacea may
    have health effects.
        In the wake of the Women's Health Initiative, NCCAM is developing a
    diverse research portfolio to explore use of CAM in treating menopausal
    symptoms, including hot flashes and osteoporosis. Some studies are
    examining the safety and efficacy of a range of CAM modalities women
    now use to treat these symptoms; others address more basic science
    questions, such as a therapy's mechanism of action. NCCAM's research
    portfolio also addresses other important health conditions exclusive to
    women--endometriosis and premenstrual syndrome (PMS)--as well as those
    that affect more women than men, such as UTIs, osteoporosis,
    fibromyalgia, osteoarthritis, breast and other cancers, and
    cardiovascular disease.

                     PARTICIPATING IN TRANS-NIH INITIATIVES

        NCCAM co-chairs a critical component of the NIH Roadmap for Medical
    Research Activity, Reengineering the Clinical Research Enterprise, to
    develop a more effective and cost-efficient model of translational
    research to move basic research into safe, well-designed clinical
    trials. In addition, NCCAM is actively involved in the NIH
    Neurosciences Blueprint, a trans-NIH initiative to accelerate the
    efficiency and pace of neurosciences research. Also, as part of the
    Trans-NIH Obesity Initiative, NCCAM is co-sponsoring efforts on
    childhood obesity and obesity prevention and treatment.

                            CHARTING NCCAM'S FUTURE

        NCCAM has accomplished much in its first 5 years. The first NCCAM-
    supported large-scale clinical trials are nearing completion; these
    findings are appearing in the nation's leading medical journals. NCCAM
    also has developed a comprehensive communications program to inform the
    public and health care professionals about CAM research findings. And
    the Center has created new opportunities in CAM research training for
    young scientists and has forged linkages between CAM institutions and
    conventional research centers. With its second strategic plan as a
    guide, NCCAM looks forward to making ongoing contributions as the
    nation's lead CAM research agency.
        Thank you Mr. Chairman. I would be pleased to answer any questions
    that the Committee may have.
                                     ______

        Prepared Statement of Dr. Lawrence A. Tabak, Director, National
                 Institute of Dental and Craniofacial Research

        Mr. Chairman and Members of the Committee: I am pleased to present
    the President's budget request for the National Institute of Dental and
    Craniofacial Research (NIDCR) for fiscal year 2006. The fiscal year
    2006 budget includes $393,269,000, an increase of $1,440,000 over the
    fiscal year 2005 level of $391,829,000 comparable for transfers
    proposed in the President's Request.

      THE ROAD AHEAD: MERGING SCIENTIFIC VISION AND TECHNOLOGY DEVELOPMENT

        Many of the opportunities that now face our nation's oral health
    researchers have never been more exciting or scientifically
    challenging. For the first time, we can envision a day when early stage
    tooth decay will be reversible with remineralizing solutions that patch
    the tooth and halt the disease process before a filling is required.
    Researchers will soon begin to learn how to engineer teeth and their
    constituent parts in the laboratory and transplant them into the mouth
    to replace a missing tooth or damaged tissue. The day also is
    approaching when saliva will be a reliable diagnostic fluid to detect
    systemic diseases, providing a rapid, non-invasive alternative to
    blood-based tests. These are but a few of the many opportunities that
    await us. And yet, as important as these visions of the future are in
    setting the course toward improved public health, it is abundantly
    clear that the road ahead will be blocked unless we develop new tools
    and technologies for working within the complex microenvironments of
    the human body. It is this merging of scientific vision with technology
    development that the NIDCR is fostering within our nation's oral
    research community and which I would like to highlight.

                    EARLY DIAGNOSIS TO PREVENT DENTAL CARIES

        Let me begin with one of the examples just mentioned. Despite
    dramatic reductions in tooth decay in the United States over the last
    half century, dental caries remains a significant public health
    problem, particularly among disadvantaged population groups. Dental
    decay also is an unexpected impediment to timely deployment of military
    personnel. At a time when our nation remains at war, dental readiness
    has been cited in testimony by the Reserve Officers Association as the
    number one deployment problem for National Guard and Reserve members.
    In a 2002 Department of Defense study, 34 percent of military personnel
    required dental care before they could be deployed, compared to only 16
    percent in 1998.
        The NIDCR will soon launch an initiative to evaluate the ability of
    emerging technologies to accurately and reproducibly measure extremely
    subtle changes in dental enamel that signal the earliest phases of
    dental caries. While this initiative may sound highly technical, its
    outcome could play an essential role in transforming dental care.
    Treatments with the potential to remineralize tooth surfaces in the
    very earliest stages of decay, long before a filling is needed, are
    emerging. In anticipation of the required clinical trials to rigorously
    evaluate these treatments, NIDCR will soon launch an initiative to
    ensure that microscopic changes in a tooth's mineral content can be
    measured accurately and reproducibly. Through this enabling research,
    the evaluation of these treatments will be firmly grounded in science,
    ensuring the greatest possible benefit to the public.

                        BIOENGINEERING: BUILDING A TOOTH

        Tooth loss has been a public health problem in the United States
    since the days of George Washington and Thomas Jefferson. Despite
    revolutionary advances in oral health over the last half century, tooth
    loss remains a problem, particularly among disadvantaged groups. In
    addition, tooth agenesis--the lack of one or more permanent teeth--is
    the most common congenital malformation in humans. While dental
    implants or dentures are often effective replacements, science has
    progressed to the point that it may be possible to generate replacement
    teeth from scratch, which would mark a truly historic advance in oral
    healthcare and in our understanding of human biology.
        Whereas just a few years ago tooth regeneration was far beyond the
    reach of science, which is no longer the case. An historic opportunity
    now awaits dental science to learn to seed and reproducibly control the
    complex, tightly orchestrated cellular and molecular interactions
    involved in producing a tooth and its supporting structures. The
    crucial first steps will be to: identify existing gaps in our knowledge
    of tooth formation; pursue viable solutions from throughout the
    biological and physical sciences to bridge these gaps; and, based on
    these comprehensive analyses, formulate blueprints for a complete
    tooth. Relying on the best of these blueprints, interdisciplinary teams
    of scientists will begin the process of engineering replacement teeth.
    It is likely that these investigations will initially yield viable
    replacement parts, such as enamel, dentin or periodontal ligament, but
    the ultimate goal is complete tooth regeneration.

                      LAB ON A CHIP: SALIVARY DIAGNOSTICS

        Another particularly exciting area of research is salivary
    diagnostics. Scientists have long recognized that our saliva serves as
    a ``mirror'' of the body's health, in that it contains the full
    repertoire of proteins, hormones, antibodies, and other molecular
    substances that are frequently measured in standard blood tests to
    monitor health and disease. Saliva is easy to collect and poses none of
    the risks, fears, or ``invasiveness'' of blood tests. The problem has
    been that the needed technologies have not existed to adequately
    develop salivary diagnostics on a large scale.
        The Institute continues to support a major research effort that
    will further develop these needed technologies and create the first
    comprehensive baseline catalogue of all proteins found normally in oral
    fluids. This is the initial step in building the needed scientific
    infrastructure required to expand salivary diagnostics. Already,
    scientists have begun to evaluate which of the myriad gene products in
    saliva correlate with various disease processes.
        The NIDCR envisions that this basic research could one day
    translate into miniature, hi-tech tests, or so-called ``labs'' on a
    silicon chip, which rapidly scan oral fluids for the presence or
    absence of multiple proteins linked to various systemic diseases and
    conditions. Given the ease of sample collection and the breadth of
    protein markers that could be arrayed on the silicon chip, salivary
    tests have the potential to revolutionize how diseases are diagnosed.
    Physicians and dentists would continue to diagnose diseases. But they
    would be in the position for the first time to monitor a patient's
    health, producing a comprehensive molecular print out of that
    individual's health status that can be assessed over time.
        Salivary diagnostics will have benefits far beyond medicine and
    dentistry as well. Law enforcement agencies could employ saliva tests
    in the field to determine rapidly whether a person is intoxicated or
    has recently used illegal drugs. These tests may also be beneficial in
    determining exposures to environmental, occupational, and biological
    substances, such as anthrax.

              ORAL CANCER: EARLY DETECTION IS KEY TO SAVING LIVES

        The field of salivary diagnostics recently yielded exciting early
    findings related to oral cancer detection. According to the American
    Cancer Society and the Centers for Disease Control and Prevention, oral
    cancer is the seventh most common cancer among U.S. males and ranks
    fourth among African American men. Unfortunately, survival rates have
    not improved significantly in decades. A patient's chance of survival
    is improved significantly with early detection and treatment. A team of
    NIDCR-supported scientists at the University of California at Los
    Angeles recently reported that they could measure elevated levels of
    four distinct cancer-associated molecules in saliva and distinguish
    within 91 percent accuracy between healthy people and those diagnosed
    with oral squamous cell carcinoma. This ``proof-of-principle'' study
    marks the first report in the scientific literature that distinct
    patterns of ``messenger RNA'' are not only measurable in saliva, but
    can indicate a developing tumor. These initial results highlight the
    potential clinical value of saliva and hold out exciting possibilities
    for development of commercially available tests capable of delivering
    early, reliable, non-invasive detection of developing tumors.

                   PAIN: TRANSLATING TARGETS INTO TREATMENTS

        Sizeable gaps exist in our understanding of some of the most basic
    cells involved in the pain process. Prime examples are the glial cells.
    For decades, scientists assumed that glial cells primarily played a
    supportive role in the central nervous system and had no direct
    influence on the transmission of sensory signals to the brain. But, as
    more powerful analytical molecular tools have emerged in recent years,
    scientists now realize that glial cells play a far more important role
    in pain than was previously appreciated. With this new awareness, it
    becomes imperative to better define the biology of these cells and
    their roles in regulating certain aspects of nervous system function.
        The NIDCR will launch an initiative that will stimulate needed
    research into the basic biology of glial cells and their interactions
    with neurons in causing orofacial pain disorders, such as
    temporomandibular joint disorders. The initiative will encourage
    multidisciplinary studies in a variety of areas to define more broadly
    than ever important aspects of the pain process. Based on this broad
    investigative approach, key aspects of the pain process will be more
    clearly defined, pointing the way to unique and highly specific
    molecular targets for drug development. Without identifying these
    additional targets, it will be impossible to ever adequately control or
    treat pain, particularly among the estimated 10 percent of Americans
    who suffer from chronic pain.

                                  NIH ROADMAP

        The NIH Roadmap themes are synergistic with NIDCR research
    initiatives and provide added impetus to the efforts of oral health
    researchers. For example, the theme Re-engineering the Clinical
    Research Enterprise is particularly relevant to the development of
    NIDCR-sponsored dental Practice Based Research Networks. Similarly, the
    goals of the initiative Building Blocks, Biological Pathways and
    Networks are closely linked to NIDCR's own bioengineering initiative,
    ``Building a Tooth.'' Research Teams of the Future provides an
    opportunity to further integrate dentists into the new clinical
    research structure, and highlights NIDCR's longstanding efforts to
    encourage multi- and interdisciplinary approaches to research
    questions.
        With the above-mentioned examples and other research progress, such
    as in salivary gene transfer, defining the oral biofilm, and the
    molecular targeting of oral cancer, NIDCR has never faced more exciting
    opportunities. By merging our vision of the future with technology
    development, the road ahead will lead this nation to a new generation
    of progress and improved oral health.
        Thank you, Mr. Chairman. I would be pleased to answer any questions
    that the Committee may have.
                                     ______

     Prepared Statement of Dr. Jack Whitescarver, Director, Office of AIDS
                                    Research

        Mr. Chairman and Members of the Committee, I am pleased to present
    the fiscal year 2006 President's budget request for the NIH AIDS
    research programs, a sum of $2,932,992,000, which is an increase of
    $12,441,000 above the comparable fiscal year 2005 appropriation.

                               WORLDWIDE PANDEMIC

        AIDS is the deadliest pandemic of modern times. More than 20
    million people have already died of AIDS, and more than 60 million
    people around the world have been infected with HIV. AIDS is the
    leading infectious cause of death worldwide, surpassing tuberculosis
    and malaria.\1\ Its impact is profound, affecting families,
    communities, agriculture, business, healthcare, education, military
    preparedness, and economic growth. The United Nations General
    Assembly's Declaration of Commitment on HIV/AIDS states . . .'' the
    global HIV/AIDS epidemic, through its devastating scale and impact,
    constitutes a global emergency and one of the most formidable
    challenges to human life and dignity, as well as to the effective
    enjoyment of human rights, which undermines social and economic
    development throughout the world and affects all levels of society--
    national, community, family, and individual.'' \2\ According to a U.N.
    report, ``The misery and devastation already caused by HIV/AIDS is
    enormous, but it is likely that the future impact will be even greater
    . . . The HIV/AIDS epidemic has erased decades of progress in combating
    mortality and has seriously compromised the living conditions of
    current and future generations.'' \3\ A CIA report estimated that by
    2010, five countries of strategic importance to the United States--
    Nigeria, Ethiopia, Russia, India, and China--collectively will have the
    largest number of HIV/AIDS cases on earth.\4\ Foreign Affairs magazine
    stated: ``. . . HIV/AIDS is set to be a factor in the very balance of
    power within Eurasia--and thus in the relationship between Eurasian
    states and the rest of the world.'' \5\ Dramatic increases in HIV
    infection also are occurring in Eastern Europe, Central Asia, Latin
    America, and the Caribbean.
    ---------------------------------------------------------------------------
        \1\ Report on the Global HIV/AIDS Epidemic: July 2002, (UNAIDS/WHO,
    Geneva, Switzerland, 2002).
        \2\ The Impact of AIDS (Department of Economic and Social Affairs,
    United Nations, 2004).
        \3\ The Impact of AIDS (Department of Economic and Social Affairs,
    United Nations, 2003).
        \4\ Intelligence Community Assessment: The Next Wave of HIV/AIDS:
    Nigeria, Ethiopia, Russia, India, and China. (CIA, 2002).
        \5\ The Future of AIDS, Foreign Affairs, November/December 2002.
    ---------------------------------------------------------------------------
                               THE U.S. EPIDEMIC

        In the United States, according to CDC, the decline in death rates
    observed in the late 1990s, due largely to expanded use of new
    antiretroviral therapies (ART), has now leveled off. The use of ART has
    now been associated with a serious side effects and long-term
    complications that may have a negative impact on mortality rates. HIV
    infection rates are continuing to climb among women, racial and ethnic
    minorities, young homosexual men, individuals with addictive disorders,
    and people over 50 years of age.\6\ This means that the overall
    epidemic is continuing to expand.\7\ \8\ \9\ CDC reports that
    approximately one quarter of the HIV-infected population in the United
    States also is infected with hepatitis C virus (HCV). HIV/HCV co-
    infection is found in 50 to 90 percent of injecting drug users (IDUs).
    HCV progresses more rapidly to liver damage in HIV-infected persons and
    may also impact the course and management of HIV infection, as HIV may
    change the natural history and treatment of HCV.\10\
    ---------------------------------------------------------------------------
        \6\ Characteristics of Persons Living with AIDS and HIV, 2001, HIV/
    AIDS Surveillance Supplemental Report (CDC, 2003).
        \7\ Year-End HIV/AIDS Surveillance Report for 2002 (CDC, 2003).
        \8\ Centers for Disease Control and Prevention HIV Prevention
    Strategic Plan Through 2005, (CDC, 2001).
        \9\ Cases of HIV Infection and AIDS in the United States 2003, HIV/
    AIDS Surveillance Report (CDC, 2004).
        \10\ Frequently Asked Questions and Answers about Co infection with
    HIV and Hepatitis C Virus (CDC, 2002).
    ---------------------------------------------------------------------------
        For the past several years, we have cautioned in our testimony that
    the appearance of multi-drug resistant strains of HIV presents an
    additional serious public health concern.\11\ \12\ \13\ \14\ \15\ In
    just the past few weeks, we have had a new warning about that
    potential. The New York City Health Department reported the possibility
    of a more virulent and aggressive multi-drug resistant HIV strain \16\
    focusing attention again upon the nature of the infection, the
    associated immune decline, and the behaviors linked to HIV
    transmission. It is too early to determine if this is some newly
    virulent form of HIV. A series of highly sophisticated tests is now
    underway to examine how the virus replicates in cells, as well as the
    efficiency and mechanisms of viral attack. The fact that the individual
    infected by this virus progressed more rapidly to immune decline may be
    reflective of a number of factors, some unrelated to the viral strain,
    such as host factors, native immune system function, or genetics. We
    have much more to learn about this case. However, it highlights a
    number of lessons about the active and ongoing U.S. HIV epidemic. HIV
    infection does not occur in a vacuum or in isolation--it occurs in the
    context of behaviors, including alcohol and drug use (the use of
    crystal methamphetamine in the New York City case), that require a
    contextually appropriate and interwoven response. This case underscores
    the importance of access to quality care that may need to include HIV
    resistance testing, and closer monitoring for immune decompensation in
    the setting of appropriate treatment. Most importantly, this case is a
    wake-up call, a reminder that the ability to interrupt HIV
    transmission, as well as the cycle of pain and suffering associated
    with HIV disease, is directly related to the robustness of HIV care,
    treatment and research infrastructure in the communities impacted by
    this disease. This expanding and evolving U.S. epidemic continues to
    present new and complex scientific challenges.
    ---------------------------------------------------------------------------
        \11\ N. Loder, Nature 407, 120 (2000).
        \12\ H. Salomon et al., AIDS 14, 17 (2000).
        \13\ Y.K. Chow et al., Nature 361, 650 (1993).
        \14\ M. Waldholz, Drug Resistant HIV Becomes More Widespread, Wall
    Street Journal, 2/5/99.
        \15\ World Health Report on Infectious Diseases: Overcoming
    Antimicrobial Resistance, (WHO, Geneva, 2000).
        \16\ ``New York City Resident Diagnosed with Rare Strain of Multi-
    Drug Resistant HIV that Rapidly Progresses to AIDS,'' New York City
    Health Department Press Release 2/11/2005.
    ---------------------------------------------------------------------------
                         ROADMAP FOR NIH AIDS RESEARCH

        In response to this worldwide crisis, NIH is the world's leader in
    the magnitude and quality of our AIDS research effort--a comprehensive
    program of basic, clinical, and behavioral research on HIV infection,
    its associated co-infections, opportunistic infections, malignancies,
    and other complications. No other disease so thoroughly transcends
    every area of clinical medicine and scientific investigation, crossing
    the boundaries of nearly all of the NIH Institutes and Centers. The
    Office of AIDS Research (OAR) plays a unique role at the NIH,
    establishing a roadmap for the AIDS research program. OAR coordinates
    the scientific, budgetary, and policy elements of the NIH AIDS program,
    prepares an annual comprehensive trans-NIH strategic plan and budget
    for all NIH-sponsored AIDS research; facilitates NIH involvement in
    international AIDS research activities; and identifies and facilitates
    multi-institute participation in priority areas of research. These
    legislative authorities are critical to identify and ensure support for
    the areas of highest scientific priority.

                  COMPREHENSIVE AIDS RESEARCH PLAN AND BUDGET

        The OAR planning process is inclusive and collaborative, involving
    the NIH Institutes, eminent non-government experts from academia,
    industry, foundations, and AIDS community representatives. The Plan
    serves as the framework for developing the annual AIDS research budget
    for each Institute and Center, for determining the use of AIDS-
    designated dollars, and for tracking and monitoring those expenditures.
    The planning process also serves to monitor and assess scientific
    progress. The Plan establishes the NIH AIDS scientific agenda in the
    areas of: Natural History and Epidemiology; Etiology and Pathogenesis;
    Therapeutics; Vaccines; and Behavioral and Social Science;
    Microbicides; Racial and Ethnic Minorities; Women and Girls; Prevention
    Science; International Research; Training, Infrastructure, and Capacity
    Building; and Information Dissemination.
        In consultation with the Director of NIH, the OAR determines the
    total annual AIDS research budget. The Institutes and Centers submit
    their AIDS budget request to OAR, and the OAR establishes their AIDS
    research budgets, in accordance with the priorities of the Plan, at
    each step of the budget development process.

                     FUNDING FOR HIGHEST PRIORITY RESEARCH

        To develop the fiscal year 2006 request, OAR initiated a
    comprehensive trans-NIH review of all grants and contracts supported
    with AIDS-designated funds to ensure that these projects represent the
    highest scientific priorities and opportunities. OAR carefully reviewed
    the mix of investments in key priority areas of research in view of the
    current epidemic. This budget request reflects OAR's redirecting of
    AIDS funds to the highest priority projects and new scientific
    opportunities in fiscal year 2006.
        This budget request places highest priority on the discovery,
    development, and testing of additional HIV vaccine candidates,
    including funding to move promising vaccine candidates into large-scale
    clinical trials to evaluate the potential for efficacy. The NIH
    priority in AIDS vaccine research to date has resulted in approximately
    70 clinical trials of nearly 40 vaccine candidates. The evaluation of
    an AIDS vaccine will require extensive testing in the United States and
    in international settings where there is a high incidence of HIV.
        In the area of therapeutics research, current drug regimens have
    resulted in extended survival and improved quality of life for many
    HIV-infected individuals in the United States and Western Europe.
    However, a growing proportion of patients receiving therapy are
    demonstrating treatment failure, experiencing serious drug toxicities
    and side effects, and developing drug resistance. The increasing
    incidence of metabolic disorders, cardiovascular complications, major
    organ dysfunction, and physical changes associated with current
    antiretroviral drugs underscores the critical need for new and better
    treatment regimens. Improved regimens also are needed to treat HIV co-
    infections such as hepatitis B and C, as well as other opportunistic
    infections to reduce drug interactions and problems with adherence to
    complicated treatment regimens. The goal of this research is to develop
    new, safe, less toxic, less expensive, and more effective therapeutic
    agents and regimens.
        OAR spearheaded a multi-IC inter-disciplinary collaboration to
    formalize plans for the restructuring of the NIH clinical trials
    networks for HIV therapeutics, vaccines and prevention. This effort
    resulted in a set of principles to guide the development of the Request
    for Applications (RFAs) for the re-competition of these essential
    multi-IC supported clinical programs in fiscal year 2006, designed to
    ensure that they operate effectively and cooperatively, making the best
    use of research dollars.
        Our prevention research priorities include the development of
    vaccines, topical microbicides, strategies to prevent mother-to-child
    transmission, including a better understanding of risk associated with
    breast-feeding, management of sexually transmitted diseases (STDs), and
    behavioral research strategies, including interventions related to drug
    and alcohol use. Efforts continue to identify the most appropriate
    intervention strategies for different populations and sub-epidemics in
    the United States and around the world.

                          INTERNATIONAL AIDS RESEARCH

        NIH bears a unique responsibility to address the global epidemic,
    with priority on the urgent need for more affordable and sustainable
    prevention and treatment approaches that can be implemented in
    resource-limited nations. The high incidence of Hepatitis B and C,
    malaria, and TB in many of these nations further complicates the
    treatment and clinical management of HIV-infected individuals. NIH
    international AIDS research includes: development of HIV vaccine
    candidates and chemical and physical barrier methods, such as
    microbicides; behavioral strategies; strategies to prevent mother-to-
    child transmission; therapeutics for HIV-related co-infections and
    other conditions; and approaches to using ART in resource-poor
    settings. NIH supports international training programs and initiatives
    that help build research infrastructure and laboratory capacity.

                              WOMEN AND MINORITIES

        In the United States, the rate of diagnoses for African Americans
    was almost 10 times the rate for whites and almost 3 times the rate for
    Hispanics. The rate of AIDS diagnoses for African American women was 25
    times the rate for white women.\17\ Women experience HIV/AIDS
    differently than men. NIH research has demonstrated that women progress
    to AIDS at lower viral load levels and higher CD4 counts than men.
    Women also experience different clinical manifestations and
    complications of HIV disease. These findings may have implications for
    care and treatment of HIV-infected women, particularly with ART. NIH is
    exploring research questions about specific characteristics of women
    and girls that might play a role in transmission, acquisition, or
    resistance to HIV infection during different stages of the life course.
    ---------------------------------------------------------------------------
        \17\ HIV/AIDS Surveillance Report 2003, Vol. 15 (CDC, 2004).
    ---------------------------------------------------------------------------
        We are focusing on the need for comprehensive strategies to
    decrease HIV transmission in affected vulnerable populations, and
    improve treatment options and treatment outcomes, including
    interventions that address the co-occurrence of other STDs, hepatitis,
    drug abuse, and mental illness; and interventions that consider the
    role of culture, family, and other social factors in the transmission
    and prevention of these disorders in minority communities. NIH
    continues to make significant investments to improve research
    infrastructure and training opportunities for minorities and will
    continue to ensure the participation of minorities in AIDS clinical
    trials, as well as in natural history, epidemiologic, and prevention
    studies.

                                    SUMMARY

        The NIH's leadership role in the response to the AIDS pandemic is
    fundamental and unprecedented, and we have established a research
    program that is complex, comprehensive, multi-disciplinary, inter-
    disciplinary, and global. Further, this research investment is reaping
    even greater dividends, as AIDS-related research is also unraveling the
    mysteries surrounding many other infectious, malignant, neurologic,
    autoimmune, and metabolic diseases. The legislative authorities of the
    OAR allow NIH to pursue a united research front against the global AIDS
    epidemic. NIH is enhancing collaboration, minimizing duplication, and
    ensuring that research dollars are invested in the highest priority
    areas of scientific opportunity that will allow NIH to meet its
    scientific goals. We are deeply grateful for the continued support the
    Administration and this Committee have provided to our efforts.

        Senator Specter. Well, that is a good juncture to discuss
    that, Dr. Zerhouni. My colleagues look at the increases in the
    NIH budget and compare them with what is done generally or in
    other research lines, the National Academy of Sciences. NIH has
    gotten a much greater increase than anyone, and I think that's
    because this subcommittee has taken an interest in the subject
    and we have seen what you can do.
        How can you quantify the good use of the money? Because
    many of my colleagues say, well, we don't know the details of
    NIH, but they've gotten too much money too fast to be
    efficient. Are you efficient?
        Dr. Zerhouni. Well, this is----
        Senator Specter. I know what the answer's going to be, but
    tell me why it's yes.
        Dr. Zerhouni. I'm going to give you very simple numbers,
    sir. I believe in facts. Are we efficient? Do we have too
    much--have we received too many resources? $96 per American per
    year is what we invest in research and development and
    knowledge faced to a $5,500 per year spending in health care,
    rising at a much faster rate than inflation.
        This ratio is really the key. We need to accelerate our
    knowledge so that we can change the paradigm of how we treat
    patients today. It would be more effective if we could develop
    methods of intervening years before the disease develops,
    rather than do what we do today, which is intervene after the
    disease has struck.
        Senator Specter. Give me an illustration of that.

                    RESULTS FROM ACCELERATING OUR KNOWLEDGE

        Dr. Zerhouni. A good illustration of that, I showed you the
    statistics on heart disease. You've seen how the mortality has
    dropped. That's because we've used as a preventive measure
    drugs that reduce high blood pressure and drugs that reduce
    cholesterol. Those two actions have led to a half of the
    reduction in mortality. That's a good example.
        In stroke, we've reduced the mortality of stroke by 50
    percent, just because we've used methods to reduce the impact
    of high blood pressure.
        In cancer, screening for cancer, in colon cancers, is
    responsible for the majority of the reduction in mortality from
    colon cancer. So there are things we can do as we learn more
    about the genetics----
        Senator Specter. Would you amplify your response on cancer?
        Dr. Zerhouni. Well, in cancer you can see, for example, in
    breast cancer--I'll give you one example in breast cancer--with
    the use of tamoxifan and the use of new drugs, we've reduced
    the occurrence, the reoccurrence of breast cancer by 50
    percent. We believe that in high risk populations, as we can
    identify them, and the National Cancer Institute is working on
    these factors, we'll be able to ultimately reduce the number of
    patients altogether who develop cancer. The same is true in
    colon cancer.
        Senator Specter. How will you do that?
        Dr. Zerhouni. Primarily by understanding----
        Senator Specter. Why haven't you done it before now?
        Dr. Zerhouni. I think we did not know the genetics of
    breast cancer or colon cancer until 10, 15 years ago. We
    started to know it, and our knowledge has accelerated over the
    past 5, 6 years with the completion of the human genome. We are
    continuing our efforts with the understanding of the genetic
    map and the continuing efforts and investments that NCI has put
    in understanding the genetics of cancer. That's the knowledge
    that allows us to do that.
        Senator Specter. On this subject, we have with us today Dr.
    Andrew von Eschenbach, who's the director of the National
    Cancer Institute. Dr. von Eschenbach, would you step forward?
        I might comment on the number of witnesses we had here
    because I had set at the outset that we have not followed the
    customary practice of having all of the directors where we
    couldn't possibly question more than 20 people who work in
    attendance. But Dr. Zerhouni and Dr. von Eschenbach are
    presidential appointees, and Dr. Zerhouni requested bringing
    Dr. Anthony Fauci and Dr. Allen Spiegel because of questions
    which might arise, and then we have added in, as I said
    earlier, Dr. James Battey because of the currency of an issue
    which has arisen on the application of the new ethics rules.
        Dr. von Eschenbach.
        Dr. von Eschenbach. Yes, sir.

                               THE WAR ON CANCER

        Senator Specter. You have the largest allocation in the
    National Institutes of Health, coming close to almost $5
    billion. President Nixon declared war on cancer in 1970.
    Thirty-five years have passed and we've won some wars, but not
    that one. What will it take to win that war?
        Dr. von Eschenbach. Well, Mr. Chairman, first of all, the
    wisdom and the support that we have received at the National
    Cancer Institute from the Congress in providing the resources
    has led us to a point where in 1971 when we began this effort
    we did not understand cancer. We didn't understand that it was
    a spectrum of diseases, and we certainly didn't understand the
    basis of that disease. But today----
        Senator Specter. A spectrum of diseases?
        Dr. von Eschenbach. Yes, sir.
        Senator Specter. How many roughly?
        Dr. von Eschenbach. Well, there are certainly a large
    number of cancers, but what we're learning even today is that
    even when we think of one cancer like breast cancer or
    lymphoma, or even colon cancer, there are subsets of those
    cancers because of the fact that there are unique, different
    changes in the genes and the molecules that cause and drive
    that cancer----

                                    LYMPHOMA

        Senator Specter. How many subsets of lymphoma? I have a
    special interest.
        Dr. von Eschenbach. There are two major subsets of
    Hodgkin's and non-Hodgkin's lymphomas. But even within those
    groups, even as we speak, we are learning that there are
    subsets----
        Senator Specter. Subsets within Hodgkin's lymphoma?
        Dr. von Eschenbach. Correct, sir, and especially in non-
    Hodgkin's lymphomas. For example----
        Senator Specter. But how about subsets in Hodgkin's
    lymphoma? You'll pardon my special interest.
        Dr. von Eschenbach. Yes, sir. If you allow me, one of the
    ways that we're beginning to understand even what we think is a
    single disease of Hodgkin's lymphoma is to recognize that in
    different patients that lymphoma may have different molecules
    or proteins on the surface of the cell that cause it to behave
    differently and respond differently to different therapies or
    interventions.
        For example, a recent drug that has been created is a drug
    that can attach itself to those proteins on the surface of the
    cell. One of those proteins is CD-20, an antibody. So if we can
    look at a Hodgkin's tumor and determine whether the antibody is
    present or not, we can then design and apply specific therapy
    for that specific patient.

                              RETURN ON INVESTMENT

        To follow up on the question of the return on investment,
    this investment in cancer research that has led us to a point
    today where we're beginning to understand cancers at the
    molecular and genetic and cellular level is influencing our
    selection of therapy and moving us to personalized medicine and
    personalized oncology.
        We're sparing patients unnecessary treatments that we can
    predict will not help them, while at the same time making
    certain we're giving patients the specific and exact therapy
    that we can predict and know at the molecular level will help
    them.
        This drug I alluded to that's recently been released,
    Bexxar, combines the knowledge of that antibody, of CD-20, in a
    group of other lymphomas, non-Hodgkin's lymphomas, called
    follicular lymphoma. By identifying that antibody and coupling
    to it a radioactive material, we can target those lymphoma
    cells, and patients who were previously considered incurable
    now have a 75 percent complete response rate in elimination of
    their tumor.
        Senator Specter. Before yielding to Senator Cochran, the
    distinguished chairman of the full committee I want to ask you
    one more question, Dr. Zerhouni, and you one more question, Dr.
    von Eschenbach. If we have a flat-level funding for NIH this
    year, how many grants will you have to reduce because of
    inflationary factors and other factors, contrasted with what
    you could do if we were able to get the extra $1.5 billion
    which is in the budget resolution?

                                 SUCCESS RATES

        Dr. Zerhouni. The total number of grants will decrease by
    about 400 total. As I said, we were going to make a special
    effort to increase the number of grants for new investigators
    or what we call competing investigators so that----
        Senator Specter. With the extra $1.5 billion, then what?
        Dr. Zerhouni. We could reestablish--you know, one of the
    things you said that is very important that we hear a lot is
    NIH has too much money, it cannot spend any more money. The
    best statistics I can give you is we are getting more and more
    ideas we cannot fund, and our success rate is actually
    dropping. I'll show you some statistics here that you can see,
    and we were at about 32 percent a few years back to 30 percent
    to 25, 22, and eventually we will reach 21 percent in 2006.
    With----
        Senator Specter. Of grants on applications, percentage that
    you grant?
        [The information follows:]

        Dr. Zerhouni. By those number of scientists we can fund
    when they apply, one in five, or a little bit above that. So
    clearly anything we could do to reestablish the ability of
    fulfill and satisfy the scientific demand would be helpful.
    However, we recognize as you did the very, very difficult
    fiscal times we're in.

                           FUNDING THE WAR ON CANCER

        Senator Specter. Dr. von Eschenbach.
        Dr. von Eschenbach. Yes, sir.
        Senator Specter. With sufficient funding, can we win the
    war on cancer in the reasonably near future?
        Dr. von Eschenbach. Senator, we have made a commitment at
    the National Cancer Institute to eliminate the suffering and
    death that results from cancer, to eliminate the outcome of
    cancer, and to bring that about as early as 2015 in this
    Nation. We have made that commitment because we believe that
    this investment that has been made in cancer research has led
    us to a point today where we can build on our understanding of
    cancer and use that knowledge to develop new and more effective
    interventions that can in fact achieve the goal----
        Senator Specter. Do you have sufficient funding to reach
    that goal by 2015?
        Dr. von Eschenbach. The funding that we have we are
    applying as effectively and as efficiently as possible to
    achieve that trajectory. Obviously, with increase resources we
    have increasing opportunities to even further accelerate that
    pace of progress.
        Senator Specter. If your funding were increased, could you
    reduce that date to 2010?
        Dr. von Eschenbach. We certainly could accelerate the pace
    of progress, and how quickly and how soon we could bring that
    about, I could not absolutely predict.
        Senator Specter. I would like you to give that some thought
    and provide the subcommittee with a projection as to what kind
    of funding you would require to reduce the figure to 2010. A
    lot of people are going to have a lot of suffering in those
    other 5 years.
        Dr. von Eschenbach. Yes, sir.
        Senator Specter. Really in the 5 years from now until 2010.
        [The information follows:]

                           National Cancer Institute

        What would it take to accelerate the achievement of the NCI's 2015
    goal to eliminate suffering and death due to cancer from 2015 to 2010?
        You have requested information on the amount of money necessary for
    the National Cancer Institute (NCI) to achieve its 2015 goal by 2010.
    It should be noted, though, that these funding estimates for additional
    resources were developed without taking into consideration overall
    fiscal constraints and other competing priorities of NIH, HHS, or the
    rest of the Federal government over this five-year time period. The
    current annual NCI budget is nearly $5 billion, and the resources
    discussed below would be in addition to this base.
        NCI has established an ambitious goal of eliminating the suffering
    and death due to cancer by 2015 by sustaining and integrating progress
    in the discovery, development, and delivery of more effective
    interventions based on molecular mechanisms of cancer. We estimate that
    expenditure of an additional $4.2 billion above the NCI base of nearly
    $5 billion over the next five years could accelerate progress. While
    the elimination of suffering and death due to cancer may not be fully
    achievable by 2010, there would be significant progress toward
    narrowing the gap between 2015 and 2010.
        This $4.2 billion estimate reflects an additional up front
    allocation of $2.5 billion to be expended over five years for a
    National Advanced Technology Initiative for cancer (NATIc) to
    accelerate the emerging disciplines of molecular oncology,
    nanotechnology, and bioinformatics for use in creating a pipeline of
    new personalized cancer diagnostics and therapeutics. This would also
    reflect an annual increase of $171 million over current base NCI levels
    for five years to deploy a modern integrated cancer clinical trials
    infrastructure and an annual increase of $164 million for five years to
    expand and integrate the NCI-designated Cancer Centers program from 60
    existing centers to 75. In addition to resources, additional
    legislative authorities related to exemptions from specific parts of
    current procurement, grant review and processing, and licensing and
    patenting rules would also help speed progress toward an accelerated
    cancer goal.
        Three decades ago there were 3 million U.S. cancer survivors; today
    that number has increased to over 10 million. Today, each minute of
    every hour of every day, one American dies from cancer: 570,280 lives
    will be lost this year due to this disease. Despite this fact, there
    has been remarkable progress in understanding the cancer process and
    applying that knowledge. Today, 65 percent of patients diagnosed with
    cancer can expect to survive. If we had the ability to apply what we
    know today to every cancer patient, we could have an immediate impact
    on survival, largely through the NCI Cancer Centers. Incremental
    improvements in survival will continue toward our 2015 goal, but we can
    accelerate these gains. Even improving the overall survival rate to 90
    percent by 2010 could mean an additional 850,000 lives saved. The
    impact of this strategy could produce annual changes in the first two
    years of around 2-3 percent, with larger increases occurring in 2008-
    10.
        For most cancer patients, survival is greatly influenced by early
    detection. The rapid deployment of advanced imaging, nanotechnology
    supported early detection platforms and targeted therapies will change
    the face of diseases such as ovarian cancer, lung, colon and breast
    cancers; where survival is low because we can not currently detect them
    before they spread. Ovarian cancer, which is very difficult to detect
    and diagnose in its early stages, has over 25,000 new cases diagnosed
    annually and over 14,000 deaths; the mortality rate is nearly 85
    percent. Imaging and detection techniques presently under development
    and broadly applied could reverse that mortality rate to be an 85
    percent survival rate. Lung cancer, with approximately 170,000 expected
    deaths this year, would see a significant reduction in the number of
    deaths if the application of new technologies combined with other
    interventions could be universally applied in an accelerated manner.
        The challenge to achieving the goal of eliminating the suffering
    and death due to cancer by 2010 is daunting, but with the authorities
    and appropriations commensurate with the task, the pace of progress
    could be accelerated, and the gap between 2015 and 2010 narrowed. The
    following reflects a brief overview of how such funds, if available,
    could be applied.
      --Rapid Deployment of a National Advanced Technology Initiative for
            cancer--$2.5 billion one time appropriation with commensurate
            authorities.
      --Deployment of a Modern Integrated Clinical Trials Infrastructure--
            $171 million addition to the NCI base budget.
      --Expansion and Integration of the Cancer Centers Program--$164
            million addition to the NCI base budget.
      --Mechanisms and Flexibilities--streamlined procurement and review
            processes to acquire materials and services; coordination of
            licensing and patenting activities.
        A National Advanced Technology Initiative for cancer (NATIc) could
    provide a linkage between the National Cancer Program and R&D
    initiatives being developed in selected National Laboratories and
    advanced technology facilities located in more than 40 states and
    regions. Connected in real time through a common bioinformatics grid,
    NATIc as a ``network of networks'' of science, technology, and
    treatment, could serve to accelerate the emerging discipline of
    molecular oncology to create a pipeline of new personalized cancer
    diagnostics and therapeutics from bench concept to bedside and
    community delivery. In the next few years, such an initiative could:
      --Accelerate the implementation of a nationwide high-end information
            technology grid for bioinformatics that could be uniquely
            adapted for real time data sharing. NCI's pilot version, called
            caBIG, is currently being implemented among 50 cancer centers,
            the Food and Drug Administration (FDA), and other
            organizations.
      --Develop a comprehensive biomarker discovery and validation program.
      --Foster the application of emerging technologies, such as
            nanotechnology, and integrate molecular agents with advanced
            imaging devices.
      --Accelerate a nationwide ``real time'' medical information
            electronic system for research and medical data sharing using
            technologies and devices currently employed by the banking
            industry and large-scale commercial enterprises.
      --Enhance the discovery and validation of new targets of genes and
            proteins critical to cancer development.
        NCI could deploy a more modem and integrated infrastructure for
    cancer clinical trials. This clinical research infrastructure could:
      --Strengthen collaborations with industry, FDA, Centers for Medicare
            and Medicaid Services, and other public, private, academic, and
            patient advocacy organizations to oversee the conduct of cancer
            clinical trials.
      --Develop new infrastructure and procedures to standardize,
            coordinate, and track clinical trials development and accrual
            across all NCI-supported clinical trials.
      --Increase utilization of imaging tools in screening and therapy
            trials, evaluate new imaging probes and methodologies, enable
            access to the imaging data from trials in an electronic format,
            and facilitate evaluation of image-guided interventions.
      --Expand access and improve the timeliness for completion of the
            highest priority clinical studies.
      --Foster the development of a cadre of established clinical
            investigators who could work between bench and bedside.
      --Pilot new approaches and develop prototypes for clinical trials
            networks that could improve the efficiency, coordination, and
            integration of our national efforts.
      --Develop a common clinical trials informatics platform that could be
            made available to the full range of investigators working
            within the cancer clinical trials system.
        NCI could accelerate the expansion and integration of the NCI
    designated Cancer Centers program, including the addition of 15 new
    cancer centers, increasing the number of centers from the current 60 to
    75. The Cancer Centers program could:
      --Implement progressive bioinformatics and communication systems to
            achieve horizontal integration.
      --Fund additive programs in collaborative, multidisciplinary
            research, and require integration and sharing of results.
      --Broaden the geographic impact of the centers, networks, and
            consortia and vertically integrate them with community and
            regional health care delivery systems.
      --Improve the access of minority and underserved populations to
            state-of-the-art research and resources.
      --Create and strengthen partnerships with government agencies and
            community organizations.
      --Broadly provide expertise, and other resources to caregivers,
            patients and families, and appropriate health agencies.
        In addition to appropriations, flexible legislative authorities
    related to exemptions from specific parts of current procurement, grant
    review and processing, and licensing and patenting rules could also
    help accelerate progress. A streamlined procurement process could
    facilitate the acquisition of materials and services to support the R&D
    activities. Technology development could also be enhanced by sufficient
    flexibility and integration to enable interactions among a wide array
    of laboratories and other entities. Expedited review procedures and
    workflow processing could help to award funds in sequence as needed.
    This might include direct solicitation from known laboratories or other
    sources of technology, and capability to terminate funding instruments
    at the convenience of the government with limited appeal processes so
    that funds could be redirected from low performing consortia to the
    more productive venues.
        Coordination of the licensing and patenting activities among
    grantees, contractors and the intramural program could also be useful
    for many of the multi-component technology platforms that could be
    created through this effort. An accelerated process for Determination
    of Exceptional Circumstances (DEC) and deviations from appropriate
    Federal Acquisition Regulation (FAR) clauses, when deemed valuable to
    the broad research enterprise, could be utilized.

        Senator Specter. Senator Cochran, thank you for joining the
    subcommittee.

                       STATEMENT OF SENATOR THAD COCHRAN

        Senator Cochran. Mr. Chairman, thank you very much. We
    appreciate you chairing this hearing and also inviting Dr.
    Zerhouni and selected members of the National Institutes of
    Health staff who can help us understand the budget request and
    do our best to identify the areas that need emphasis in this
    budget. We appreciate your leadership on this subcommittee and
    on the full committee as well.
        I notice that the budget request is $144.5 million over
    last year's appropriate level for the National Institutes of
    Health. I'm hopeful that that will permit the NIH to continue
    its research into health disparities, examining why a
    disproportionate number of African-Americans, for example,
    suffer from heart disease than the rest of the population. I
    think taking the research to the underserved areas of our
    country is beneficial. I hope you can let us know what your
    reaction to that initiative is at this point and what you
    foresee in terms of the needs for funding will be.
        I think I'll stop at that point and let you respond, and I
    then have a couple of other questions.

                         STRATEGIC GOALS AND OBJECTIVES

        Dr. Zerhouni. Those points are absolutely on target,
    Senator. As you know, we have five major goals that we have
    outlined in our strategic plans. One is aging of the
    population, the change from acute to chronic diseases. The
    third one is health disparity, not in any particular order.
    Those are amongst the five. And then we have biodefense and
    emerging and re-emerging diseases, including, for example,
    obesity.
        We're acutely aware of the disparate impact of these
    conditions on the American population. As you know, we have the
    vanguard study in the Jackson heart study that in fact studies
    how to do this better. As part of the Roadmap for Medical
    Research, we are also developing the idea of a community-based
    corps of clinical researchers that will be included within the
    underserved areas of the country and connected through a better
    information system, so that more patients in those communities
    can participate.
        A good example of that, Senator, was the ALLHAT study,
    which was the study of hypertension conducted in over 600
    practices. A great majority of the practices were in African-
    American communities and showing which drugs were the most
    effective in those populations.
        So we will continue that. I think the investment needs to
    be continued, Senator. This is not an easy problem to tackle,
    but we need to look forward to more activities that will
    integrate the main research that we do with the research that
    needs to be done in those communities.

                    COMPLEMENTARY AND ALTERNATIVE MEDICINES

        Senator Cochran. One other interesting new area of inquiry
    for the National Institutes of Health is in the area of dietary
    supplements and herbal products. There is a growing number of
    Americans using these supplements and products. The National
    Center for Complementary and Alternative Medicines is playing a
    role in helping us understand the effects of that activity and
    the use of those products.
        What are the current research needs or priorities in terms
    of this budget request that we need to consider when we are
    reviewing the request and deciding on the amounts to
    appropriate?
        Dr. Zerhouni. First and foremost is your statement about
    the increasing use of dietary supplements across our population
    is real. Herbal products are becoming very popular. One of the
    things we need to do as scientists is to figure out whether or
    not these products are of equal effectiveness across their
    compositions. So we need to have more research done in exactly
    how to make these herbal products reliable and safe.
        We are doing that at NCCAM. We verify the purity of these
    herbal products. We also have trials verifying their
    effectiveness. This year NCCAM and the Office of Dietary
    Supplements are going to fund five new botanical research
    centers across the country. There is a request for applications
    that has gone out. We've received the applications. So we'll
    have at least an infrastructure now of five centers that will
    look exactly at these issues of how do you really make sure
    that when you buy a particular product it's effective for what
    you think it is effective for.
        Senator Cochran. My final question has to do with the role
    for new technologies in the detection and treatment of disease.
    For example, the National Institute for Biomedical Imaging and
    Bioengineering was created specifically to enhance research on
    these technologies across the NIH Institutes. What budget
    levels are needed for this work to be done and to improve the
    rate of discovery in biomedical research across the Institutes
    and increase the development of new tools for diagnosis and
    treatment in clinical practice?

          NATIONAL INSTITUTE FOR BIOMEDICAL IMAGING AND BIOENGINEERING

        Dr. Zerhouni. This is newest Institute, as you all know,
    that is essentially going through its strategic first steps. It
    is the only Institute that has for a mission the interaction of
    technologies, physical sciences, biological sciences, in the
    context of bioengineering or biomedical imaging. In that
    regard, it is very important to continue to invest, because as
    we see, you know, when we look at detection, for example, of
    new diseases, new technologies to do research, it's becoming
    very apparent that we need to make specific investments in
    those areas if we are going to make progress in both detection
    and therapy.
        For example, nanotechnology is a good example whereby you
    can through nanotechnology techniques concentrate energy inside
    a tumor and treat a tumor in a way that you couldn't otherwise.
    NIBIB is key to that interface. It's taken a role, a lead role,
    in matching physical sciences and biological sciences at NIH,
    works with the National Institute of General Medical Sciences.
        Obviously, the budgetary environment is such that they have
    to make very tough choices in terms of prioritization. But from
    my standpoint, Senator, emerging research technologies, I see
    that and we've identified in the Roadmap for Medical Research,
    as a major area of investment. In the past, biomedical
    researchers tended to wait for technology to be developed and
    then used it off the shelf, whether it be computers or robotics
    or other technologies.
        In the future, as we are going to areas of research that
    are only specific to medical research, no one in the free
    market is going to develop an off-the-shelf technology that
    will have just application to medicine. And therefore, NIBIB's
    strategic role has to increase over time, and all of NIH's
    investment in that area.
        Senator Cochran. Thank you very much. I appreciate your
    leadership in these areas that I've touched on and generally at
    NIH. I think you're doing a great job and we appreciate your
    service.
        Dr. Zerhouni. Thank you, Senator.
        Senator Specter. Thank you very much, Senator Cochran. I'm
    now going to yield to the distinguished ranking member, Senator
    Harkin. I'm going to go vote and I will return promptly so we
    can maintain the continuity of the hearing.
        Senator Harkin [presiding]. Thank you very much, Dr.
    Zerhouni.
        Dr. Zerhouni. Good morning.
        Senator Harkin. I apologize for being a little late for
    your presentation. Obviously we all have a lot of committees we
    have to go to. But I just wanted to make a brief opening
    statement and welcome you back and the others back.
        As you know, Dr. Zerhouni, both Senator Specter and I have
    been very strong supporters of NIH and funding. We've partnered
    in doubling the funding for NIH over 5 years. We got that job
    done. It was one of my proudest moments as a Senator to
    actually get that accomplished.
        Yet as I look at the President's budget for 2006, it's with
    a sense of disappointment. We didn't double the funding for NIH
    to then have the bones cut out of the funding. But that's what
    it seems is happening. This budget would provide the smallest
    percentage increase since 1970, .5 percent. The total number of
    grants would drop by 402. Most importantly, the success rate
    for new and competing grants would fall to 21 percent. I have
    the table here. I guess you put it up here. I missed it, but my
    staff told me you put it up here. Twenty-one percent, that's
    the lowest since 1970, and that's as far back as our records
    go, 21 percent. This is very disturbing.
        Our scientists have just mapped the human genome. We should
    be entering a golden age of medical research. Scientists should
    be flocking to this field. It's the wrong time to hold this
    budget flat.
        I'm also troubled by other developments. Top researchers
    are leaving NIH. Recruitment is suffering because of new
    conflict of interest regulations. While I strongly support
    restrictions on outside compensation, I am concerned that the
    new regulations go too far, Dr. Zerhouni, especially when it
    comes to requiring employees to divest stocks that they've had
    for many years.
        I just, as an aside, ran into a woman yesterday, just
    yesterday afternoon. The AACI group had a reception yesterday
    and I was just talking to a woman. I mentioned this hearing and
    she mentioned how it was her sister, I believe, was a
    researcher at the National Institute of Environmental Health
    Sciences in North Carolina, had been there for a long time, is
    leaving because through the years she said the most income she
    and her husband ever had was $125,000 a year. Lately, because
    she's worked all these years, she bought some stock early on,
    that's her retirement, that's for her kids going to college,
    and according to her--I don't know, I'm just telling you what
    she told me--she has zero input to any kind of drugs or drug
    companies or anything. Yet she's told she's got to divest that
    stock. You know what? She's leaving. That's wrong. That's
    wrong. We've got to change this, Dr. Zerhouni. We've got to
    change this.
        I look forward to working with you and I'll have some more
    questions about that.
        Jim Battey, who's leaving, has been a great researcher,
    great leader. I've worked with him on deafness and
    communication disorders. As I understand it--I don't mean to
    get into all this personal stuff--but I understand there's a
    family trust set up that he has to administer and stuff like
    that, and he has to leave because of this. This isn't right. We
    have to have a change and we have to have a change soon,
    immediately.
        Now, let me just switch to something else, and that's the
    whole issue of stem cell research. The administration's
    outdated policy on stem cells is making NIH increasingly
    irrelevant in one of the most exciting areas of research today.
    We know about California putting in $300 million a year. NIH is
    spending less than one-tenth of that amount, NIH one-tenth the
    amount of one State. Inevitably, researchers are going to look
    to individual States for direction on stem cell research
    instead of the NIH.
        What's happening to NIH? Is it just a shell of its former
    self? It's supposed to be the greatest biomedical research
    institution in the world. I'm beginning to wonder.
        Our federally funded scientists are on the front lines in
    the war against cancer and heart disease, diabetes, on down the
    line. To me there is no higher priority in this appropriations
    bill than funding NIH at an adequate level.
        So that's my opening statement and I just want to return to
    the conflict of interest rules. Now, you know I have the
    greatest personal admiration for you and friendship. I think
    you're doing a great job in leading the institution. But I must
    chastise you. These are too onerous. They've got to be redone,
    and they've got to be redone soon before you start losing more
    people out of there. I mean, you know, sometimes we tend to see
    a conflict of interest and we go overboard, and I think we've
    gone overboard here.
        So I'm just asking, are you prepared to recommend to HHS
    that the Department issue new revised regulations that won't
    hurt NIH's ability to retain and attract top scientists?

                       PENDING CONFLICT OF INTEREST RULES

        Dr. Zerhouni. Well, I'm glad you asked the question,
    because as you know, this has been a painful episode for NIH
    where we've looked at several hundred issues that came up
    through the activities of scientists for private pay with
    biotech and pharmaceutical companies, as you were concerned
    about. From my standpoint it was very important to take care of
    that issue, and we did.
        We proposed the moratorium because I think there were two
    reasons there that prompted me to do that. One was the fact
    that there were activities there that truly did not advance
    research. They were more into the marketing and product
    endorsement activities. I thought that we needed new
    guidelines. Second, I believed that our management system of
    ethics was not functional, and to establish a new one, to re-
    centralize it, takes a while.
        Now, you should know that these rules and regulations are
    not under my direct authority.
        Senator Harkin. I understand.
        Dr. Zerhouni. They are those of----
        Senator Harkin. I misspoke. It's HHS.
        Dr. Zerhouni [continuing]. HHS and the Office of Government
    Ethics. We've consulted with them and indicated to them that
    some of the applications may need to be tested on the ground.
    That's why we insisted that these be called interim final
    regulations and they be subject to comments and evaluation and
    adjustments. I have to say that I'm as concerned as you are.
        Remember that at this point the most impact I have seen,
    because the rules have not been implemented in terms of stock
    divestiture, is the impact on families and the impact on all of
    the employees that would be required to divest of stock. That
    part of the rule frankly is the one that I think we need to
    reevaluate very quickly, as you said. I have requested a delay
    in the application of this rule from Secretary Leavitt, who's
    been extremely responsive and extremely concerned about any
    impact.
        In the preamble to the rule, as you may know, we have
    stated very clearly that the Department and NIH will carefully
    look at the impact on retention and recruitment and the impact
    on the activities of our scientists in terms of outside
    activities.
        So we are totally prepared to look at that, I am totally
    prepared to look at that, and request from those who have the
    authority--the Office of Government Ethics and the Department--
    to consider changes. So far I would say that, number one, we've
    had a responsive interaction. Number one, we've had a 90-day
    delay, and no one has been asked to divest at this point.
        But nonetheless, the uncertainty itself can be damaging to
    morale and damaging to recruitment and retention. You've
    mentioned the example of Dr. Battey, who's a very good
    colleague of mine, an outstanding scientist, and I understand
    very much his predicament and I've made that known to the
    Secretary and to the Department.
        There's another case, as you know. I've taken a lot of time
    and effort in recruiting outstanding directors. When I became
    director there were six vacancies and two others. I was very
    proud of the fact that we've been able to recruit outstanding
    directors from outside of the NIH and inside of the NIH. The
    latest one was Dr. David Schwartz from Duke University, who
    last week sent me a letter saying that he was delaying his
    coming until this issue of stock divestiture is clarified.
        So I feel the same way you do in the sense that the
    philosophy of the interim regulation as promulgated by those
    who promulgated that with our consultation is in my view one
    that would be more appropriate for a regulatory agency rather
    than a scientific agency, and does require in my view more
    selective approaches rather than these approaches.
        I think the Department has been responsive. As you may
    know, the Department has excluded trainees from these rules.
    That's over 5,000 scientists who are not subject to these
    rules. However, we've also encouraged our scientists at NIH to
    come forward. I've had multiple meetings with scientists who
    are very concerned about this, and gotten their comments, and
    based on those comments we'll adjust accordingly.
        So I share your concern and I do believe that, as you will
    see, we will be adjusting accordingly to correct for that
    issue, which I think is the one that is at the core of the
    complaints that you've heard. But also I am concerned about any
    impediments that free academic exchange might incur because--
    with trade associations--because of this over-regulatory
    interpretation of what NIH does. I don't think NIH has the
    influence of a regulatory agency, and I think as we go through
    the evaluation comment period, you will see improvements in
    that, Senator.
        Senator Harkin. I appreciate that and I apologize for
    misstating. Sometimes I look out there I just see HHS, and I
    said--I meant not you but the whole Department----
        Dr. Zerhouni. It's okay. I'm used to it.
        Senator Harkin. The whole Department for what they did. But
    we----
        Dr. Zerhouni. I'll take responsibility for----
        Senator Harkin. We've got to settle this. I'm sorry. I've
    got to go vote, and I assume Senator Specter will be right
    back, and so the committee will stand in recess until the chair
    gets back.
        Dr. Zerhouni. Thank you.
        Senator Specter [presiding]. The hearing of the
    Appropriations Subcommittee on Labor, Health, Human Services,
    and Education will now proceed.
        Dr. Zerhouni, at the outset I thanked you for the
    assistance which NIH has provided on an arrangement with the
    Institute of Medicine to fund an examination of certain areas
    of asbestos-related injuries. We are trying to put through an
    asbestos bill and there is a question as to whether there is a
    causal connection between asbestos and certain ailments, and
    the Institute of Medicine has agreed to expedite a study in the
    course of 1 year. I worked with Dr. Raynard Kington in your
    absence and we were able to work that out expeditiously, and I
    thank you for that.
        Dr. Zerhouni, let's turn to the issue of the guidelines on
    ethics and the concerns which have been expressed by some. And
    I'm going to want to hear from--we're going to want to hear
    from Dr. James Battey in a few moments as to the range of the
    restrictions which have been imposed and the reaction and
    whether you think there might be some justification for a
    review of the standards and practices.

                              GUIDELINES ON ETHICS

        Dr. Zerhouni. Senator, first and foremost, the rules as we
    have--as they have been promulgated by the Department of Health
    and Human Services and the Office of Government Ethics are
    interim final regulations. In that process we made it very
    clear that those rules will be subject to an impact analysis
    and a comment period, especially when it comes to recruitment
    and retention areas and the maintaining of the excellence of
    the science at NIH.
        Now, as you know, when we developed the rules there was a
    component of the rules that was related to consulting with
    industry. I believe that the rules that we have put in place do
    establish and re-establish public trust and maintain public
    trust in that we will ban those until we are completely certain
    that we have an oversight system that is more functional than
    the one we had before.
        Senator Specter. Do they go too far?
        Dr. Zerhouni. In that context--in the consulting area, I
    think this is something that we need to do because we do not
    have, I believe, at this point an ethics oversight management
    system that can assure you and assure myself that those
    interactions are----
        Senator Specter. How about in areas other than consulting?
        Dr. Zerhouni. In areas such as stock divestiture, as you
    know, the rules require that all employees and their spouses
    divest of stock in either directly or indirectly related
    industries of NIH. As I looked at that rule over the past 2
    months, I've had extensive consultation with our scientists,
    with outside entities, directors of the Institutes, and it is
    clear to me that in the short 2 months, where these rules have
    not been implemented by the way, no one has been asked to
    divest, that this would have a deleterious impact. Best
    example, as you mentioned, is Dr. Battey, who really cannot
    disentangle himself from his family obligations; Dr. Schwartz,
    who's the new director that I just appointed and recruited from
    Duke University, who was to take his job on April 11, who has
    delayed his coming until we can understand these rules a little
    bit better.
        Senator Specter. How about the issue raised that someone
    couldn't accept train fare to travel to a distant city to give
    a lecture?
        Dr. Zerhouni. That is not correct. I've heard that. That,
    Senator, that is not correct. People can accept train fares,
    hotel reimbursement when they go to do an academic lecture at
    some other points.
        Senator Specter. Is there any other area besides consulting
    and divestment on a broad category?
        Dr. Zerhouni. I think the interaction between our
    scientists and trade associations, scientific associations,
    should not be hampered to the extent that we have seen them
    being hampered over the past two months. We need to work on
    that.
        I have to tell you, Senator, that Secretary Leavitt has
    been very responsive and receptive. We've requested a delay in
    the implementation of the stock divestiture rule of 90 days so
    we can understand it better. We have also asked that all of our
    scientist trainees, 5,000 of them, be exempted from these
    rules.
        So, again, I think we do believe that through this process
    of comments and evaluation that we have put in place in the
    interim final regulations, that we will be able to adjust
    accordingly.
        Senator Specter. How about on the trade association issue?
        Dr. Zerhouni. Right.
        Senator Specter. How about on the trade association issue?
        Dr. Zerhouni. Again, I think, Senator, from my standpoint,
    if you look at the framing of these interim final regulations,
    they make an assumption that NIH has the same influence as a
    regulatory agency. In that context obviously these interactions
    have to be scrutinized, but I don't at this point have a final
    opinion, but it seems to me that they may restrict areas of
    academic interchange----
        Senator Specter. So you do not have a final opinion, so
    you're still looking at that?
        Dr. Zerhouni. We're still looking at that, but I do believe
    that we should not as a policy goal restrict interactions that
    are purely scientific or academic in any way, shape or form.

                               STOCK DIVESTITURE

        Senator Specter. Let us hear from Dr. James Battey, if we
    may. Dr. Battey, thank you for joining us. We know that there
    has been an issue as to divestment which has been problemsome
    for you with retention at NIH. Would you tell the subcommittee
    your situation?
        Dr. Battey. Absolutely. But let me preface my remarks by
    wishing you Godspeed in recovering from your illness, Senator
    Specter.
        Senator Specter. Well, thank you. Thank you.
        Dr. Battey. I have the greatest job in the world as far as
    I'm concerned right now. I've been the Director of the National
    Institute on Deafness and Other Communication Disorders for 8
    years, and I have enjoyed every single minute of it for 8
    years. But I manage a family trust on behalf of my mother and
    father, it's their sole source of income, as well as my two
    sisters, as well as educating my father's seven grandchildren.
    That is a responsibility that I must put before even the
    greatest job in the world. I cannot divest the stocks in that
    trust. The cost to my family would be very, very substantial,
    and that is not something that I am willing to entertain on
    behalf of my sisters, my father's seven grandchildren, and my
    mother and my father.
        Dr. Zerhouni. I should point out, Senator, that Dr. Battey
    at no time had any consulting activity with industry during his
    entire career. He's been one of the outstanding citizens of
    NIH.
        Senator Specter. Well, Dr. Zerhouni, did Dr. Battey's
    situation run afoul of the ethical guidelines which have
    recently been established?
        Dr. Zerhouni. Not all of them obviously. It really relates
    specifically to the obligation to divest, forced divestiture of
    all holdings related to the industries that relate to NIH.
        Senator Specter. Well, is that rule----
        Dr. Zerhouni. That's really what the issue is.
        Senator Specter [continuing]. In effect at NIH?
        Dr. Zerhouni. This rule is not in effect. It is proposed to
    be implemented by July 3. We have asked the Secretary and
    received a delay of 90 days. It was supposed to be activated 2
    months after the beginning of the rule on February 3. It was
    clearly obvious to us at NIH that this would have a deleterious
    impact. We've been requesting and informing the Department, I
    believe that the Secretary by delaying the implementation of
    this part of the rule, the forced divestiture, by 90 days, is
    giving us the opportunity to adjust accordingly.
        Senator Specter. If, Dr. Battey, if this rule is not
    promulgated and become final, can we save you from California?
        Dr. Battey. There are a set of circumstances under which I
    would entertain remaining with the National Institutes of
    Health. As I said before, I love this job, I think it's the
    greatest job in the world.
        Senator Specter. Well, we will leave to Dr. Zerhouni the
    exploration of those set of circumstances. But my telephone
    number is in the book.
        Dr. Battey. Senator, I very much appreciate your support.
        Senator Specter. Because as I had said earlier, very much
    concerned about the impact and I'm not faulting anyone. This is
    a tough area to move in, and there are bound to be unintended
    consequences. But with your record and your reputation, it
    would be very unwise, not helpful, to have the NIH lose you on
    this issue. I'm glad to see that Dr. Zerhouni and the others
    who are promulgating the rules are having a delay and will take
    these issues into account.
        Dr. Battey. Thank you. Let me just add that I agree 100
    percent with Dr. Zerhouni that it is absolutely essential that
    the Agency maintain the public trust and be a neutral broker in
    the eyes of all those who consult with us and ask us to give
    opinions in the area of biomedical research.
        Senator Specter. Well, I'm pleased to hear you say that,
    and let's see if we can't get it to work out to retain Dr.
    Battey and move ahead with the ethical guidelines in ways which
    are really meaningful and necessary.

                               STEM CELL RESEARCH

        Before Senator Harkin returns, Dr. Zerhouni, just a
    question or two about stem cells. Where are we heading? Are we
    going to be losing all of our stem cell geniuses to Europe, to
    California, to Massachusetts?
        Dr. Zerhouni. California right now is probably the State
    that has the most wide-ranging policy allowing research in the
    field of regenerative medicine. Clearly, when you look at the
    scientific evolution of this field, and as I've said before,
    from the purely scientific standpoint, there's no doubt that
    access to more cells is seen by scientists as very important to
    their progress.
        Much can be done with the cells available through NIH and
    they're federally funded through the current policy. However,
    it is clear that when you look forward, NIH is funding about
    $30 million worth of human embryonic stem cells and over $390
    million total in regenerative medicine. The California
    investment is about $300 million total, not just in embryonic
    stem cells. So it's not fair to say that the Federal investment
    is one-tenth of the California investment. That relates to the
    human embryonic stem cells. The California investment is not
    specific to just human embryonic stem cells.
        Senator Specter. Dr. Zerhouni, why shouldn't we utilize the
    stem cells which are frozen, several hundred thousand created
    for in vitro fertilization? They have the potential to save
    lives. Why shouldn't we use them for scientific research?
        Dr. Zerhouni. From the purely scientific standpoint,
    scientists will tell you, I will tell you that there are areas
    of research that could be advanced, especially when you look at
    the 22 cell lines that we have. There is mounting evidence that
    we have contamination issues that may prevent their use for
    clinical applications, other issues of genetic stability are
    also emerging.
        Clearly from the purely scientific standpoint, more cell
    lines may well be very helpful. The issue is not a scientific
    issue, as you well know. The issue is the policy is predicated
    on a moral and ethical line that says that we could not use
    Federal funds to remove the potential for life of these
    embryos.
        Senator Specter. Well, what is the moral and ethical line
    if they're going to be destroyed? If they could create life--
    Senator Harkin and I took the lead in appropriating funds for
    embryo adoption. People would take the embryos and utilize them
    to produce children, people. But if they're going to be
    destroyed, where is the moral issue?
        Dr. Zerhouni. I think you'll have to ask that from those
    who hold that view. I mean, obviously there are--there is a
    polarization of views on this issue. Some believe very strongly
    that an embryo is the beginning of life, and therefore, any use
    of that is inappropriate. Others obviously see the good on the
    other side. Every ethical issue is a balance between a social
    good and something that is seen by some as destructive.
        I think that debate needs to go on, needs to occur. It is
    occurring, I think, amongst yourselves as legislators. From a
    purely scientific standpoint we believe, and we've said so,
    that more lines may well be helpful to this research.
        Senator Specter. The legislation which Senator Harkin and
    Senator Feinstein, Senator Hatch, Senator Kennedy, and I have
    introduced bans cloning. We have the issue of nuclear
    transplantation, which does not come near the question of
    cloning. There are reportedly remarkable opportunities on
    nuclear transplantation to provide cures for the individual
    himself, herself, whose bodily substance is satisfied. Why not,
    Dr. Zerhouni?
        Dr. Zerhouni. Well, again, the issue here is Federal
    funding being used on the one hand to use discarded embryos, as
    you mentioned. Then the other is somatic cell nuclear transfer
    where you create an embryo. The issue here is fundamentally the
    use of Federal funds for this kind of research. It's not a
    scientific issue.
        Senator Specter. Well, I know the issue. The President's
    policy permits the use of some lines developed up to August 9,
    2001. But there is growing evidence that the stem cell lines
    available on the NIH registry are showing epigenetic and
    genetic changes in small regions of the chromosomes. This is a
    prepared statement, Dr. Zerhouni, so I'm reading. Deputy
    Senator Taylor just made this available to me and I want to ask
    you the question.
        I've been instructed to ask you this, Dr. Battey. When I
    get an instruction from Bettilou Taylor, I take it.
        Dr. Battey. I think that's very well-advised, Senator.

                     FEDERAL FUNDING FOR STEM CELL RESEARCH

        Senator Specter. Well, this is a joint question from Ellen
    and Bettilou and Tom and Arlen. All of those lines are being
    used to study basic biology of stem cells. Their use in
    clinical applications is questionable. There is confusion among
    scientists and administrators at universities where scientists
    have both Federal and non-federal funding for stem cell
    research about exactly what research infrastructure or core
    facilities developed with NIH funds in the past can be used in
    studies involving stem cells not eligible for Federal funding.
        Dr. Battey, in addition to the position which you
    identified, and until last week you were chair of the NIH Stem
    Cell Task Force, what is your view of the current limitations
    of Federal funding?
        Dr. Battey. Senator, the state of the science is moving
    very, very rapidly here, and we have learned many things since
    the last time I had an opportunity to testify before this
    subcommittee. For example, scientists at the University--or in
    the city of Chicago have now made stem cell lines from embryos
    that were identified in pre-implantation genetic diagnosis to
    harbor mutations that cause disease.
        These stem cell lines could potentially be used to create
    cellular model systems that would allow the development of
    drugs to treat these diseases. I'm talking about diseases like
    muscular dystrophy and Huntington's disease. These cell lines,
    however, were all created after August 9, 2001, and are
    therefore ineligible for Federal funding.
        The issue you mentioned about funding streams, it's a real
    issue. Let me give you an example. Imagine for the sake of
    argument an investigator who has a cell line he got from Doug
    Melton, it's not eligible for funding, and a cell line from
    Wisconsin that is. That investigator extracts messenger RNA
    from those two cells and then wants to go to his core facility
    for doing a study of what's been expressed in terms of gene
    expression that was funded initially by support from the
    National Institutes of Health. Can that investigator analyze
    that sample in that facility?
        These are the sorts of complex issues that are now arising
    on a daily basis in places where there are substantial amounts
    of funding for stem cell research that is outside the confines
    of that which can be funded using Federal dollars.
        Senator Specter. Well, thank you very much, Dr. Battey.
    Senator Harkin has this on his agenda, and I'm going to excuse
    myself at this point and turn the hearing over to my
    distinguished colleague, Senator Harkin. We often say that when
    the gavel changes hands, it's seamless. Show them, Tom. We have
    had a unique partnership in this contentious Senate and
    Congress to put aside party differences in the interests of
    moving ahead on a factual basis. I think the American people
    are really sick and tired of the bickering, and Senator Harkin
    and I have, I think, established the kind of a relationship
    which is in the public interest. It's all yours, Tom.
        Senator Harkin [presiding]. The only follow-up I had with
    Senator Specter's question for you, Dr. Battey, was on the
    scientific basis of this. Now, I don't know what all these
    words mean, but your statement says: ``there's growing evidence
    that the HESC lines available on the NIH human embryonic stem
    cell registry are showing epigenetic and genetic changes in
    small regions of the chromosomes.'' Please explain what that
    means.

                 EXPLANATION OF EPIGENETIC AND GENETIC CHANGES

        Dr. Battey. I'll try to explain as best as I can. A genetic
    change, Senator, is an actual change in the order of bases in
    the DNA sequence itself. An epigenetic change is a change that
    involves marking on those DNA bases that have implications for
    which genes get expressed and under what circumstances. What is
    becoming increasingly apparent is that as the cells are
    cultured for prolonged periods of time, we are observing both
    small genetic changes as well as epigenetic changes. This does
    not come as any great surprise to a cell biologist, and in fact
    is observed almost any time you culture cells for prolonged
    periods of time.
        The reason for that is, although all the words are
    complicated, the reason is very simple and easy to grasp, and
    that's that when you grow cells in culture, you are continually
    selecting for a more rapidly growing cell. That is intrinsic to
    the process of passaging and growing cells.
        So it is inconceivable to me that you would not evolve
    changes that would confer a growth advantage as you culture
    cells over prolonged periods of time. In fact, what is
    remarkable is how stable these embryonic stem cell lines are
    over time. The fact--but nevertheless, these changes will
    evolve if you culture the cells for maybe 50, 75, or 100
    passages.
        Senator Harkin. To my layman's mind, it seems what you're
    saying is that somehow this would affect their use in any kind
    of further down-the-road treatment in humans?
        Dr. Battey. That we don't know. That is not clear yet. If
    the changes, however, move the cell towards a more rapidly
    growing state, it is possible that you would have a cell that
    would evolve a genetic change that would take it one step
    closer to becoming a tumor of the stem cells, which is a
    teratoma. I think that's the major concern.
        Dr. Zerhouni. Senator, the best analogy--sorry.
        Senator Harkin. No, go ahead. Yes, please.
        Dr. Zerhouni. The best analogy to this is the one I had to
    come up with to explain this in layman's terms. That is that
    if, suppose you have an original document and you want to make
    Xerox copies of that document, and you make billions of copies
    each generation from the previous document. What may happen is
    that after the 150th generation, after making billions of
    copies of the DNA, you'll have errors, and you'll have a poorer
    copy and a poorer copy and a poorer copy as you go forward.
        At the onset of this field, 5 or 6 years ago, everyone
    thought that stem cells were renewable in a perfect state, as
    if you had a perfect copy each time. Well, as the science has
    advanced and our methods of measurements have become more
    accurate, we are finding that in fact there are errors that
    occur over the transmission of information through that copying
    process. That may, in fact, have profound implications as to
    the viability of an experiment and the viability of the use of
    these over a long period of time.
        Senator Harkin. Again, in my layman's mind, it sounds like
    that argues for getting as many stem cell lines as possible.
        Dr. Zerhouni. From a scientific standpoint, I think there
    are lots to be learned. In addition to the new science that has
    occurred recently, in terms of disease-specific cell lines that
    could be used such as the lines that Dr. Battey mentioned that
    have specific diseases in them, so that you could use that to
    study that disease process in a laboratory. From the scientific
    standpoint, this might be helpful.
        Senator Harkin. I just had a couple of other questions that
    I really wanted to go over here. Dr. Zerhouni, one of them had
    to do with, again, the success rate down to 21 percent overall.
    I noticed that at NCI, National Cancer Institute, it's 19
    percent. At NCCAM it's 8 percent. I'm concerned about, again,
    what message this sends to young investigators who have a
    particularly hard time winning grants when money gets tight.
        If a young med school student with huge loans to pay knows
    he faces only a 1-in-5 or a 1-in-10 chance of getting a grant,
    he or she may want to think twice about whether they want to
    enter this career. Would you just speak if you can for a little
    bit on the impact that you might see that a 21 percent success
    rate would have on your ability to attract young scientists to
    medical research?

                            NATURE OF SUCCESS RATES

        Dr. Zerhouni. Again, the 21 percent success rate reflects
    two facts. One is the doubling has been very successful in
    attracting a larger number of excellent scientists to NIH. So
    the number of applications has in fact increased over time. I
    wanted to show you again the graphic there. The black line
    shows the number of applications rising all the way to 44,000.
    So we have more--go ahead.
        Senator Harkin. Now, are those applications or are those
    peer-reviewed applications that are----
        Dr. Zerhouni. Peer-reviewed applications.
        Senator Harkin. Peer-reviewed.
        Dr. Zerhouni. Right. The applications----
        Senator Harkin. Not the total. These are just the----
        Dr. Zerhouni. These are the ones that are peer-reviewed by
    NIH that are----
        Senator Harkin. Made it through.
        Dr. Zerhouni. Made it to review. Of those, we funded 32
    percent in 2001, 25 percent in 2004, and 22 and 21. Obviously
    if the number of applications had stayed level, our success
    rate would have been higher. But the fact is we have more areas
    of research that we are into today than we were 5 or 10 years
    ago.
        Now, your concern about young scientists is my concern as
    well. As you may know, I have requested a study from the
    Institute of Medicine. Two years ago we engaged our advisory
    councils about the issue of the lengthening of the time it
    takes for a young scientist today to be independent and to have
    their own research ideas worked on. Thirty years ago, 27
    percent of our NIH grantees were 35 years or younger. Today,
    less than 4 percent of our NIH grantees are 35 years or
    younger.
        That reflects two things--I'm sorry.
        Senator Harkin. What was that year cut-off?
        Dr. Zerhouni. 30 years ago.
        Senator Harkin. 30.
        Dr. Zerhouni. 27 percent of our scientists 30 years ago
    were younger than 35 years of age. Today it's 4 percent. On
    average when you look at the first grant, median is about 39,
    40 years of age. This to me is a little too long. I really
    believe that there is a lot of creativity that occurs early in
    a scientific career.
        The effect is twofold. One is the lengthening of the
    training period, but also the competitiveness of our grant
    process. That's why a 21 percent success rate, if not balanced
    by new grants, as I've done, and if not carefully managed, can
    lead to a loss of talent.
        Think about it this way, Senator. If you're a 25-year-old
    scientist and you look at your career and you have to wait
    until age 39 to have a chance to get a grant from NIH, you
    might consider other career tracks. That to me is the one thing
    that I worry the most about. We're going to consider very
    carefully the IOM recommendations and try to do the best we can
    within the fiscal constraints that we have.
        But I think it is a trend, Senator, that all of us have to
    be aware of, and that is the plight of the young scientist, not
    just in biomedical sciences, by the way, Senator. It affects
    science and technology in general.
        Senator Harkin. It seems to me in my memory bank someplace,
    that this has been a discussion point in the past. Do you have
    a fund in the Director's office or something like that where--
    who was it termed it the ``ah-ha'' fund? Some young scientist
    says ah-ha, I got this idea, and you can kind of pick some of
    these young people and say, oh, they're on to something maybe,
    maybe, we don't know. But don't you have some fund like that?
    Is there something at NIH that allows that to happen under your
    direction?

                           VARIOUS SOURCES OF FUNDING

        Dr. Zerhouni. I do not have a fund for that. But through
    the Roadmap, we've established a Pioneer Award to try to in
    fact encourage that, to try to find out if there are scientists
    out there that we're not funding through the process.
        Institutes themselves, by the way, through loan repayment
    programs, career award developments, K-22 awards, all kinds of
    mechanisms are responsive to a different degree to this issue
    of the young scientists. We have Shannon awards, which provide
    a young scientist with transitional dollars.
        I think, as the IOM recommends, it's time for us to look at
    all of our policies across NIH and find out, especially in
    tougher times, what we need to do proactively to in my view
    protect the pipeline of talent that 20 years from now will be
    the discoverers of the new cures and new treatments and new
    knowledge that we need.
        We have a retreat with the NIH directors planned later this
    year to talk just about this as well. We have discussed this
    issue amongst ourselves quite a bit, as we are concerned about
    it.

                                AVIAN INFLUENZA

        Senator Harkin. I'll look at that some more myself, see if
    there's some way we can set something up like that. There were
    a couple of other areas I wanted to cover, one for Dr. Fauci
    and one for Dr. von Eschenbach. I'll start with Tony.
        A lot of stuff being written about avian flu. Why is the
    spread of this avian influenza so alarming? What steps is the
    Institute taking to address this issue?
        Dr. Fauci. Well, thank you for that question, Senator
    Harkin. It's a very important public health issue. The concern
    surrounding the avian flu threat that we are currently
    undergoing now relates to the fact that the situation in
    countries in Southeast Asia, particularly Thailand, Vietnam,
    and to a lesser degree Cambodia, is that there a virus called
    H5N1 circulating among chicken flocks. That is the way we
    designate influenzas by an H and an N, which are two of the
    proteins that are the important identification markers.
        The regular flu that's circulating around this winter was
    an H3N2, a totally human influenza virus. The H5N1 is a bird
    flu. It has been infecting and killing large numbers of
    chickens in Asia. But what has happened over a period starting
    from the first identification in 1997 in Hong Kong of H5N1,
    which infected 18 people by jumping from the chicken to the
    human, and killing six of those, over the past year-and-a-half,
    in 2003 and now in a very accelerated way in 2004 and 2005,
    we've now had larger numbers of chickens infected and larger
    numbers of people. As of last night's count, there were 79
    official cases confirmed and 49 official deaths confirmed.
        Now, that may seem like a small number, but first of all,
    the mortality is very high, and second, there's a transition of
    the viruses getting a greater efficiency of spreading from the
    chicken to the human. Then what we're very concerned about is
    human-to-human spread. That has not occurred efficiently up to
    this point. There is at least one documented case in Thailand
    of a mother who got it from her 11-year-old child who, the
    child got it from the chicken, but the mother actually got it
    from the child.
        If there is increased efficiency of spread from person to
    person, we have the possibility of what we call a pandemic.
    Now, that means that the society in general, our civilization,
    doesn't have any baseline immunity to H5N1, because unlike
    H3N2, where each year we get exposed to one variety or another
    of that strain, we get vaccinated or we get infected, so that
    our society has some degree of background immunity to an H3N2.
    We have zero background immunity to H5N1.
        So the possibility of there being rampant spread,
    particularly with the high mortality that we're seeing right
    now, is a very sobering prospect that we're looking at. What
    are we doing about it?
        Senator Harkin. So the flu shot I got does not protect me
    from----
        Dr. Fauci. Not even a little bit. Not even a little bit.
    So--but don't worry because there's not H5N1 right here now.
    But we're concerned about it.
        So what are we doing about it? The NIH component of the
    broader Department of Health and Human Services pandemic flu
    preparedness plan is the research limb. You know, the CDC does
    the surveillance, the identification, the public health
    measures. The FDA does the regulation of the vaccines and the
    drugs that we're screening for, and that's all done under the
    Office of Public Health Emergency Preparedness.
        What we're doing is fundamental basic research on the
    virus, understanding its virulence and pathogenesis, getting
    sequence data on all of the various strains so that we can make
    them available to investigators to do things like screening for
    drugs, targeting for drugs, and the development of vaccines.
        Probably the thing that's of most practical concern to you
    and the committee and the general public is that we have moved
    very rapidly in identifying the H5N1 using a particular
    molecular technique developed by one of our grantees to develop
    a seed virus. Two weeks ago, we started the screening for a
    trial. Last week we gave the first injections, and as of
    yesterday, we have over 150 people enrolled in a phase 1 trial
    of H5N1 in three centers in our network of vaccine centers in
    Rochester, New York, UCLA, and Baylor, I believe.
        We have now data that we're going to be collecting on the
    safety, what is the proper dose of the vaccine, and what is the
    difference in the immunogenicity in normal adults. That will be
    finished within a period of a couple of months, people from 18
    to 64. Then we're going to move on to people greater than 65,
    and then we're going to do it in children.
        In addition, finally, as part of the departmental program,
    we've purchased 2 million doses for the strategic national
    stockpile of H5N1 in anticipation of being able to scale this
    up in commercialized lots, not just thousands or millions, but
    tens of millions if we need it.
        Finally, the Department's plan is to stockpile Tamiflu,
    which is the antiviral to which this particular virus is
    susceptible.
        Senator Harkin. What did you say?
        Dr. Fauci. Tamiflu. The regular name for it is Oseltamivir.
    It's an anti-influenza drug.
        Senator Harkin. I'm glad you've cleared that up for me.

                  TRAVEL RISKS ASSOCIATED WITH AVIAN INFLUENZA

        Well, now, the only follow-up question I have is--okay, so
    we're not exposed to avian influenza, but they are in Southeast
    Asia. How concerned should we be of people traveling back and
    forth, picking up the virus, bringing it back here, and
    transmitting it?
        Dr. Fauci. At this point not. But the CDC, together with
    WHO, is heightening in a very accelerated way their
    surveillance mechanism in Southeast Asia. Since the virus does
    not transmit efficiently at all from human to human, it is
    extraordinarily unlikely that you would have a situation where
    someone would be infected, that most likely would be a chicken
    farmer, who would then get on a plane and come to Washington.
        So the chance of that is extremely unlikely. For that
    reason, there are no public prohibitions on travel with regard
    to this.
        I just want to mention one thing, I just thought of it. I
    gave you--just because I want the record to be correct--the
    other center that's doing the trial is not Baylor. It's the
    University of Maryland in Baltimore.
        Senator Harkin. Thanks very much, Dr. Fauci.
        Dr. Fauci. You're welcome.

                          HUMAN CANCER GENOME PROJECT

        Senator Harkin. Dr. von Eschenbach, I want to ask something
    Dr. Jim Watson brought up to me a couple of times, and that has
    to do with the human cancer genome project.
        Dr. von Eschenbach. Yes, sir.
        Senator Harkin. About the need for that kind of effort. I
    understand that NCI and the Human Genome Research Institute,
    Dr. Collins, have teamed up on an effort called the human
    cancer genome project. Just what is this? What are you doing?
    Tell me about this.
        Dr. von Eschenbach. Well, thank you, Senator, for the
    question, and also thank you very much for your passion and
    concern for patients, especially cancer patients. This effort
    is intended to address much of our opportunity in understanding
    cancer. We know, though it is a series of complex diseases, it
    is also a disease process. There is a portion of that process
    that defines our susceptibility to cancer and then the
    development and progression of that cancer to the point where
    it causes the suffering and death that we see all around us.
        So we're trying to understand that cancer process. We're
    trying to understand it at the very fundamental genetic and
    molecular and cellular level as to why and how we're
    susceptible to different cancers, how and why they develop and
    then progress in some patients to the point that they actually
    take our life.
        We have a series of investigations to understand that
    process. We're trying to understand it at the genetic level and
    also understand it at the molecular and proteomic level. We've
    even launched recently an effort in nanotechnology to begin to
    utilize that field to understand the process.
        The specific project that you are referring to is one of
    those initiatives where we are teaming up with another NIH
    Agency, the National Human Genome Research Institute, to co-
    partner in an effort to understand and to determine all the
    genetic changes and mutations that determine our susceptibility
    to cancer and define the development of cancer.
        We believe that if we understand those genes and those
    genetic changes, we'll be able to use that knowledge and that
    information to be able to select and screen patients to
    determine susceptibility, to be able to define the risk that
    one has for a particular type of cancer, so that we then have
    that knowledge and can use that to intervene earlier in a way
    to try to prevent that process from occurring. Also to be able
    to use the knowledge of those genetic changes so that we can
    find better methods to detect the development of cancer,
    because if we can pick up the development of those genetic
    changes and know that cancer is now starting in someone's body,
    we could then eliminate that cancer when it's still very early
    and do that much more safely and much more easily.
        If we can detect and eliminate cancer early, we could
    eliminate the outcome of cancer, the suffering and death that
    we see. So this is one initiative that we believe holds great
    promise for achieving the goal of 2015, the elimination of
    suffering and death due to cancer.
        Senator Harkin. So you've embarked on this and----
        Dr. von Eschenbach. It's in process of development, sir.
    And we have a pilot project that we are in the midst of
    planning and developing so that we can create the
    infrastructure for a broader application of this.
        Senator Harkin. So when we meet again here later on, you'll
    be able to keep us updated as to what the progress of this is?
        Dr. von Eschenbach. Absolutely, sir.
        Senator Harkin. I appreciate that very much. I really don't
    have any more time. Did anybody else have any--Dr. Zerhouni,
    did you have anything else you wanted to add for the record?
        Dr. Zerhouni. No. I really appreciate the questions you've
    posed today.
        Senator Harkin. Thank you. Again, I apologize for jumping
    on you on the conflict of interest, but I hope there's some
    people here from HHS, because that's really who I was directing
    it at.
        But I'll say, we need you in forefront of this too. This is
    your NIH.
        Dr. Zerhouni. I certainly am.
        Senator Harkin. I just don't think we can afford to
    continue to put this off. We've got to address it right away.
        Dr. Zerhouni. I think you've heard me, sir.
        Senator Harkin. I know, and I appreciate that. Thank you
    all very much for the great job you do. Hopefully we can get
    that .5 up, but I don't know. We'll try our best.
        Dr. Zerhouni. Thank you very much.

                         ADDITIONAL SUBMITTED STATEMENT

        Senator Harkin. Thank you all very much.
        The subcommittee has received a statement from The National
    Alliance for eye and Vision Research which will be placed in
    the record.
        [The statement follows:]

    Prepared Statement of The National Alliance for Eye and Vision Research

        The National Alliance for Eye and Vision Research (NAEVR) is
    pleased to submit this written testimony to the file of the April 6,
    2005, hearings of the Labor, Health and Human Services, Education and
    Related Agencies Subcommittee of the Senate Appropriations Committee.

                                  ABOUT NAEVR

        Founded in 1997, NAEVR is a non-profit advocacy organization
    comprised of 50 professional, consumer and industry organizations
    involved in eye and vision research. NAEVR's goal is to achieve the
    best vision for all Americans through advocacy and public education
    about the value and cost-effectiveness of eye and vision research
    sponsored by the National Institutes of Health (NIH), the National Eye
    Institute (NEI) and other federal research entities.

    NAEVR REQUESTS FISCAL YEAR 2006 NIH FUNDING AT $30 BILLION TO MAINTAIN
                           THE MOMENTUM OF DISCOVERY

        Although NAEVR realizes that Congress faces an expanding set of
    challenges at home and abroad, we join the community of support for
    medical research in requesting Congress to fund the NIH at $30 billion
    in fiscal year 2006, or a 6 percent increase over the fiscal year 2005
    level, to maintain the momentum of discovery. NAEVR believes that the
    NIH has made tremendous contributions that have served to improve the
    quality of lives for millions of Americans and contain healthcare
    costs.
        NAEVR commends Chairman Specter's leadership in introducing Senate
    Amendment 173 to the fiscal year 2006 Senate Budget Resolution that
    would add $1.5 billion to the NIH beyond that proposed in the
    administration's budget, to a level of approximately $30 billion. NAEVR
    also recognizes the leadership demonstrated by the full Senate in
    successfully passing the amendment and Senate Budget Resolution, and we
    strongly urge the Senate and House conferees to maintain this number in
    the conference bill.
        Congress' past bipartisan leadership in doubling the NIH budget
    from fiscal year 1998 to fiscal year 2003 has had a profound impact on
    the health care of all Americans, in terms of earlier, more accurate
    diagnosis of disease; more targeted, effective treatment options; more
    comprehensive, cost-effective prevention strategies; and the
    transformation of acute diseases to chronic, manageable diseases. With
    this basis, NIH has plans to further transform how basic and clinical
    research is conducted through initiatives such as the NIH Roadmap for
    Medical Research (the NEI is a lead Institute on the Nanomedicine
    project) and NIH Neuroscience Blueprint, in which 15 Institutes are
    engaged, including the NEI.
        NAEVR commends NIH Director Dr. Zerhouni for his leadership in
    eliminating roadblocks that prevent collaborative research and using
    NIH-directed dollars in a cost-effective manner. However, his efforts
    to maximize the return on medical research dollars can only go so far.
    For example, in the fiscal year 2006 funding process, NIH would need an
    increase of at least 3.5 percent just to keep pace with the Biomedical
    Research and Development Price Index (BRDPI). Since the fiscal year
    2006 funding level in the administration's budget proposal would
    represent the third year in which the NIH would not keep pace with
    inflation, the gains realized from the past investment in the NIH will
    be jeopardized.
        In summary, to ensure that NIH's momentum is not eroded further,
    and to continue the fight against diseases and disabilities that affect
    millions of Americans, NAEVR requests that Congress seek an NIH budget
    of at least $30 billion in fiscal year 2006.

     NAEVR REQUESTS FISCAL YEAR 2006 NEI FUNDING AT $711 MILLION AS VISION
               HEALTH IS A ``TOP PRIORITY'' AMONG MANY PRIORITIES

        NAEVR requests that Congress fund the NEI at $711 million in fiscal
    year 2006, or a 6 percent increase over fiscal year 2005. This
    ``Citizens Budget'' for the NEI represents the eye and vision research
    community's judgment as the level necessary to advance the
    breakthroughs resulting from NEI's basic and clinical research that
    will result in treatments and therapies to prevent eye disease and
    restore vision.
        In presenting this request, NAEVR asks Congress to make this
    nation's vision health a ``top priority'' among the many priorities it
    faces in the fiscal year 2006 funding cycle for the following reasons:
      --Eye and vision research responds to the nation's top public health
            challenges and touches the lives of all Americans.
      --The eye is a unique biological system offering exceptional
            experimental advantages in which to conduct genetic,
            neuroscience and cellular mechanism research.
      --Vision impairment and eye disease is a major public health problem
            that is growing and which disproportionately affects the aging
            and minority populations.
      --The economic and societal costs of vision impairment and eye
            disease are significant and growing; adequately funding the NEI
            is a cost-effective investment in our nation's health.
      --Past NEI-funded basic and translational research is resulting in
            treatments and therapies to slow the progression of vision loss
            and restore vision.

      EYE AND VISION RESEARCH RESPONDS TO THE NATION'S TOP PUBLIC HEALTH
               CHALLENGES AND TOUCHES THE LIVES OF ALL AMERICANS

        Dr. Zerhouni has identified the NIH's top public health challenges
    as an aging population; chronic diseases; health disparities; emerging
    diseases (primarily co-morbidities); and biodefense. NEI is responding
    to all of these challenges as they relate to eye and vision research:
      --Not only has the NEI sponsored studies to characterize the
            incidence of age-related eye diseases such as age-related
            macular degeneration (AMD), glaucoma, diabetic retinopathy and
            cataracts, it sponsors extensive research into the cause and
            potential prevention of and treatments for these chronic
            diseases.
      --Working with the National Center on Minority Health and Health
            Disparities (NCMHD), the NEI has sponsored studies to
            characterize vision impairment and eye disease disparities to
            direct further research--whether into the underlying
            physiological cause and potential concomitant therapy, or to
            the socio-economic or access issues that may enable it to focus
            its public health education programs.
      --NEI has taken its basic research on diabetic retinopathy, a co-
            morbidity of diabetes, and tested treatments through a Clinical
            Trials Network. This optimal example of translating basic
            research ``from bench to bedside'' has resulted in treatments
            that are more than 95 percent effective and save the United
            States $1.6 billion annually.
      --Going beyond the traditional focus on battlefield visual acuity,
            NEI's biodefense research has resulted in new therapies to
            treat infectious eye diseases and promote corneal healing.
        While addressing the nation's top public health challenges, NEI
    research also touches all Americans, whether directly or through loved
    ones. NEI research has the potential to ensure the best vision health
    of individuals at all stages of life--from newborns to the most
    elderly?thereby ensuring their independence, productivity and quality
    of life.

    THE EYE IS A UNIQUE BIOLOGICAL SYSTEM OFFERING EXCEPTIONAL EXPERIMENTAL
       ADVANTAGES IN WHICH TO CONDUCT GENETIC, NEUROSCIENCE AND CELLULAR
                               MECHANISM RESEARCH

        As the entire medical research community gains a better
    understanding of the genetic basis of disease, the eye emerges as a
    unique biological system in which to study cellular mechanisms and
    pathways. The eye and vision community is at the forefront of genetic
    research, as the eye offers accessibility and a system in which one can
    measure the potential effect from a treatment. For example, NEI-
    sponsored researchers have recently announced the discovery of a gene
    strongly associated with a person's risk of developing AMD, which is
    the leading cause of vision loss in older Americans. This may enable
    researchers to develop tests for the disease before symptoms begin to
    appear and when drug therapies might help slow its progress.
        Since the retina is a direct outgrowth of the brain and nerve cells
    underlie the ability to process vision, the eye also serves as an
    important system in which to study neurodegenerative diseases. For
    example, NEI-funded researchers have recently announced the
    regeneration of the optic nerve in mice, which could potentially result
    in treatments for Americans blinded by glaucoma or other injuries that
    destroy the optic nerve, as well as for other Central Nervous System
    disorders.

    VISION IMPAIRMENT AND EYE DISEASE IS A MAJOR PUBLIC HEALTH PROBLEM THAT
         DISPROPORTIONATELY AFFECTS THE AGING AND MINORITY POPULATIONS

        Over the past 40 years, Americans have consistently identified fear
    of vision loss as second only to fear of cancer in public opinion
    polls. In recent NEI-sponsored research, patients with advanced AMD
    equated that condition to the gravest chronic diseases. These societal
    implications of vision impairment and eye disease are important since,
    as of the year 2000 census, there were more than 119 million Americans
    age 40+ who are most at risk from age-related eye disease such as AMD,
    glaucoma, diabetic retinopathy and cataracts.
        In 2004, an NEI-sponsored study reported that vision loss from eye
    diseases will increase as Americans age. Also in 2004, the NEI reported
    on an African American subset analysis in its Ocular Hypertension
    Treatment Study (OHTS) and initial findings from its Los Angeles Latino
    Eye Study (LALES), both of which were co-sponsored by the NCMHD.
    Combined, these three studies reported that:
      --Blindness or low vision currently affects 3.3 million Americans age
            40+, or 1 in 28, and is projected to reach 5.5 million by year
            2020.
      --Age-related eye diseases currently affect more than 35 million
            Americans age 40+, and include intermediate-to-advanced AMD,
            glaucoma, diabetic retinopathy and cataracts. This number is
            projected to increase to about 50 million by the year 2020.
      --More than 1.8 million Americans currently have advanced AMD, and
            this number is expected to grow to 3 million by the year 2020.
            Another 7.3 million Americans currently have intermediate-stage
            AMD. Currently, 200,000 Americans each year develop advanced
            AMD, and this number is expected to double by 2020. Because AMD
            affects the part of the eye called the macula, which is
            necessary for central vision, it affects a person's ability to
            read and drive. This has an enormous impact on quality of life
            and independence for older Americans.
      --Glaucoma, a chronic potentially blinding disease that requires
            life-long treatment to control it, currently affects 2.2
            million Americans, with 3.3 million expected to develop it by
            the year 2020. Glaucoma is now the leading cause of blindness
            in the fast-growing Hispanic population age 65+. Glaucoma is
            almost three times as common in African Americans as in White
            Americans and is the leading cause of blindness in the African
            American population.
      --Diabetic retinopathy is the leading cause of blindness in the
            industrialized world in people between ages 25 and 74. It
            currently affects 4.1 million Americans age 40+, or one out of
            12 Americans with diabetes in that age group, and is expected
            to increase to 7.2 million by the year 2020. Although
            successfully treatable in more than 95 percent of cases, many
            people do not know they are diabetic until symptoms, such as
            vision loss, occur. And with estimates of 50 million Americans
            having diabetes by the year 2020 at a yearly cost of $1
            trillion, and one-third of all American children born in year
            2000 developing it in their lifetimes, there will be increasing
            demand for research into new treatments and prevention
            therapies.
      --Cataracts, which are the leading cause of low vision, currently
            affect nearly 20.5 million Americans age 65+, which is
            projected to increase to 30.1 million Americans by the year
            2020. In the United States, a cataract is widely treatable by
            removing the natural lens and implanting an intraocular lens
            (IOL). However, in the rest of the world, cataracts are the
            leading cause of blindness due to lack of access to adequate
            care.
        The past investment in the NEI's basic research has yielded
    breakthrough discoveries in the potential cellular mechanisms that
    result in these diseases, and its clinical research has resulted in an
    array of treatments for these conditions. However, the expanding
    population at risk for eye and vision disease will demand new and more
    effective therapies that restore vision or ultimately prevent the onset
    of these diseases. Adequately funding the NEI now ensures that its
    basic and clinical research ``in the pipeline'' comes to fruition and
    can be responsive to this growing public health problem.

     THE ECONOMIC AND SOCIETAL COSTS OF VISION IMPAIRMENT AND EYE DISEASE
          ARE SIGNIFICANT; FUNDING NEI IS A COST-EFFECTIVE INVESTMENT

        Although the NEI estimates that the current annual cost of vision
    impairment and eye disease to the United States is $68 billion, this
    number does not fully quantify the impact of lost productivity and
    diminished quality of life. And as noted above, this financial burden
    to both the public and private sector is expected to increase
    dramatically, primarily due to an aging population and the growing
    prevalence of eye diseases that result in vision loss.
        Adequately funding the NEI can delay, save and prevent
    expenditures, especially those associated with the Medicare and
    Medicaid programs, and is, therefore, a cost-effective investment. For
    example:
      --As previously cited, the NEI-sponsored Early Treatment Diabetic
            Retinopathy and Diabetic Retinopathy studies have saved as much
            as $1.6 billion per year in costs of blindness and vision
            impairment and resulted in treatments that are more than 95
            percent effective.
      --NEI-funded researchers have developed treatments for Retinopathy of
            Prematurity (ROP), a blinding complication in premature babies.
            As a result, more than 1,500 infants born this year with the
            most serious form of this condition can experience sighted
            lives, which would have cost the government $1 million in
            benefits and lost taxes over the lifetime of each child.
      --Economists estimate that cataract surgery provided Americans over
            $300 billion in benefits in 2003 alone.
        Funding the NEI at $711 million in fiscal year 2006 is a cost-
    effective investment, as it will directly save healthcare expenses and
    return individuals to productive roles in society.

     PAST NEI-FUNDED RESEARCH IS RESULTING IN TREATMENTS AND THERAPIES TO
             SLOW THE PROGRESSION OF VISION LOSS AND RESTORE VISION

        The NEI has an impressive record of accomplishment over the past 5
    years, as documented in its National Plan for Eye and Vision Research.
    Some of the most exciting developments that have widespread
    implications for Americans of all ages and races include:
      --NEI is conducting additional clinical trials on nutritional
            supplements that may slow the progression of AMD, following
            previous research demonstrating that zinc and three antioxidant
            vitamins are effective in reducing vision loss in people at
            high risk for developing advanced AMD.
      --An NEI-sponsored study has found that eye injections of bone-marrow
            derived stem cells prevented vision loss in two rodent models
            of Retinitis Pigmentosa (RP), a family of eye diseases that
            cause vision loss. This study raises the possibility that
            patients could receive an injection of their own bone marrow
            stem cells to preserve central vision.
      --NEI-supported investigators are moving closer to human clinical
            trials of a gene therapy to treat neurodegenerative eye
            diseases, including Leber Congenital Amaurosis (LCA), which is
            a rapid retinal degeneration that blinds infants in the first
            year of life. Previous research has restored vision in dogs
            with LCA. This gene therapy not only has direct implications
            for the 9 million Americans affected by AMD, RP, Usher Syndrome
            and the entire spectrum of retinal degenerative diseases, but
            can potentially lead to therapies for glaucoma, diabetic
            retinopathy and cataracts.

                                   CONCLUSION

        NAEVR supports fiscal year 2006 NIH funding at $30 billion to
    ensure that our nation's medical research infrastructure can maintain
    its momentum of discovery. NAEVR also requests that Congress make our
    nation's vision health a ``top priority'' among many priorities by
    funding the NEI at $711 million in fiscal year 2006. NEI-funded
    research results in therapies that reduce health expenses and return
    individuals to productive lives. It is a cost-effective investment in
    maintaining the momentum of discovery and vision health for all
    Americans.

                         ADDITIONAL COMMITTEE QUESTIONS

        Senator Harkin. There will be some additional questions
    which will be submitted for your response in the record.
        [The following questions were not asked at the hearing, but
    were submitted to the Department for response subsequent to the
    hearing.]

                  Questions Submitted by Senator Arlen Specter

                                OBESITY RESEARCH

        Questions. Last year, NIH announced release of a comprehensive
    Strategic Plan for Obesity Research. What initiatives have you
    undertaken, particularly to address the critical problem of childhood
    obesity, since release of this plan?
        Answer. The NIH is pursuing a broad spectrum of research avenues
    consistent with the recommendations in the Strategic Plan for NIH
    Obesity Research. An important area of focus of these efforts is
    childhood obesity, to address the serious impact obesity has on
    children--potentially leading to a lifetime of serious health problems.
    Highlights of such efforts include fostering new research on prevention
    and treatment of pediatric obesity in primary care settings and other
    site-specific settings, which may include the home, day-care, school,
    or other community venues. In another effort, the NIH is beginning a
    project to develop a rating system for youth obesity-related policies.
    The current effort involves developing, for use as a research resource,
    a system to rate factors associated with physical activity and
    nutrition that are addressed by such policies. Such factors may
    include, for example, aspects of physical education or recess in
    schools. Once developed, this research resource would then be made
    available to investigators as a tool to facilitate analysis of the
    relative impacts of these factors on behaviors relevant to obesity.
    This effort would encompass policies at both the state and local
    levels. In developing this research resource, the NIH is coordinating
    with the CDC and other organizations which are supporting related
    efforts.
        Other recently-launched NIH research would impact obesity in both
    adults and children. For example, the NIH is encouraging new studies to
    address the influence on obesity of factors in the ``built
    environment,'' such as aspects of community design that may hinder
    physical activity. An upcoming conference will focus on environmental
    factors and obesity in youth. Improved technologies would facilitate a
    wide range of investigations. Such improved technologies would
    encompass, for example, the areas of more accurately measuring calorie
    consumption (energy intake) and physical activity (energy expenditure),
    and monitoring whether a person's energy intake and expenditure match
    (a state of energy balance) or whether one is greater. Thus, the NIH
    released research solicitations to bring innovative bioengineering
    technology to address issues in energy balance, intake, and
    expenditure. Capitalizing on major ongoing NIH research investments,
    the NIH is continuing to solicit proposals for ancillary studies to
    several existing obesity-related clinical trials and networks; the NIH
    is also encouraging other productive partnerships between basic and
    clinical researchers. Interdisciplinary research focused on obesity is
    also being enhanced as a result of a recent NIH Roadmap initiative to
    support new Exploratory Centers for Interdisciplinary Research; several
    of these centers will focus on obesity. The NIH is also continuing to
    pursue genetic studies of obesity. Efforts are underway to develop an
    Intramural Obesity Clinical Research Center, on the NIH campus, to
    generate new knowledge regarding the prevention, treatment, and
    underlying molecular mechanisms of obesity and its associated diseases.
    Intramural-extramural collaboration will be a focus of these efforts.
        Examples of efforts currently being developed include a new
    initiative to study how factors such as maternal weight during
    pregnancy can lead to obesity in offspring. Another effort is being
    planned to support collaborative research on the neurobiological basis
    of human eating behavior, bridging the gap between understanding at the
    genetic and molecular level of neural pathways involved in food intake
    and the understanding of behavioral influences on human obesity.

                                   INFLUENZA

        Question. Dr. Fauci, why is the spread of avian influenza so
    alarming?
        Answer. The spread of avian influenza is of great concern because
    in the past, highly virulent pandemic influenza strains have originated
    as avian influenza. Influenza pandemics are global outbreaks that
    emerge infrequently and unpredictably and involve strains of virus to
    which humans have little or no immunity. Three deadly influenza
    pandemics have occurred in the 20th century: in 1918, 1957, and 1968.
    The 1918-1919 pandemic was by far the most severe, killing
    approximately 500,000 people in the United States and 20-40 million
    people worldwide--almost two percent of the global population at that
    time. Worldwide, the pandemics that began in 1957 and 1968 killed
    approximately 2 million and 700,000 people, respectively.
        H9N2 and H5N1 influenza are two avian viruses that have jumped
    directly from birds to humans and have significant pandemic potential.
    In 1999 and 2003, H9N2 influenza caused illness in three people in Hong
    Kong and in five individuals elsewhere in China; fortunately, the virus
    did not acquire the ability to spread from human to human. Between
    January 28, 2004 and April 14, 2005, there were 88 confirmed cases of
    and 51 deaths from H5N1 avian influenza infection in humans in
    Cambodia, Thailand, and Vietnam, according to the World Health
    Organization. To date, there have been a small number of cases where
    human-to-human transmission of the virus may have occurred. However,
    public health experts fear that the longer and more widely the H5N1
    virus circulates in poultry, the greater the likelihood that the virus
    may evolve into one that is more easily transmitted between people. If
    this were to happen, a worldwide pandemic could follow.
        Question. What steps is your Institute taking to address this
    issue?
        Answer. The National Institute of Allergy and Infectious Diseases
    (NIAID) is using a multi-faceted approach to address the threat of
    avian influenza, including surveillance of animals, vaccine and
    antiviral development, basic research, and genome sequencing. Through a
    contract to St. Jude Children's Research Hospital, NIAID is supporting
    disease surveillance in wild birds, live bird markets, and pigs in Hong
    Kong, allowing scientists to track potential emergent influenza
    strains. In January 2005, the contract was expanded to include animal
    surveillance in Vietnam, Thailand, and Indonesia.
        The Institute has taken a number of steps to develop and clinically
    test vaccines against the two influenza viruses with the greatest
    pandemic potential. For example, under contract to NIAID, Chiron
    produced 40,000 doses of an H9N2 inactivated vaccine; a Phase I
    clinical trial of this vaccine in healthy adults began March 31, 2005.
    NIAID intramural scientists have also developed an attenuated H9N2
    vaccine candidate that will soon be evaluated in humans.
        NIAID has also initiated clinical testing of an H5N1 influenza
    candidate vaccine developed by NIAID-supported researchers at St. Jude
    Children's Research Hospital. In January 2004, these researchers
    obtained a clinical isolate of the highly virulent H5N1 virus that was
    fatal to humans in Vietnam in late 2003 and early 2004. They used a new
    technique called reverse genetics to create an H5N1 candidate vaccine
    from this strain. In May 2004, NIAID awarded contracts to Sanofi
    (formerly Aventis) Pasteur and Chiron for the manufacturing and
    production of inactivated vaccine against H5N1 influenza using this
    strain. Sanofi Pasteur delivered vaccine to NIAID in early March 2005;
    delivery of the Chiron vaccine is estimated to be in fall 2005. NIAID's
    Vaccine and Treatment Evaluation Units (VTEUs) currently are conducting
    a clinical trial of the Sanofi Pasteur vaccine in healthy adults.
    Following the review of the safety and immunogenicity data from the
    adult trial, NIAID plans to initiate trials of the H5N1 vaccine in
    healthy elderly and other populations. In addition, NIAID intramural
    researchers have developed three attenuated H5N1 vaccine candidates,
    which have been shown to be protective in mice; initial clinical trials
    of one of these vaccine candidates may begin as early as this year.
        Efforts also are underway to test and improve antiviral drugs to
    prevent or treat avian influenza. NIAID is supporting an animal study
    to determine if combination therapy with two classes of antiviral
    drugs--neuraminidase inhibitors and adamantanes--is more effective that
    a single antiviral in reducing viral replication and emergence of drug
    resistant strains. The Institute is also supporting the development and
    testing of a long-acting next generation neuraminidase inhibitor that
    can be administered once per week.
        NIAID supports a number of basic research projects that could lead
    to significant advances in pandemic influenza preparedness, including
    research that could lead to vaccine strategies that would provide
    broader protection against a wide range of influenza strains and
    strategies to allow rapid production of a vaccine against a newly
    emergent strain. In addition, the Influenza Genome Sequencing Project,
    launched in the fall of 2004, is a collaboration between NIAID, the
    Centers for Disease Control and Prevention (CDC) and other
    organizations. The complete genetic sequences of thousands of influenza
    virus isolates will be determined and made available to the scientific
    community; to date, approximately 120 viruses have been sequenced. This
    program will enable scientists to better understand the emergence of
    influenza epidemics and pandemics by observing how influenza viruses
    evolve as they spread through the population. Moreover, scientists will
    be able to match viral genetic characteristics with virulence, ease of
    transmissibility, and other properties; this knowledge could lead to
    improved methods of treatment and prevention, as well as guide the
    public health emergency response should an influenza pandemic emerge.

                               BIOTERROR THREATS

        Question. Dr. Fauci, please update us on the progress in the
    development of countermeasures against bioterror threats?
        Answer. Since the attacks of September 11, 2001, and the anthrax
    attacks the following month, the United States has made significant
    progress in developing countermeasures against bioterror threats. The
    National Institute of Allergy and Infectious Diseases (NIAID) supports
    a comprehensive biodefense research and development program, which
    includes the development of biodefense countermeasures to combat
    Categories A, B, and C biological agents, as well as the expansion of
    the national research infrastructure and resources available to
    biodefense researchers. Basic research on microbes and host immune
    defenses serves as the foundation for applied research to develop the
    vaccines, therapeutics and diagnostics that the United States will need
    in the event of a bioterror attack.
        The NIAID biodefense program has benefited from the passage of the
    Project BioShield Act of 2004, which granted the National Institutes of
    Health and NIAID authorities to expedite and simplify the solicitation,
    review, and award of grants and contracts for the development of
    critical medical countermeasures. NIAID used its new BioShield
    authorities to make recent grant awards for research aimed at the
    development of therapeutics for botulinum toxin, Ebola virus, anthrax,
    pneumonic plague, tularemia, and smallpox. Using BioShield authorities,
    the standard eighteen-month timeline from the conception of an
    initiative to grant award was reduced to approximately nine months. In
    fiscal year 2005, the Institute anticipates making additional awards
    using these BioShield authorities for research related to the
    protection of the immune system against damage by radiological or
    nuclear attacks.
        The following are a few specific examples of NIAID's progress in
    the research and development of biomedical countermeasures against
    Category A bioterror agents:

    Anthrax
        In 2002 and 2003, NIAID initiated early and advanced product
    development and testing of the next-generation anthrax vaccine (rPA) by
    awarding contracts to two companies, Avecia and VaxGen. In November
    2004, DHHS used its own Project BioShield authorities to award a
    contract to VaxGen to supply 75 million doses of rPA anthrax vaccine to
    the SNS. In addition, NIAID-supported scientists are conducting
    research to identify new targets for therapeutics. Scientists supported
    by NIAID determined the structure of the anthrax toxin, providing a
    better understanding of how the toxin causes disease and giving
    scientists the opportunity to design drugs that will specifically
    inhibit the anthrax toxin.

    Smallpox
        In 2003, NIAID initiated the advanced development of Modified
    Vaccinia Ankara (MVA) smallpox vaccine through contracts to Acambis and
    Bavarian Nordic. Contracts awarded in October 2004 are supporting
    larger scale manufacturing of the MVA vaccine as well as additional
    studies of safety and effectiveness in animals and humans. Though a
    vaccine is the only proven way to prevent smallpox infection,
    therapeutics to fight an infection are also an important component of
    the biodefense arsenal. NIAID-supported scientists have discovered a
    new way to block the ability of smallpox to spread from cell to cell,
    which may lead to the development of next-generation antiviral drugs to
    combat smallpox and other viral infections.

    Plague
        NIAID is supporting the manufacture of a plague vaccine through a
    contract awarded to Avecia in October 2004; this award will also
    support preclinical testing in animals and initial human clinical
    trials.

    Tularemia
        In collaboration with the Department of Defense (DOD), NIAID is
    conducting a Phase I clinical trial using the DOD's Live Vaccine Strain
    (LVS) tularemia vaccine. In October 2004, NIAID modified an existing
    contract with DynPort Vaccine Company to support the manufacture of
    additional LVS vaccine in anticipation of possible future clinical
    trials as well as for use in evaluation of the stability of the
    vaccine.

    Botulinum toxin
        In March 2005, NIAID made its first contract award using Project
    BioShield authorities to XOMA LLC, for the production of botulinum
    toxin monoclonal antibodies (serotype A) for clinical evaluation. In
    fiscal year 2005, NIAID expects to use Project BioShield authorities to
    make an additional contract award for the production of a recombinant
    botulinum toxin vaccine (serotype E) for clinical evaluation.

    Viral hemorrhagic fevers
        NIAID's Vaccine Research Center (VRC) is currently conducting the
    first human trial of a vaccine to prevent Ebola infection. In addition,
    NIAID grantees and scientists recently made a critical discovery
    related to how Ebola virus infects cells. These findings raise the
    possibility that a broad-spectrum antiviral therapeutic could be
    effective against multiple hemorrhagic fever viruses such as Ebola and
    Marburg.

                               BIODEFENSE FUNDING

        Question. Dr. Fauci, we have heard that members of the scientific
    community have criticized that increased biodefense funding at NIH has
    come at the expense of other important public health research. Can you
    comment on this?
        Answer. The terrorist attacks of September 11, 2001, and the
    dissemination of anthrax spores through the U.S. mail later that fall
    prompted the Administration, with bipartisan support from Congress, to
    dramatically increase spending on biodefense research, with the
    specific goal of developing medical countermeasures to protect the
    public against agents of bioterror. More than $1.5 billion was added to
    the National Institutes of Health (NIH) budget in fiscal year 2003 for
    biodefense research. These funds are additive to funds for other
    infectious diseases research; the biodefense funds did not and will not
    divert resources from other important infectious diseases research.
        The non-biodefense resources of the National Institute of Allergy
    and Infectious Diseases (NIAID) increased by more than 50 percent from
    fiscal year 2000 to fiscal year 2005, keeping pace with or exceeding
    the average annual increases received by NIH during this same period.

                        DEVELOPING ADVANCED TECHNOLOGIES

        Question. From everything being written in the media, there is
    reason to be optimistic that we are close to unraveling the mysteries
    of cancer. Much of the progress being made is a direct result of new
    technology that wasn't available even only a few years ago. If there
    are still gaps in available technology that are preventing researchers
    from having a complete understanding of the complexities of cancer, has
    NCI considered ways in which the necessary tools could be developed?
        Answer. Research over the past three decades has led to unimagined
    progress in our understanding of the cancer process at the genetic,
    molecular, and cellular levels. The combination of scientific talent,
    infrastructure, partnerships, and expertise coupled with an
    extraordinary array of advanced technologies is allowing us to
    understand cancer as a process--a process that begins with a single
    genetic alteration and proceeds through several stages to a lethal
    disease. Even now, as we stand an inflection point for progress in
    eliminating the suffering and death due to cancer, emerging
    technologies hold the key to accelerating our understanding of the
    complexities of cancer and how to prevent, diagnose, and treat cancer
    in its many forms. As we search for the most effective ways to harness
    the power of scientific discovery and to enhance our understanding of
    cancer's complexities, we know that the most direct path will be
    through the optimal integration of science and technology, specifically
    advanced technologies such as bioinformatics, cancer imaging,
    proteomics (the study of proteins), and nanotechnology (man-made
    devices minuscule enough to enter living cells).
        The National Cancer Institute (NCI) has already taken steps to
    achieve paradigm shifting technology advances through the launch of the
    cancer Bioinformatics Grid (caBIG), an unprecedented platform to be
    available to the entire cancer research community. NCI has also
    established the Alliance for Nanotechnology in Cancer to unite a broad
    array of programs to maximize the technology outputs. Initiatives in
    proteomics and cancer imaging are underway as well. As these
    technologies mature, we must also create the technology development
    resources and the seamless system needed to capitalize on their
    discoveries.

                             PERSONALIZED MEDICINE

        Question. Over the past year, there has been a great deal of
    discussion surrounding research areas such as genomics, proteomics, and
    metabolomics. Articles suggest that research in these areas will
    provide research breakthroughs that will translate into new forms of
    targeted therapies and a way to personalize the treatment that cancer
    patients will receive in the future. Is this a realistic expectation or
    just science fiction?
        Answer. Personalized medicine is not only a real possibility; it is
    critical to achieving NCI's goal to eliminate the suffering and death
    due to cancer by 2015. The Nation's investment in cancer research has
    led us to a point today where we're beginning to understand cancers at
    the molecular and genetic and cellular levels, and this understanding
    is influencing our selection of therapy and moving us to personalize
    medicine and personalize oncology. As our understanding of the cancer
    process increases, so does our ability to seek out and target key
    points in that process to disrupt and reverse the development of
    cancer. Part of our challenge is to understand how those targets differ
    from cancer type to cancer type and how each patient might react
    differently to potential therapies. Technologies such as molecular and
    genetic profiling and proteomics are opening the door to understanding
    these diseases and how they behave on an individual basis.
        Using molecular profiling, NCI scientists have been able to
    identify and predict mantle cell lymphoma patients' survival following
    diagnosis based on the each cancer's distinct signature. Knowing whose
    disease is slow-moving and whose is progressing rapidly should help
    determine who would do well with a watchful waiting approach and who
    may benefit from early and aggressive treatment, possibly with new
    therapeutic regimens. For chronic lymphocytic leukemia, scientists have
    known for several years that there were two types of this leukemia, but
    the means for telling the two apart and affecting treatment choices was
    complex and not available to most patients. The same NCI group recently
    showed that expression of a single gene, ZAP-70, is a surrogate for
    this distinction, paving the way for better treatment choices for more
    patients.
        Recent breakthroughs are also enabling scientists to identify
    patterns of protein markers associated with cancer initiation and
    progression and with particular cancers. Biomarkers (tumor indicators
    found in body fluids or tissues) hold promise for making personalized
    medicine a reality. They have many potential applications including
    early diagnostic testing, monitoring response to treatment, detecting
    metastatic disease, and building ``designer'' therapies. Already,
    information-rich blood sample proteins are being use to detect patients
    with ovarian cancer, effectively differentiating early-stage cancer
    patients from unaffected individuals. Similar methods potentially may
    be used to monitor a patient's response to molecularly targeted drugs,
    which could prove useful in designing patient-tailored therapies.

                       CANCER BIOMEDICAL INFORMATICS GRID

        Question. NCI has built an impressive network of cancer centers
    around the country. Have you developed any resources that would enable
    the cancer centers and the broader cancer research community to share
    data and information?
        Answer. By using the power of modern information technology, NCI is
    leading the way in developing a bioinformatics platform that promises
    to revolutionize the biomedical research enterprise. Scientists in
    various disciplines will have access to a common infrastructure for
    collaboration and integration of findings, and new ``plug and play''
    tools developed by the researcher community will make it possible for
    investigators to greatly accelerate their research. For example,
    researchers at Cancer Centers across the country will be able to access
    data on the molecular characteristics of patients with a particular
    type of cancer who are being treated with a specific drug. Diverse data
    mounted on common platforms will permit researchers to use innovative
    analytic tools to mine the information in ways inconceivable a few
    years ago.
        Up to the present, bioinformatics resources have been developed in
    organizational isolation, with tremendous variability in rules,
    processes, vocabularies, data content, and analytical tools. NCI will
    address these concerns and strengthen the potential for bioinformatics
    integration with the cancer Biomedical Informatics Grid (caBIG). The
    caBIG will provide a unifying architecture to transparently connect
    information and tools much like a home entertainment system in which
    components are made by different manufacturers but built to common
    standards that allow users to combine them in various ways. Our long-
    term goal for bioinformatics is to improve the sophistication of
    information technology use and surmount the barriers that limit
    interaction across research institutions. NCI is currently piloting a
    core infrastructure with the participation of 50 Cancer Centers.
        We are also fostering the development and use of new informatics
    technology to accelerate, better coordinate, and facilitate
    participation in NCI-supported clinical research. Currently, volumes of
    valuable raw data are not tapped, effective best practices are not
    widely distributed, and resources are wasted because of duplication of
    effort. With new bioinformatics tools and infrastructure, trials will
    be completed more quickly in multi-institutional settings with uniform
    electronic case report forms and data reporting systems. Databases and
    analytical tools will make information from all clinical trials
    available to NCI-supported researchers for efficient patient accrual,
    information retrieval, and data analysis. Informatics systems will
    assist the cancer community with priority setting and allow for fuller
    participation and a more transparent decision making process. Advocacy
    groups and individual patients will be empowered to participate in
    clinical research and to authorize use of materials for basic science
    investigations. Confidential clinical and proprietary information will
    be protected by controlled, secure access. Just as e-business models
    have transformed the American market place, the caBIG platform will
    overcome traditional institutional limitations. Community
    practitioners, clinical research organizations, and academic centers
    will be linked through this new model of clinical research. Healthcare
    providers will become full partners in the research enterprise and
    educated consumers of research findings.

                              CANCER SURVIVORSHIP

        Question. Recent statistics show that there are now nearly 10
    million cancer survivors in the United States. This is a dramatic
    change from the outcome that the majority of people diagnosed with
    cancer faced in the not too distant past. What have been the key
    advances in medicine that have provided so many more people with a
    healthy outcome after being diagnosed with cancer?
        Answer. Healthy outcomes for cancer can be primarily attributed to
    two key areas--early detection and prevention, and better treatment
    regimens. Newly aligned goals focused on preventing cancer from
    occurring and detecting it early when it is most curable are the keys
    to reducing the incidence of cancer. Dramatic developments in
    technology and a more complete understanding of the causes and
    mechanisms of cancer have given us more effective ways to prevent the
    disease. New evidence-based interventions encourage lifestyle
    improvements in diet and physical activity, discourage smoking, and
    promote the use of safe and fully tested chemoprevention approaches for
    people at risk. Pioneering proteomic and biomarker advances and the
    promise of nanotechnology give hope for the early detection and
    diagnosis of cancer and prediction of patient response to treatment.
    Advanced information systems and methods of evaluation maximize the
    impact of existing technologies. NCI is ramping up specimen
    repositories and widely accessible bioinformatics resources to support
    the development of these breakthroughs.
        Newer and better drugs are being developed every day, and
    combinations of many of these drugs are leading to longer survival
    times for many cancer patients. For example, the long-term outlook for
    breast cancer survivors improved significantly with news of a study
    that revealed the benefits of a drug that inhibits the synthesis of the
    hormone estrogen. The large, international study of the drug letrozole
    was specific to postmenopausal women who had been treated for early
    stage breast cancer that was estrogen-receptor positive and had just
    completed a five-year course of tamoxifen. Women who took letrozole
    (Femara) were 43 percent less likely to experience a recurrence
    compared to women who took a placebo. The study, begun in 1998, was
    stopped ahead of schedule in 2003 when the positive effects became
    clear so that the women taking a placebo could be offered the drug.
        Another example is the promising agent, iodine-131 tositumomab
    (Bexxar), which is easier to take and less toxic than standard
    chemotherapy and has significant impact in extending the lives of
    patients who took it. In a phase II trial that included 76 patients
    with advanced-stage follicular lymphoma, nearly all of the patients (95
    percent) responded to treatment, and three out of four were free of the
    disease after a single course of treatment. Five years later, most of
    the patients were in remission.

                               CANCER PREVENTION

        Question. The development of new ways to treat cancer seems to be
    highlighted in the press quite often. It makes more sense to find ways
    to prevent cancer--can you tell us about any progress NCI has made in
    cancer prevention?
        Answer. The prevention of cancer focuses on studying and modifying
    behaviors that increase risk, mitigating the influence of genetic and
    environmental risk factors, and interrupting the carcinogenesis process
    through early medical intervention. We can save many lives, for
    example, by continuing to advance understanding of the biological and
    behavioral basis of nicotine addiction and energy balance. Evidence
    from recent NCI-sponsored studies suggest specific gene variations can
    affect smokers' cravings and that bupropion, an antidepressant used to
    help smokers quit, may ease these cravings, especially in women. Other
    medications to help smokers quit are under development and current
    evidence suggests that information and referrals from quit lines, as
    well as behavioral counseling from healthcare providers, significantly
    increase abstinence rates.
        NCI is also supporting the development of prevention vaccines and
    chemopreventive agents for suppressing the carcinogenic process either
    at its inception or in pre-invasive stages. A new vaccine that targets
    the infectious agent human papilloma virus (HPV), implicated in
    cervical cancer, is being tested in clinical trials and is anticipated
    to be available to women at risk in the near term. Preclinical studies
    are beginning to identify prevention agents that impact cellular level
    targets to intervene in the cancer process, and clinical trials will
    test the value of these agents in preventing disease. NCI has
    established a new consortium of research centers to conduct early phase
    cancer prevention clinical trials. In 2004, NCI completed recruitment
    of 19,747 postmenopausal women at increased risk of breast cancer to
    participate in a clinical trial of the chemopreventive agent
    Raloxifene. Another prevention trial, the Prostate Cancer Prevention
    Trial, ended early after showing that men who took finasteride reduced
    their chances of getting prostate cancer by nearly 25 percent compared
    to men taking a placebo. A new proteomics technique has been used to
    successfully distinguish people who responded well to a drug that
    reduces colon polyps from those who did not. This technique increases
    our ability to target preventive agents to those who will most benefit.
    The impact preventative medicine and behavioral research have on
    reducing the cancer burden will continue to grow as similar techniques
    are developed and refined.
        As we make such breakthroughs, we must actively translate
    prevention research into improved outcomes and facilitate the role of
    public policy to see that all people have knowledge of and access to
    preventive medicine and approaches. NCI understands that the media are
    a critical component of health communication as it relates to cancer
    prevention and we are working to optimize dissemination to patients,
    caregivers, and at-risk populations. For example, inadequate nutrition
    and physical activity appear to contribute to a sizable proportion of
    cancers. Through NCI's 5 A Day for Better Health Program, we seek to
    increase public awareness of the importance of eating 5 to 9 servings
    of fruits and vegetables every day for better health and provide
    consumers with specific information about how to include more servings
    of fruits and vegetables into their daily routines. NCI has also
    established Centers of Excellence in Cancer Communication Research, two
    of which are examining how the media communicate about cancer
    prevention. Through efforts like these, NCI is seeking ways to better
    work within media constructs to raise the level of dissemination and
    understanding of evidence-based cancer prevention messages.

                 CLINICAL RESEARCH AND ACADEMIC HEALTH CENTERS

        Question. Dr Zerhouni, as a result of the recent doubling of NIH by
    Congress we've seen a remarkable increase in fundamental knowledge
    about diseases like Alzheimer's, Parkinson's and diabetes. But I'm sure
    you understand that knowledge, in and of itself, is not enough unless
    it's put to use. Many of us are concerned that the next step in the
    process--the clinical research that translates into cures and improved
    treatments--isn't getting enough attention. Please tell us specifically
    what's being done to get science from the bench to the bedside, and
    whether you have enough legislative authority to put more emphasis on
    that side of the equation?
        Answer. In order to improve human health, scientific discoveries
    must be translated into practical applications. Such discoveries
    typically begin with a clinical observation in a single patient or
    group of patients, or at ``the bench'' with basic research--in which
    scientists study disease at a molecular or cellular level. However, the
    discovery must then be translated to the clinical level, or the
    patient's ``bedside.'' Translation is complicated, with input needed
    from a multidisciplinary team of scientists and other professionals.
        In recent years, NIH-supported studies have addressed important
    translational issues, which have had direct implications for patient
    care on the front lines of medicine. The Women's Health Initiative
    assessed whether hormone replacement therapy (HRT) in post-menopausal
    women reduced heart attack rates; results demonstrated that it did not,
    and in fact, increased health risks; the Antihypertensive and Lipid-
    Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) compared the
    occurrence of heart attack and stroke in high-risk hypertensive
    patients treated with either newer classes of drugs or with long
    established, inexpensive diuretics, and found that the diuretics were
    at least as effective as the new, more expensive medications; the
    Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) tested whether
    an implantable cardiac defibrillator (ICD) or an antiarrythmic drug
    would help prevent sudden death in heart failure patients, and reported
    that the ICD significantly reduced deaths (while the drug was no better
    than placebo); the National Emphysema Treatment Trial (NETT) tested the
    effectiveness of bilateral lung volume reduction surgery (LVRS) in the
    treatment of emphysema, and established that that LVRS benefits some
    but is harmful to others. Results were used as the basis for CMS
    coverage decisions regarding LVRS.
        Despite these and other important findings, NIH recognizes that
    concerns have been raised about the status of clinical and
    translational research. The agency is accelerating and strengthening
    this focus through the ``Re-engineering the Clinical Research
    Enterprise'' initiative, which is part of the NIH Roadmap. By
    integrating clinical and translational resources--such as informatics,
    biostatistics, career development, regulatory support--into a unified
    program, the NIH aims to greatly enhance the efficiency and scope of
    clinical research. This will allow more rapid translation of basic
    research into studies that can be performed in human subjects and
    provide tools for the rapid and broad dissemination of the results of
    clinical trials.
        As a result of Roadmap initiatives, academic institutions are
    beginning to undergo transformative changes to break down
    organizational roadblocks and disciplinary silos and bring individuals
    with different types of expertise into newly collaborative, integrative
    structures focused on solving complex health problems. There are also
    experiments underway that will allow for the creation of enhanced
    training and career pathways for individuals in the translational and
    clinical sciences. Because there is broad heterogeneity among the
    individual cultures of the AHCs, NIH is encouraging flexibility in
    experimenting with different and innovative approaches to address the
    need for training the clinical and translational investigators of the
    21st century.
        Moreover, the NIH Clinical Roadmap is working to develop a cadre of
    community-based physicians trained to carry out clinical studies in the
    context of their own health care settings, and to be leaders in
    translating cutting edge research findings directly into clinical care.
    An ongoing study is evaluating the feasibility and mechanisms necessary
    to succeed in implementing such a program.
        Also under the aegis of the Roadmap, the NIH has established a new
    Clinical Research Policy Analysis and Coordination Program to stimulate
    the development of coordinated policies, practices, and tools to
    harmonize Federal regulatory policy and to ensure efficient oversight
    of clinical and translational research and of human subject
    protections.
        In addition, NIH is fostering intergovernmental relationships with
    the Centers for Medicare and Medicaid Services (CMS), the Agency for
    Healthcare Research and Quality (AHRQ), the Centers for Disease Control
    and Prevention (CDC) and other agencies and health care plans to help
    ensure that clinical research results are used to develop evidence-
    based, cost-effective healthcare.
        In its efforts to address the bottlenecks in translating results
    from clinical research into improved treatments and other
    interventions, the NIH aims to create a coordinated and supportive new
    infrastructure that will facilitate the more rapid translation of
    discoveries from the laboratory to the healthcare setting.
        Question. On a related note, the academic health centers where
    clinical research is carried out--like Case Western Reserve, for
    example--are being squeezed. Part of the problem is the result of
    unfunded federal mandates like HIPAA. How does this affect NIH's
    ability to support clinical research, and ultimately help patients?
        Answer. NIH recognizes the many requirements to which institutions
    must respond as they conduct and oversee clinical research. While these
    requirements pertain to important matters like human subject
    protections and safety oversight, NIH believes that much can be done to
    streamline them, thereby enhancing their effectiveness and diminishing
    unnecessary burden. To promote specific initiatives in this regard, the
    NIH established as a key element of its Roadmap effort a new Clinical
    Research Policy Analysis and Coordination (CRpac) Program.
        CRpac's goal is to create a trans-government forum for stimulating
    the harmonization, streamlining, and optimization of policies and
    requirements pertaining to the conduct and oversight of clinical
    research. CRpac staff thus work closely with other Federal agencies and
    offices that have responsibilities related to the funding and oversight
    of clinical research, including the Office for Human Research
    Protections, the Food and Drug Administration, the Department of the
    Veterans Administration, the Department of Defense, and other Federal
    agencies that have adopted the ``Common Rule'' for human subjects
    protections. Ensuring the more effective protection of research
    participants, as well as promoting the more efficient translation of
    research findings into clinically useful products, are two major aims
    of this program.
        Some specific foci of the CRpac program include harmonizing diverse
    adverse event reporting requirements; clarifying policy where
    variability in the interpretation of the human subjects regulations
    exists; providing guidance on the use of IRBs and DSMBs; and
    stimulating a dialogue and consensus on clinical trial design issues to
    advance the science, safety, and ethics of translational research.
        Question. Again, what do you need in the way of legislative
    authority to meet the demands placed on these academic health centers?
        Answer. NIH has sufficient legislative authority and flexibility to
    meet the demands placed on academic health centers.

                              ALZHEIMER'S DISEASE

        Question. For the past several years this Subcommittee has
    consistently encouraged NIH to assign a high priority to research on
    Alzheimer's disease. In fiscal year 2002, the Subcommittee went so far
    as to encourage NIH to boost its investment in Alzheimer's disease
    research to $1 billion. But despite the steady increase in
    appropriations for the Aging Institute, I understand that your
    investment in Alzheimer research actually declined by nearly $20
    million between fiscal year 2003 and fiscal year 2004. Would you
    explain how that could possibly happen?
        Answer. It is true that NIH funding for Alzheimer's disease (AD)
    research--for which the National Institute on Aging (NIA) is the lead
    NIH institute, although several NIH Institutes support AD research--
    decreased from fiscal year 2003 to fiscal year 2004. Since its
    inception in 1974, the NIA has placed a very high priority on
    Alzheimer's disease and AD-related research, such that AD has received
    by far more funding by NIA than any other aging-related disease
    research. In fiscal year 2004, despite the Institute's best efforts,
    which included the funding of a major new multi-million dollar
    initiative, the Alzheimer's Disease Neuroimaging Initiative, the NIA--
    and to a lesser degree, the NIH as a whole--experienced its first-ever
    decrease in AD funding.
        In fiscal year 2004, the number of Research Project Grant (RPG)
    applications submitted across all NIA programs was unusually high, up
    40 percent from fiscal year 2003. This made fiscal year 2004 a very
    competitive year overall for RPG funding at NIA. Of the applications
    the Institute received that were judged highly meritorious in peer
    review, considerable more dealt with other diseases and conditions
    included in the NIA mandate, while far fewer were AD-related, than in
    the preceding year. This was highly unusual, and there is every
    expectation that it will not re-occur and that funding for AD-related
    research will increase in fiscal year 2005.
        Question. Can you give the Subcommittee some assurances that this
    will not occur again?
        Answer. An immediate assurance can be offered to the Subcommittee
    that Alzheimer's disease research continues to be a high priority for
    the NIA, and that the situation is being continually monitored and
    proactive steps have been taken that should prevent the re-occurrence
    of this unanticipated situation. So far during fiscal year 2005, AD
    research applications have been more competitive in peer review than
    this time last year, so that AD-related awards are outpacing non-
    Alzheimer's disease awards. In addition, $8 million of approximately
    $10.2 million available for new NIA initiatives in fiscal year 2005 has
    been allocated for AD initiatives. Finally, the fiscal year 2005
    Centers allocation will provide an increase in the AD Centers program
    funding of at least 1.5 percent above fiscal year 2004.
        We are continuing to monitor the situation closely, but currently
    fiscal year 2005 AD funding is on track and consistent with application
    success rates seen in previous years. If this rate continues through
    the rest of the fiscal year, fiscal year 2005 AD funding will most
    assuredly be higher than fiscal year 2004.

                                                [In millions of dollars]
    ----------------------------------------------------------------------------------------------------------------
                                                                                    Fiscal year
                                                             -------------------------------------------------------
                                                                  2003          2004          2005          2006
    ----------------------------------------------------------------------------------------------------------------
    Alzheimer's Total NIH...................................          658           633           647           649
    Aging Institute share...................................         (502)         (483)         (496)         (498)
    ----------------------------------------------------------------------------------------------------------------

                           POLYCYSTIC KIDNEY DISEASE

        Question. The National Institutes of Health in general--and the
    National Institute of Diabetes and Digestive and Kidney Diseases
    [NIDDK], in particular, has--under your NIH Roadmap to the Future
    initiative--focused anew on translating basic research discoveries into
    therapeutic interventions to treat/cure some of the world's most
    prevalent life-threatening diseases, including polycystic kidney
    disease or PKD . . . the most common life-threatening genetic disease
    affecting 600,000 Americans. I would appreciate your comments about
    whether the discovery of the PKD genes in 1994/1995 culminating in the
    current clinical drug trial for PKD in humans--enabled by research
    partnerships between the Federal government (via NIDDK), private
    funding sources, and industry, combined with innovative technological
    advances such as provided from the CRISP study--is an example of what
    was envisioned in the development of the NIH Roadmap initiative, and--
    if so, in what respects?
        Answer. The intent in developing the NIH Roadmap for Medical
    Research was to tackle very broad scientific challenges and thereby to
    generally move translational research forward for the benefit of all.
    Thus, NIH Roadmap initiatives are not specific to any particular
    diseases, but are expected to yield benefits for a wide range of
    diseases. While not directly funded under the Roadmap, the PKD research
    you cited--such as the Consortium for Radiologic Imaging Studies of
    Polycystic Kidney Disease (CRISP) study--is indeed consistent with the
    vision of the broader NIH Roadmap for Medical Research. The CRISP study
    has been a successful collaborative effort of imaging specialists and
    clinicians focused on PKD. The focus of the CRISP study is investment
    in the groundwork that will facilitate the development and eventual
    testing of clinically practical intervention strategies for PKD. The
    CRISP investigators have used state-of-the-art imaging techniques to
    develop new non-invasive methods that can reliably assess PKD
    progression. Such methods are important as they will facilitate design
    of future clinical trials of new therapies for PKD, which will likely
    require shorter follow-up periods and fewer patients than current
    trials of kidney disease. Similarly, it is hoped that NIH Roadmap
    initiatives will, among other things, provide technologies and other
    resources to facilitate discovery and characterization of disease
    genes; integrate expertise from multiple disciplines to more
    effectively attack problems in health and disease; enable more rapid
    testing of promising therapies in animal models of disease and in
    humans; and promote partnerships between the public and private
    sectors. By optimizing scientific tools and removing barriers to
    progress for researchers across all research fields, the NIH Roadmap
    should help pave the way to an accelerated pace of discovery from the
    bench-to-the-bedside for specific diseases such as PKD.
        Question. In testimony before Congress on April 22, 2004, Dr. Allen
    Spiegel, the Director of NIDDK, said that ``PKD represents an
    intersection of public health need, scientific opportunity and input
    from stakeholders regarding research directions, and that the NIDDK--
    working in conjunction with patient groups, such as the PKD Foundation,
    and investigator groups, such as the American Society of Nephrology--
    resulted in a strategic plan to exploit research opportunities, engage
    in expanded molecular research, develop new animal models and establish
    four PKD Research Centers.'' In sum, he said NIDDK is committed to
    moving the research agenda forward toward the goal of developing more
    effective diagnosis, treatment and prevention of disease. Therefore,
    considering these developments and the fact that the prime cause of
    death for PKD patients is chronic cardiovascular disease, that PKD
    patients suffer greatly from psychosocial problems like depression,
    anxiety and suicide due to PKD's chronic nature, and the recessive form
    of PKD has such a high rate of morbidity and mortality in neonates and
    infants, to what extent is NIH considering ``inter-institutional''
    research involving NIDDK, NHLBI (the National Heart, Lung and Blood
    Institute), NICHD (National Institute of Child Health & Human
    Development) and the NIMH (the National Institute for Mental Health) as
    a means to uncover potential interventional methods which could address
    these significant co-morbidities?
        Answer. There are two major avenues through which the NIH is able
    to pursue collaborative research opportunities and initiatives on the
    co-morbidities of PKD and other chronic kidney diseases. First, the
    statutory Kidney, Urologic, and Hematologic Diseases Interagency
    Coordinating Committee (KUHICC)--chaired by the National Institute for
    Diabetes and Digestive and Kidney Diseases (NIDDK)--encourages
    cooperation, communication, and collaboration among all relevant
    Federal agencies. Meetings of the Kidney Diseases Subcommittee provide
    an important opportunity for the NIH Institutes and Centers to initiate
    collaborations on shared interests in kidney disease.
        Second, as the lead Institute for research on chronic kidney
    diseases, including PKD, the NIDDK has spearheaded collaborative
    efforts to address many of the comorbidities experienced by PKD and
    other chronic kidney disease patients. Let me provide a few examples. A
    major new collaborative study being led by NIDDK, with participation of
    the NICHD, the NHLBI and the NINDS, is the Pediatric Chronic Renal
    Insufficiency Cohort Study (``CKIDS''). This important new undertaking
    will address the impact of chronic kidney disease on cardiovascular
    morbidity as well as neurocognitive development and emotional health;
    it will include children with both the recessive and dominant forms of
    PKD. In a related area, an initiative on chronic illness self-
    management in children is currently being supported by the NIDDK,
    NHLBI, NICHD, and the National Institute on Nursing Research. The NHLBI
    convened a working group, ``Cardio-Renal Connections in Heart Failure
    and Cardiovascular Disease,'' on August 20, 2004 to further
    understanding of the interaction of the heart and the kidney in
    cardiovascular disease. The NHLBI is also a cosponsor of a planned
    NIDDK program announcement ``Pilot and Feasibility Program Related to
    the Kidney'' to foster the development of high-risk pilot and
    feasibility research; it is anticipated that this PA will be issued in
    2005. In 2001, the NIDDK collaborated with the NIMH and the NIH Office
    of Behavioral and Social Sciences Research (OBSSR) in holding a major
    conference to determine the state of knowledge with regard to the co-
    morbid condition of depression in patients with diabetes, kidney
    disease, and obesity/eating disorders, and to propose a research agenda
    for the future. Finally, NHLBI and NIDDK have created a working group
    to address the relationship between hypertension and kidney disease,
    and are working collaboratively to design new initiatives in this area.
    All of these collaborative activities complement NIDDK's continuing
    efforts to address comorbidities of chronic kidney disease, such as the
    Chronic Renal Insufficiency Cohort (CRIC) study, which is examining the
    relationship between cardiovascular disease and chronic kidney disease
    in adults, in order to try to find opportunities to prevent and better
    treat both. Another example is the Folic Acid for Vascular Outcome
    Reduction in Transplantation (FAVORIT) trial, which is testing whether
    treatment to lower total homocysteine levels using a high-dose
    combination of folic acid, vitamin B12, and vitamin B6 will reduce
    cardiovascular damage in kidney transplant recipients. Both of these
    large studies include substantial numbers of patients with PKD.

                           BASIC BEHAVIORAL RESEARCH

        Question. As a matter of some concern I would like to bring to your
    attention an item relating to the National Institute of General Medical
    Sciences. I would also like to include Dr. Berg, as Director of NIGMS,
    on this item.
        Dr. Zerhouni, for the past seven years, starting in fiscal year
    1999, the Committee has included report language urging NIGMS to fund
    basic behavioral research and training. two years ago, Senator Inouye,
    Senator Harkin, and I had a colloquy on the senate floor expressing the
    Committee's strong support for basic behavioral research and training.
    Following the colloquy, I know the NIH commissioned a Task Force to
    study the matter and report back to the Director's Advisory Committee.
    I understand that report was made available to you and your Advisory
    Committee last December and it, too, very strongly urged that NIH
    initiate such a program and create an Institutional presence for it in
    an Institute like NIGMS.
        Dr. Zerhouni, what are your plans to implement a basic behavioral
    research and training program at NIGMS?
        Answer. In keeping with the preferred approach of performing
    portfolio analysis across NIH rather than on an institute-by-institute
    basis, a working group of the Advisory Committee to the Director, NIH,
    was formed to examine basic behavioral research across NIH. The working
    group reported to the Advisory Committee on December 2, 2004. Their
    analysis revealed that the institutes and centers (including NIGMS)
    supported approximately $2.68 billion in behavioral research, including
    approximately $936 million in basic behavioral research, in fiscal year
    2003. In addition to this base, several components of the NIH Roadmap
    for Medical Research are directed toward basic behavioral research. In
    particular, several mechanisms are being used to stimulate
    interdisciplinary research at the interface of the behavioral/social
    and biological sciences, provide the interdisciplinary training
    necessary for postdoctoral investigators to work in these areas, and
    support development of innovative methods and technology that will
    facilitate research at the intersection of the behavioral, social and
    biomedical sciences.
        Following the submission of the working group report, NIGMS has
    taken several steps to more clearly articulate the basic behavioral
    research it supports, encourage the submission of more research
    applications in these areas, and increase the number of investigators
    who can work at the interface of the behavioral and biological
    sciences:
        Research Training at the Interface of the Behavioral and Biological
    Sciences.--Basic behavioral research is of critical importance to the
    mission of the NIH and can play a crucial role in understanding the
    etiology of disease and enhancing preventive and therapeutic
    inventions. Greater understanding of the molecular, genetic, and neural
    processes governing behavior, and the reciprocal effects of behaviors
    on physiological processes, is crucial for a complete understanding of
    human health and those diseases in which behavior is a risk factor,
    diagnostic indicator, or symptom. To advance our knowledge in these
    areas, researchers will need to integrate multiple disciplinary
    perspectives, methodologies, and levels of analysis. NIGMS has a strong
    background in developing and supporting such interdisciplinary research
    training. While some existing NIGMS training programs such as the
    Medical Scientist Training Program and the Systems and Integrative
    Biology program include elements of the behavioral sciences, there has
    not been a program dedicated to training at the basic behavioral
    science-biological science interface. NIGMS has developed a proposal
    for such a predoctoral program and is coordinating its further
    development with other NIH Institutes having an interest in this area.
        Collaborative Research on Basic Mechanisms of Behavior.--To
    encourage the multidisciplinary research that is needed for a fuller
    understanding of the basic mechanisms of behavior, NIGMS has proposed
    an initiative to facilitate collaborations between basic behavioral
    scientists and investigators with expertise in state-of-the-art
    genetics, molecular biology, and genomics. It is anticipated that this
    collaborative research, performed with model organisms, will either
    enhance existing models or lead to the development of new models of
    normal or abnormal human behavior. The concept for this solicitation is
    to be presented for approval at the May 2005 meeting of the National
    Advisory General Medical Sciences Council.
        Assessing Interactions Among Social, Behavioral, and Genetic
    Factors in Health.--NIGMS is a major contributor to an Institute of
    Medicine committee examining the state of the science on gene-
    environment interactions that affect human health. The study will
    identify approaches and strategies to strengthen the integration of
    social, behavioral, and genetic research in this field as well as
    consider relevant training and infrastructure needs. The results of
    this study will be used by the NIH to guide its programs in these
    areas.

                              WORK WITH PUBLISHERS

        Question. I know that you are putting together an Advisory Working
    Group to provide advice on implementation of the NIH Public Access
    policy. I understand that the Working Group will not be able to convene
    prior to the May 2nd implementation date of the new policy.
        Publishers are eager to work with you as they formulate their own
    policies for accommodating the NIH policy. They are important to the
    success of the NIH plan and I urge you to consult with them before May
    2nd, as you finalize the details of the implementation policy.
        Do you plan to consult with stakeholders before finalizing the
    details for implementing the access policy?
        Answer. Throughout the implementation phase, we have had inquiries
    from and communicated with a number of publishers and members of the
    library community concerning the operation of the submission system.
    The initial submission system has been designed to enable individual
    investigators to submit their manuscripts in keeping with the basic
    goals of the Policy. We plan to seek feedback from users, and we will
    make system enhancements based on substantial input from all
    stakeholders, including publishers, to facilitate submissions in the
    future by others designated to do so for the authors.
        Question. Given that your policy is to take effect May 2, can you
    outline the process NIH is following to assure such representation, and
    whether you expect to have scientific publishers identified and cleared
    for membership by May 2?
        Answer. Invitations to Working Group members have been made. The
    following publishers have accepted and will be participating in the
    Working Group: Jeffrey M. Drazen, M.D., Editor-in-Chief, New England
    Journal of Medicine; Brian Nairn, Chief Executive Officer, Health
    Sciences; Elsevier Mark E. Sobel, M.D., Ph.D., Executive Officer,
    American Society for Investigative Pathology; and Annette Thomas,
    Ph.D., Managing Director, Nature Publishing Group

                            SPINAL MUSCULAR ATROPHY

        Question. It is my understanding that the new Spinal Muscular
    Atrophy ``model'' for preclinical research and development for
    candidate therapeutics is in place. Please outline the applicability of
    this model to Muscular Dystrophy.
        Answer. The SMA Project, which is now underway, represents a new
    and as yet untested approach for developing therapies for diseases that
    meet certain criteria essential to a highly targeted therapy
    development strategy. SMA is a consequence of inherited mutations in
    the SMN1 gene. The SMN2 gene product has a very similar function to
    that of SMN1; thus, increasing the expression of the intact SMN2 gene
    was both a rational and plausible mechanism for therapeutic
    development. Moreover, since research had already identified several
    chemical structures with the biologic activity of increasing SMN2
    protein expression, there was a consensus that development of drugs
    targeting SMN2 expression represented the best pathway for SMA
    treatment development. In sum, the key traits in the design of the SMA
    project were: (a) a consensus pathway to SMA treatment development,
    such that resources were not diverted away from other, potentially
    successful, strategies and (b) the availability of lead chemical
    compounds on which to base drug development. It remains to be seen
    whether the unique drug development strategy that was selected for the
    SMA pilot program will be sufficiently effective to warrant its
    consideration for other neurological disorders.
        The important question with respect to MD is not whether the SMA
    model could be applied to MD in some way, but whether it is the best
    possible approach to apply the resources available for MD therapy
    development. There were critical criteria used in the NINDS's design of
    the SMA project (consensus on strategy and availability of lead
    compounds) that do not currently apply to MD. In the area of MD, there
    are at least five or six potential strategies under active study, any
    of which may prove to be effective in the treatment of MD. These
    strategies range from those that have a relative high probability of
    success in delaying the loss of muscle mass and thereby augmenting
    quality of life, to those that have a higher risk of sort-term failure
    but in the long run may more dramatically increase both quality and
    length of life. At this point in time, there is no consensus on any one
    strategy for emphasis, since the potentially most successful strategy
    is not nearly as clear as it was for SMA. Instead of choosing to divert
    resources to any one of a number of plausible strategies in MD therapy
    development, the NIH is making parallel investments in all of the
    strategies. As research progresses along these multiple, parallel
    pathways, their relative potential for therapeutic development and
    availability of candidate lead compounds likely will change and the NIH
    would adjust its aggressive pursuit of an MD therapy accordingly.
    Unless an arbitrary choice was made to exclude potentially successful
    treatment strategies in order to provide the necessary focus, an SMA-
    type program is not applicable to MD.
        Question. The committee understands that the SMA Model statement of
    work is based upon an NIH Strategic plan developed by a steering
    committee. How does this separate steering committee reconcile research
    priorities with the NIH Director's strategic vision?
        Answer. The formal statement of work for the Spinal Muscular
    Atrophy (SMA) Project was developed by the NINDS scientific and
    contract staff to specify what services the contractor for the SMA
    Project would provide. The NINDS recruited the scientists and
    physicians on the SMA Project steering committee from industry,
    academia, the FDA, and the NIH based on their expertise in drug
    development and areas relevant to SMA. NINDS scientists serve on this
    committee in an ex officio capacity. This committee is advisory to
    NINDS, and the recommendations of the committee are implemented by
    NINDS in the context of the Director's strategic vision for NIH, which
    emphasizes applying innovative approaches to translate basic science
    progress into the development of therapies.
        Question. Please outline NIH assessment of the technical and
    contractual risk associated with the SMA model.
        Answer. There are two major aspects of risk associated with the SMA
    Project, neither of which can be meaningfully quantified. First and
    foremost, the scientific challenges of developing a therapy for a
    neurogenetic disorder are enormous. Medical science, despite extensive
    efforts, has had few successes so far in this endeavor for many
    reasons, not the least of which is the complexity of the nervous system
    and its diseases. Thus, the goal of developing a therapy within four
    years to the point that it is ready for human testing is extremely
    ambitious. This is one of the reasons that the selection criteria for
    the first disease of focus were necessarily stringent, and explains why
    the project must focus on one basic therapeutic strategy in order to
    move quickly toward the goal. The second aspect of risk concerns the
    structure of the program itself. The program is intended to expedite
    therapy development, but several aspects of the project are novel and
    untested, so whether it will indeed be an efficient and effective use
    of resources remains to be seen. In effect, the SMA Project must
    develop de novo a virtual drug company and develop a drug. It has
    proven challenging to identify contractors who are willing and able to
    perform services in disease areas that are outside the normal scope of
    their operations, particularly with such a rapid and restricted time
    line. Once the contracts are in place, the coordination of the various
    efforts and the marshalling of the whole toward accomplishment of the
    goal present considerable organizational, as well as scientific
    challenges, as evidenced by the high failure rate among even
    established biotechnology and pharmaceutical companies in this type of
    endeavor. It is difficult to anticipate what hurdles might arise in
    such a novel undertaking.
        Question. The committee understands that the SMA model was chosen
    because of the state of scientific understanding of this disease. What
    are the specific metrics and measures of merit for this determination?
        Answer. The NINDS chose SMA as the focus of the SMA Project because
    this disease best met the criteria that are critical for success of a
    narrowly focused approach to therapy development. These criteria
    include: (1) severity of disease (2) scientific readiness--which
    includes a defined genetic cause (loss of the SMN1 gene), a consensus
    strategy for treatment (increasing the SMN2 gene product), and the
    availability of ``lead'' chemical compounds. The focus of the SMA
    Project is a type of translational research that is normally conducted
    only in industry settings, which is the chemical conversion of an
    active chemical compound into a drug that is safe enough for human
    testing. Applying this strategy relies on the availability of ``lead''
    chemical compounds that have a desirable biological activity and have
    the potential to be chemically improved for human use. Most
    importantly, previous academic and privately funded efforts had applied
    this strategy and identified small drug-like molecules with the desired
    activity, and the SMA Project is optimizing the activity and
    pharmacology of these molecules to make them suitable for clinical
    testing.
        Question. What would be the comparable level of understanding in MD
    research that would justify an MD model for translational research?
        Answer. Like SMA, MD is a severe, debilitating disease, and for
    some of the forms of MD, there are defined causes. However, unlike SMA,
    there is no consensus strategy for treatment, there is no single
    biological activity to target for treatment, and there are no ``lead''
    compounds identified as potential therapeutics.
        In the case of Duchenne MD, there are several quite different and
    equally promising approaches to develop therapies. These include
    strategies to replace the defective gene, to repair that gene, to alter
    gene splicing, to override premature gene stop codons, to upregulate
    potentially compensatory genes, to increase the regenerative capacity
    of muscle by providing various trophic substances or by blocking the
    effects of growth inhibiting substances, to reduce the rate of muscle
    degradation by blocking various components of that process, and to
    replace cells via stem cells or progenitor cells. Unfortunately, none
    of these approaches have yet yielded the drug-like molecules that could
    form the basis of a drug development program for MD to the same degree
    that these are available for SMA, and the goal of identifying promising
    leads in these approaches to therapy development for MD is better
    served by a more diverse and competitive approach. The narrow focus of
    optimization efforts applied in the SMA Project will only be relevant
    to MD once these leads have been identified.
        The NIH is aggressively investing resources in translational
    research for MD through other mechanisms. These include the Wellstone
    Muscular Dystrophy Centers, the NINDS Cooperative Program in
    Translational Research, and investigator initiated research grants.
    Given finite resources, undertaking an SMA Project for MD at this time
    would require the NIH to divert funds from these other programs. The
    broad-based approach that the NIH is currently pursuing is the more
    appropriate way to advance MD translational research at this time.

                           MUSCULAR DYSTROPHY CENTERS

        Question. Please outline for the committee how MD centers are
    promoting translational research from advancements in basic MD
    research.
        Answer. Several of the Senator Paul D. Wellstone Muscular Dystrophy
    Cooperative Research Centers are supporting projects on translational
    research, which is research designed to take basic research to the
    stage of clinical testing. For example, investigators at the University
    of Washington are doing translational research in dystrophic mice that
    is designed to lead to a phase I clinical trial of gene therapy for
    Duchenne MD (DMD). Researchers at the University of Pittsburgh are also
    exploring methods for improved gene delivery using an adeno-associated
    virus (AAV) in a canine model of MD. AAV is a viral vector (the
    ``delivery vehicle'' for a gene) that has been designed to carry a
    mini-dystrophin gene to a specific muscle location. If successful, this
    technique could allow the muscle to become more resistant to injury and
    restore function. A second translational study at the University of
    Pittsburgh center is using a dystrophic mouse model to explore the
    delivery of normal muscle derived stem cells to diseased heart tissue.
    The newest center at the University of Iowa will study the use of stem
    cell and novel gene therapy strategies for MD. One project in
    particular will study the development of mouse embryonic stem cells as
    therapeutic tools for muscular dystrophy. This center will also
    emphasize study of muscle membrane repair mechanisms that could lead to
    an alternative strategy for treatment of MD.
        An essential component of the Wellstone Centers program are the
    research cores at each center, which are developing improved research
    resources for use by the entire MD research community to accelerate
    translational research. For example, the core modules at the University
    of Washington are developing research and clinical grade gene transfer
    vectors and these vectors will be studied for their utility in gene
    therapy for the muscular dystrophies. The Wellstone Center at the
    University of Rochester uses one of its core modules to serve as a
    repository of resources, including cell lines, animal models, small
    molecules, and autopsy tissue. Core modules at the University of
    Pittsburgh support translational and clinical studies in clinical
    vector production for gene therapy. One of the cores within the new
    University of Iowa center will develop new in vitro models by
    inactivating genes that cause the various types of MD in an existing
    human embryonic stem cell line.
        Collaboration and coordination among the Wellstone Centers is
    another important component of the Centers program, and the Centers are
    awarded funds to support these collaborative efforts. Currently, the
    Wellstone Centers are using these funds to support two dog colonies--
    one at University of Missouri and one at the Fred Hutchinson Cancer
    Research Center--as a national resource for research in MD, and working
    to ensure that these colonies are maintained and available for
    translational research. The dog MD models appear to have a phenotype
    that is very similar to that of Duchenne MD patients. The dog model is
    also important for assessing immune problems that may be associated
    with vectors used for gene therapy; thus, testing in the dog is an
    important stage after initial work in mouse muscular dystrophy models.
    These dogs are currently being used by researchers at a number of the
    Wellstone centers, as well as other researchers in the MD field.

                               MUSCULAR DYSTROPHY

        Question. Muscular Dystrophy researchers are exploring various
    avenues for therapeutic solutions, which include small molecule
    compounds, gene therapy and stem cell research. Please outline for the
    committee efforts in integrating these research efforts and
    prioritizing research investment strategies.
        Answer. NIH-funded researchers are pursuing a number of strategies
    to develop treatments for the MDs. These encompass drug-based (such as
    small molecule compounds), gene-based (such as gene therapy) and cell-
    based (such as stem cells) approaches. For example, several studies are
    aimed at developing drug-based therapies to protect muscle mass and
    slow muscle degeneration by blocking various components of the
    degenerative process. Compounds such as protease inhibitors and
    glycosylating enzymes are potentially promising in this area. Other
    studies are pursuing strategies to enhance muscle repair and
    regeneration mechanisms to slow, and possibly stabilize muscle
    degeneration by either providing various trophic substances or by
    blocking the effects of growth inhibiting substances. In addition, NIH-
    funded researchers are optimizing cell-based muscle replacement
    strategies, particularly strategies using stem cells or progenitor
    cells to populate skeletal and cardiac muscles with muscle fibers that
    express the absent proteins. Scientists are also developing and testing
    strategies for gene replacement therapy, including both gene or drug
    therapy strategies to replace the defective gene or increase expression
    of functionally homologous or compensatory genes. Finally, genetic
    modification therapies are being studied to bypass inherited mutations,
    using, for example, drug and antisense oligonucleotide exon skipping
    strategies.
        NIH is taking steps to ensure integration and coordination of these
    research efforts. For example, coordination of research efforts at the
    Senator Paul D. Wellstone Muscular Dystrophy Cooperative Research
    Centers is facilitated by a Steering Committee made up of
    representatives from the Centers and from the NIH institutes that fund
    them (NIAMS, NINDS, and NICHD). The steering committee's goal is to
    maximize collaborative utilization of the unique resources in
    infrastructure, expertise, and clinical recruitment created by the
    Wellstone Centers. This integration is particularly important in the
    areas of gene therapy and stem-cell based treatment strategies as a
    number of the Centers have projects and support cores focused on these
    two areas.
        Integration of research efforts and prioritization of strategies is
    also an important function of the Muscular Dystrophy Coordinating
    Committee (MDCC). This summer, a scientific working group will meet to
    develop and prioritize specific research aims based on broad research
    goals in the Muscular Dystrophy Research and Education Plan developed
    by the MDCC. Treatment strategies is one of the programmatic areas
    addressed in Plan and includes approaches such as developing effective
    gene therapy techniques, optimizing potential cell-based therapies, and
    pursuing pharmacological treatment approaches. The working group will
    not only prioritize research strategies, but will also identify
    additional obstacles and barriers to the progress of MD research and
    treatment, noting those that are likely to be addressed through ongoing
    research and programs, and those that might benefit from additional
    emphasis. At the next meeting of the MDCC (November 2005), the MD
    Scientific Working Group recommendations will be presented for
    discussion by MDCC member agencies.
        The MDCC also serves as a venue to coordinate research efforts
    among member agencies and organizations. The November 2005 MDCC meeting
    will have a specific focus on translational research, examining the
    relationship of current translational efforts by the NIH, the
    Department of Defense, the Muscular Dystrophy Association, and Parent
    Project Muscular Dystrophy. This meeting will identify the
    translational research strategies that are currently supported by
    federal agencies and advocacy groups and will reinforce efforts to
    minimize overlap and maximize utilization of resources available for
    MD.
        Question. Please outline for the committee the specific
    translational research efforts for MD; indicating their relative
    maturity. What percentage of research is investigator-initiated versus
    Institute generated?
        Answer. Translating scientific advances into therapies that can
    help people with muscular dystrophies is a very high priority for the
    NIH, and multiple strategies for therapeutic development are currently
    being pursued. The relative maturity for the most promising of these
    translational research approaches and some of the NIH-funded research
    and research initiatives in these areas are described below. These
    approaches are presented in ascending order of risk and projected
    development time, starting with the lowest risk and shortest time
    frame. The risk/development time assessments should be recognized as
    estimates, and those that are most easily achieved may dramatically
    improve quality of life for muscular dystrophy patients but are not the
    cures that may be possible from higher risk/longer time frame
    approaches.
        Blocking the loss of muscle mass.--Muscle fiber degeneration and
    the profound loss of muscle mass is the most visible consequence of MD
    and is directly responsible for progressive deterioration of muscle
    function in several types of MD. Strategies to block muscle fiber
    degeneration have shown promise. For example, several studies have
    shown that systemic treatment with a protease inhibitor reduces muscle
    membrane damage and ameliorates muscle degeneration in the mdx mouse
    model of DMD. Investigators in the NINDS intramural research program
    are currently pursuing the use of a protease inhibitor as a therapeutic
    strategy in MD patients.
        A project has also been approved for funding through the NINDS's
    ``Cooperative Program in Translational Research'' for development of
    protease inhibitors that may be capable of delaying muscle degeneration
    in a variety of types of MD.
        Enhancing muscle regeneration mechanisms.--Muscle has an inherent
    repair capacity that allows it to overcome damage but this mechanism
    appears to be overwhelmed in MD. NIH-funded researchers have identified
    genes that regulate muscle regeneration; these represent potentially
    important therapeutic targets for MD. One of these genes, GDF8 or
    myostatin, inhibits muscle development and regeneration. Myostatin
    inhibition studies using molecular genetics or a specific blocking
    antibody suggest that the strategy can increase muscle mass in several
    types of MD. The very recent development of a strategy using an
    endogenous myostatin inhibitor may hold promise. Alternatively, growth
    factors that promote muscle growth and regeneration also have shown
    promise as a therapeutic strategy.
        Replacing degenerating muscle with new muscle derived from stem
    cells.--Muscle and other tissues contain stem cells that can be
    directed to form muscle fibers. There has been considerable progress in
    isolating and expanding stem cells, directing their fate, targeting
    them to dystrophic muscle, and using imaging technology to monitor the
    efficacy of stem cell transplantation. Overcoming the host immune
    response is one of the significant obstacles to the success of cell-
    based therapy in MD.
        A project at the Wellstone Center at the University of Pittsburgh
    is focused on delivery of stem cells to diseased muscle, while the
    Center at the University of Iowa will use one of its cores as a stem
    cell resource for the MD community. In addition, a project funded as a
    result of an NIH program announcement entitled, ``Muscular Dystrophy:
    Pathogenesis and Therapies,'' as well as other NIH-supported studies,
    are exploring how to coax stem cells to become skeletal muscle cells
    with the ultimate goal of transplanting these differentiated cells.
        Gene therapy.--Gene targeting to replace a defective gene must
    overcome the problems of accessing the muscle tissues and avoiding an
    immune response to the delivery system. In addition, the large size of
    the dystrophin gene--in the case of Duchenne MD--has necessitated the
    development of novel vectors and mini-dystrophin and micro-dystrophin
    constructs. NIH-supported research has made considerable progress in
    these areas. Dystrophin constructs that are capable both of restoring
    muscle function and of being contained in the AAV vectors have been
    generated and tested in animal models. An additional obstacle in gene
    therapy is delivering the gene construct to sufficient numbers of
    muscle fibers such that muscle function is improved. Delivery systems
    are currently being tested for achieving the goal of treating MD
    patients.
        A number of projects at the Wellstone Centers are pursuing gene
    therapy strategies, and the research cores at two of the Centers are
    developing tools for use in gene therapy studies, as outlined earlier.
    The NINDS Cooperative Program in Translational Research also recently
    funded a major project that brings together a team of basic and
    clinical scientists to carry out the steps necessary to bring gene
    therapy for Duchenne MD to readiness for clinical trials. In addition,
    the program announcement, ``Muscular Dystrophy: Pathogenesis and
    Therapies,'' has resulted in a number of funded projects focused on
    developing novel or modified vectors, using mini-dystrophin constructs,
    and studying ways to effectively deliver the genes to muscle.
        Genetic strategies to bypass the mutations that cause MD.--Other
    approaches to correct a defective gene besides gene replacement are
    also being pursued. For example, antisense oligonucleotide (AO)
    technology may be used to skip, or splice out, those portions of the
    gene containing mutations and then produce a shortened, but still
    functional protein. Through research in cell culture and in animal
    models, AO administration has been shown to enhance expression of
    normal dystrophin protein. Studies supported by the NIH have made
    critical breakthroughs in AO technology and in demonstrating proof of
    principal in cell culture. While this technology is very promising, the
    delivery of AOs is subject to the many of the same obstacles as in the
    gene therapy studies described above. Other approaches include the use
    of drugs to produce ``read-through'' past the gene defect. An NINDS-
    supported clinical trial for gentamicin-mediated read-through in DMD
    patients is underway.
        Both of these approaches--AO therapy and identification of
    compounds to promote read through--are being pursued in studies funded
    as a result of the program announcement, ``Muscular Dystrophy:
    Pathogenesis and Therapies.''
        It is difficult to estimate the percentage of MD translational
    research that is investigator-initiated versus institute generated,
    although the NIH MD portfolio contains a significant amount of both
    types. Investigators may submit a grant to the NIH as part of the
    regular submission process, or in response to a particular Institute-
    generated initiative. The NIH Institutes, with considerable input from
    the research community, have been working to develop initiatives and
    programs to stimulate translational research in the MDs. For example,
    in April 2005, NIAMS announced a request for applications for Centers
    of Research Translation. Furthermore, NIH is currently developing a
    translational research initiative specific to MD, which will stress the
    milestone-driven approach to research and will include substantial
    project development and grant management interactions with NIH program
    staff.
        Question. Accelerated review of research proposals remains a
    concern for patient advocacy groups and the committee. Please outline
    for the committee all efforts NIH has undertaken with the Center for
    Scientific Review to expedite review decisions. Please provide
    supporting data regarding the length of time from RFP to award on MD
    related research.
        Answer. NIH's peer review process is widely recognized as the
    cornerstone of the remarkable success of the NIH extramural program.
    The NIH Center for Scientific Review (CSR) receives all grant
    applications submitted to NIH (approximately 75,000 per year), logs
    them in, refers these applications to a peer review panel to be
    evaluated on technical and scientific merit, and identifies a potential
    funding source at NIH. The majority of applications that come to NIH
    are reviewed by CSR, while the remaining ones are reviewed by specific
    institutes, in particular those that are received in response to a
    specific solicitation.
        Currently, the interval between NIH receiving an application and
    the application being considered for funding is typically 6-7 months.
    For example, in the case of the Senator Paul D. Wellstone MD
    Cooperative Research Centers, applications in response to the first
    Request for Applications (RFA) were received in February 2003, and
    awards were made in September 2003. NIH and CSR are considering ways to
    reduce this interval. However, it is essential that efforts to speed
    the process do not compromise the core values of NIH peer review
    system--a thorough and fair review of the application by a review panel
    with the appropriate scientific and technical expertise. One approach
    to accelerate the review cycle is the electronic receipt of
    applications. NIH is now accepting several types of grant applications
    electronically and will continue to introduce electronic receipt of
    other application types. When electronic receipt of grant applications
    is fully implemented at NIH, the system should offer considerable time
    savings because data, which in the past have been manually entered,
    will be automatically captured as soon as applications are submitted.
    In addition, it may be possible to automatically analyze some of the
    data initially captured during electronic receipt and streamline the
    referral process, thereby offering additional time savings.
        Expediting review of grant applications while maintaining review
    quality is a high priority for NIH. To underscore this, Dr. Zerhouni
    has recently created a new NIH Peer Review Advisory Committee to
    provide guidance on developing ways to advance NIH peer review and
    ensure its vitality. In addition, in March 2005, Dr. Zerhouni named a
    new CSR Director, Dr. Antonio Scarpa. When Dr. Scarpa begins work on
    July 1, 2005, he is expected to place a high priority on the goal of
    compressing the peer review cycle.

                       PEER REVIEW ON MUSCULAR DYSTROPHY

        Question. Continuity in Peer Review for Muscular Dystrophy research
    remains a concern. Please outline for the committee all efforts to
    ensure peer reviewers' areas of expertise encompass the full body of
    muscular research.
        Answer. The peer review of the majority of applications received by
    NIH is conducted at the Center for Scientific Review (CSR). In response
    to concerns expressed by the MD community, a working group of the
    Center for Scientific Review (CSR) Advisory Committee met in March 2001
    to evaluate the review of skeletal muscle biology research
    applications. The Skeletal Muscle Biology Working Group was composed of
    17 leading scientists in the field and several NIH staff. A particular
    concern of the working group was the locus of review for muscular
    dystrophy applications. Ultimately, the working group recommended the
    formation of a Skeletal Muscle Biology Special Emphasis Panel (SMB
    SEP). Nearly all muscular dystrophy related research applications
    reviewed by CSR were to be reviewed in this committee. The SMB SEP met
    for the first time in October 2001.
        The Skeletal Muscle Biology Working Group offered this
    recommendation as an interim solution pending recommendations to be
    made by the larger Musculoskeletal, Oral and Skin Sciences (MOSS) Study
    Section Boundaries Team (also a working group of the CSR Advisory
    Committee) that was scheduled to meet in July 2001 as part of a CSR-
    wide reorganization process. The MOSS Team meeting in July 2001 drew
    heavily on and expanded the recommendations of the Skeletal Muscle
    Biology Working Group. The MOSS Team recommended elevating the status
    of the review group from a special emphasis panel to a permanent
    regular study section. This recommendation was accepted by the CSR
    Advisory Committee, and a new regular study section named Skeletal
    Muscle Biology and Exercise Physiology (SMEP) was implemented. The last
    meeting of the SMB SEP was in June 2003 and the first meeting of the
    SMEP study section, its successor, was in October 2003. The SMEP study
    section is now the primary locus of review for muscular dystrophy
    related research applications at CSR.
        The range of science in the applications reviewed by SMEP is
    extremely broad, spanning fundamental molecular biology to therapeutic
    interventions. To match this breadth, the committee is composed of a
    number of individuals with the expertise necessary to cover these
    varied topics. Eleven of the regular members assigned to review these
    applications are noted investigators who themselves conduct muscular
    dystrophy related research. As members rotate off the committee they
    are replaced by individuals with a similar background--five new members
    have been nominated for the coming year. In addition, to supplement
    this broad expertise, the committee has used twelve temporary members
    who also are involved in conducting muscular dystrophy related
    research.
        As stated above, the majority of applications received by NIH are
    reviewed by CSR. In contrast, applications that respond to specific
    initiatives are reviewed by individual NIH Institutes. Like CSR, the
    Institutes are also committed to ensuring that individuals with the
    appropriate expertise review applications, and continuously work to
    identify and invite scientists with specific knowledge and appropriate
    background to participate in the review of applications.
                                     ______

                   Questions Submitted by Senator Judd Gregg

                        UMBILICAL CORD BLOOD STEM CELLS

        Question. Given that Umbilical Cord Blood Stem Cells are already
    being used to treat over 70 life threatening diseases, should the
    National Institutes of Health take steps to educate the public, and if
    so, how should education take place?
        Answer. The NIH scientists address questions from representatives
    of the news media and the public who directly contact the NIH. In
    addition, NIH scientists speak at conferences that are convened by
    professional and public interest organizations and they provide advice
    to the Health Resources and Services Administration in the development
    of a national cord blood bank program. Future directions for public
    education would involve convening a strategy development workshop of
    researchers and relevant stakeholder groups to determine what is
    currently being done to address education issues, identify major
    education gaps, and recommend and prioritize specific education
    outreach activities and areas requiring further research.
        In addition to these efforts, the NIH maintains a stem cell
    information website at http://stemcells.nih.gov. The NIH Stem Cell
    website is frequently visited by individuals seeking information on
    stem cell research, including cord blood stem cells. For example, the
    website has an NIH report entitled ``Stem Cells: Scientific Progress
    and Future Research Directions.'' This report has a chapter (http://
    stemcells.nih.gov/info/scireport/chapter5.asp) on hematopoietic (blood-
    forming) stem cells, including stem cells from the umbilical cord.
    Several stem cell literature databases that include cord blood stem
    cell research studies can also be found on the NIH website at http://
    stemcells.nih.gov/research/literature.asp. There are also links to
    several organizations, including the National Marrow Donor Program and
    the International Cord Blood Society, that have informational sites on
    cord blood stem cells. The website also contains a ``Frequently Asked
    Questions'' section (http://stemcells.nih.gov/info/faqs.asp#umbilical)
    with information on ``Where can I donate umbilical cord stem cells?''
    Overall, the NIH Stem Cell website provides useful scientific
    information to the public about stem cell science.
        Question. What research is currently being done regarding the use
    of Umbilical Cord Blood Stem Cells to treat disease?
        Answer. The NIH currently funds clinical research to evaluate the
    safety and effectiveness of matched sibling cord blood transplantation
    in children with sickle cell anemia and thalassemia (Cooley's anemia).
    The first multi-center, unrelated-donor cord blood banking and
    transplantation study (COBLT), which was funded by the NIH, was
    recently completed. The COBLT study evaluated the safety and
    effectiveness of cord blood transplantation in adult and pediatric
    patients with hematologic malignancies as well as pediatric patients
    with inborn errors of metabolism and immune deficiencies. Its results
    were shared with the Institute of Medicine for a recent report on Cord
    Blood: Establishing a National Hematopoietic Stem Cell Bank Program.
    Publication of the COBLT study results is in progress.
        A major obstacle to cord blood transplantation in adult recipients
    is the limited hematopoietic stem cell dose available in a single cord
    blood unit. The NIH currently funds research exploring alternative
    approaches to optimize transplant outcome. These approaches include the
    transplantation of two partially matched cord blood units from
    different cord blood donors, use of a less toxic (non-myeloablative)
    conditioning regimen prior to cord blood transplantation, and expansion
    of cord blood stem cells in culture and their use in conjunction with
    non-expanded cord blood for transplantation in patients with
    hematologic malignant diseases. These studies are in the early phase of
    clinical investigation. In addition, the NIH funds the Center for
    International Blood and Marrow Transplant Research, which conducts
    registry studies to evaluate the clinical outcomes of cord blood
    transplantation.
        The NIH also funds a variety of basic and pre-clinical research
    projects to examine the properties of cord blood stem cells, including
    the immune responses of cord blood cells during and after
    transplantation, the growth properties of cord blood stem cells, and
    conditions to improve the outcome of cord blood transplantation.
                                     ______

                   Questions Submitted by Senator Tom Harkin

                        POLYCYSTIC KIDNEY DISEASE (PKD)

        Question. In testimony before Congress last year, Dr. Allen Spiegel
    said the NIDDK is committed to moving the PKD research agenda forward
    toward the goal of developing more effective diagnosis, treatment and
    prevention of the disease. Considering that the prime cause of death
    for PKD patients is chronic cardiovascular disease, PKD patients suffer
    greatly from psychosocial problems like depression, anxiety and suicide
    due to PKD's chronic nature, and the recessive form of PKD has such a
    high rate of morbidity and mortality in neonates and infants, to what
    extent is NIH considering ``inter-institutional'' research involving
    the NIDDK, NHLBI, NICHD, and the NIMH as a means to uncover potential
    interventional methods which could address these significant co-
    morbidities?
        Answer. The NIH has two major avenues for pursuing collaborative
    research opportunities and initiatives on the co-morbidities of PKD and
    other chronic kidney diseases. The first avenue is the statutory
    Kidney, Urologic, and Hematologic Diseases Interagency Coordinating
    Committee (KUHICC). This Committee, which is chaired by the National
    Institute for Diabetes and Digestive and Kidney Diseases (NIDDK),
    encourages cooperation, communication, and collaboration among all
    relevant Federal agencies. Meetings of the Kidney Diseases Subcommittee
    provide an important opportunity for the NIH Institutes and Centers to
    initiate collaborations on shared interests in kidney disease.
        The second avenue is through the activities of the NIDDK, the lead
    NIH Institute for research on chronic kidney diseases, including PKD.
    In this capacity, the NIDDK has spearheaded collaborative efforts to
    address many of the comorbidities experienced by PKD and other chronic
    kidney disease patients. Let me provide a few examples. In 2001, the
    NIDDK collaborated with the National Institute of Mental Health (NIMH)
    and the NIH Office of Behavioral and Social Sciences Research (OBSSR)
    in holding a major conference to determine the state of knowledge with
    regard to the co-morbid condition of depression in patients with
    diabetes, kidney disease, and obesity/eating disorders, and to propose
    a research agenda for the future. A major new collaborative study being
    led by NIDDK, with participation of the National Institute for Child
    Health and Human Development (NICHD), the National Heart, Lung, and
    Blood Institute (NHLBI) and the National Institute of Neurological
    Disorders and Stroke (NINDS), is the Pediatric Chronic Renal
    Insufficiency Cohort Study (``CKIDS''). This important new undertaking
    will address the impact of chronic kidney disease on cardiovascular
    morbidity as well as neurocognitive development and emotional health;
    it will include children with both the recessive and dominant forms of
    PKD. The NHLBI convened a working group, ``Cardio-Renal Connections in
    Heart Failure and Cardiovascular Disease,'' on August 20, 2004 to
    further understanding of the interaction of the heart and the kidney in
    cardiovascular disease. The NHLBI is also a cosponsor of a planned
    NIDDK program announcement (PA), ``Pilot and Feasibility Program
    Related to the Kidney,'' to foster the development of high-risk pilot
    and feasibility research; it is anticipated that this PA will be issued
    in 2005. An initiative on chronic illness self-management in children
    is currently supported by NIDDK, NHLBI, NICHD, and the National
    Institute on Nursing Research. Finally, through a working group they
    created to address the relationship between hypertension and kidney
    disease, the NIDDK and NHLBI are working collaboratively to design new
    initiatives in this area. All of these collaborative activities
    complement the NIDDK's continuing efforts to address comorbidities of
    chronic kidney disease. Examples of these efforts include the Chronic
    Renal Insufficiency Cohort (CRIC) study, which is examining the
    relationship between cardiovascular disease and chronic kidney disease
    in adults, in order to try to find opportunities to prevent and better
    treat both, and the Folic Acid for Vascular Outcome Reduction in
    Transplantation (FAVORIT) trial, which is testing whether treatment to
    lower total homocysteine levels using a high-dose combination of folic
    acid, vitamin B12, and vitamin B6 will reduce cardiovascular damage in
    kidney transplant recipients. Both of these large studies include
    substantial numbers of patients with PKD.

                                 PUBLIC ACCESS

        Dr. Zerhouni, I commend you for instituting a new policy that will
    increase public access to NIH-funded research. I'm hopeful that this
    policy will help speed the pace of scientific progress and give
    patients and taxpayers better access to research that they are, after
    all, paying for.
        Question. There's still some question, though, about how many
    researchers will voluntarily submit their papers to PubMed Central, and
    how much of an embargo time they'll require between the publication of
    a paper in a scientific journal and when the paper will be posted for
    public access. Have you considered, as a way of leading by example,
    requiring your own intramural researchers to deposit their final papers
    in PubMed Central and make those papers accessible immediately at the
    time of publication?
        Answer. We have provided NIH staff training about the Policy and
    intramural research managers are now actively encouraging authors to
    submit manuscripts and designate public release as soon as possible.
    The Policy-related submissions will directly benefit NIH-supported
    investigators because recent studies have shown that freely available
    articles get cited more in other research publications. An increase in
    the number of citations helps improve the professional standing of
    investigators. Due to these benefits we anticipate that intramural
    authors will choose the earliest release dates.
        I also believe that the voluntary nature of the final policy
    permits sufficient flexibility to accommodate the needs of different
    stakeholders and leaves the ultimate decision in the hands of
    scientific investigators who are in the best position to judge the
    circumstances and the time frame under which their work may be made
    accessible to the public at large. This flexibility allows authors to
    delay posting of manuscripts if there are concerns about the policy's
    adverse impact on their area of research. Therefore, we believe that by
    having a Policy that provides maximum flexibility, authors will respond
    with maximum participation.
        Question. I'm also concerned that the policy could place
    researchers in a difficult position. It's up to researchers to
    negotiate with publishers to get permission to post the articles in the
    NIH database. Since participation is voluntary, publishers might
    pressure researchers not to release their work at all, or to wait a
    full 12 months. Do you share this concern? How will you know if this
    pressure is taking place?
        Answer. We will be gathering statistics on grantee participation
    rates and their specified embargo periods. An NIH Public Access Working
    Group of the NLM Board of Regents has been established and includes
    representatives of various stakeholder groups that will advise the NLM
    Board of Regents on implementation and assess progress in meeting the
    goals of the NIH Public Access Policy. The above statistics will be
    presented to this Working Group and, if it appears necessary, the
    Working Group may suggest modifications of the policy to ensure that
    the public archive is sufficiently timely and comprehensive.
        Question. Finally, could you provide this subcommittee with a
    report, as soon as possible after December 1, 2005, on how many
    eligible articles were deposited in PubMed Central during the first six
    months of the policy and what the average embargo period was.
    Additionally, we would like to know how many articles are in the
    pipeline awaiting posting. Lastly, do you have any way of tracking
    through PubMed the number of articles supported with NIH funds but not
    submitted to PubMed Central? In other words, will you be able to
    provide both the numerator and the denominator of the equation that
    will demonstrate success of your policy?
        Answer. We estimated that the results of NIH-supported research
    were published in approximately 60,000 to 65,000 articles based on the
    number of articles published in the last several years that contained
    an NIH grant number within the text. We will estimate participation by
    comparing the actual number of papers deposited in the NIH Manuscript
    Submission (NIHMS) system for a given interval with the historical
    average. For example, 5,000 deposited articles per month would indicate
    approximately 100 percent participation. By the close of the calendar
    year sufficient data should be available to make an assessment of the
    degree of participation. Statistics for the distribution of the embargo
    periods requested by authors will be readily available from the
    submission system.
                                     ______

                Questions Submitted by Senator Daniel K. Inouye

                     CANCER COUNCIL OF THE PACIFIC ISLANDS

        Question. The Cancer Center in Hawaii continues to provide vital
    research that will benefit Native Hawaiians, Pacific Islanders, and the
    world community. Last year, the Senate requested that a task force
    review the continuing and unique needs of Native Hawaiians and Pacific
    Islanders, specifically as those findings relate to the higher
    incidence of some types of cancers in these populations. Please provide
    an update from the Director's task force on your findings.
        Answer. As recommended by the work of National Cancer Institute's
    (NCI) task force in the Pacific Rim, NCI has created the Cancer Council
    of the Pacific Islands (CCPI), a community-and region-based council
    comprised of representatives of the professional native physicians and
    other health professionals representing the six U.S.-associated
    jurisdictions of the Pacific to address the cancer health needs within
    each of these jurisdictions. NCI has supported the development of this
    task force and conducted needs assessments in all jurisdictions, and
    continues to support capacity building and to address high priority
    cancer needs in these communities. The CCPI provides a community-based
    forum through which all federal agencies conducting programs in these
    jurisdictions coordinate efforts.
        The accomplishments of the Cancer Council of the Pacific Islands
    are substantial. These accomplishments are also significant in that,
    for the first time, Island leaders are provided a controlling voice in
    the design, development, and implementation of their own survey
    instrument and subsequent activities. With the assistance of selected
    professors and students from the University of Hawaii, a comprehensive
    cancer assessment was administered in Kosarae, Chuuk, Pohnpei, Yap,
    Belau, Marshall Islands (Ebeye, Majuro), Northern Mariannas, American
    Samoa, and Guam. We are now implementing the prioritized listings of
    health needs identified as a result of those assessments.
        NCI recently awarded a 5-year Community Networks Cooperative
    Agreement to the Lyndon Baines Johnson Tropical Medical Center in
    American Samoa to directly address cancer disparities, train minority
    investigators, reduce access barriers, and provide research
    infrastructure to link American Samoa to NCI research--Cancer
    Information Service (NCI's cancer information helpline), innovated
    screening, and diagnostic technologies and clinical trials, in
    particular.
        Recently, the CCPI met with NCI, the Health Resources and Services
    Administration, the Centers for Disease Control and Prevention (CDC),
    and other federal partners, as well as C-Change (a coalition of the
    nation's key cancer researchers and policymakers), to work on
    developing Comprehensive Cancer Plans for each jurisdiction, and a
    regional plan for the Pacific Rim. NCI is providing technical
    assistance and administrative support to augment CDC's efforts in
    developing these plans. Once these plans are developed, each
    jurisdiction and the CCPI will be able to apply for CDC implementation
    funds. NCI is committed to this community-based effort in the Pacific
    Rim and continues to develop collaborative programs for the CCPI with
    federal agencies who can improve the health and well-being of the
    Pacific Island communities.

                              CANCER AND ETHNICITY

        Question. Additionally, I chaired hearings in Honolulu during which
    data was presented showing striking differences in the incidents of
    cancer among various ethnic groups. I am told the FDA now encourages
    clinical testing for new drugs in a variety of ethnic groups because
    the drugs themselves have a different effect on each group. Has NIH or
    NCI been pursuing additional research on the genetic or cultural causes
    of cancer and the efficacy of treatment by different ethnic groups?
        Answer. Two years ago, the National Cancer Institute (NCI) launched
    the Breast and Prostate Cancer and Hormone-related Gene Variants Cohort
    Consortium (BPC3 Study) to pool data and biospecimens from 6 large
    cohorts to conduct research on gene-environment interactions in cancer
    etiology. One of these cohorts, the Multiethnic Cohort (MEC) Study, is
    evaluating the genetic and biochemical determinants of cancer risk in
    traditionally understudied minority populations and consists of 215,251
    men and women (ages 45-75 years at baseline) from Hawaii (Asians,
    Whites, and Native Hawaiians) and California (African-Americans and
    Latinos). NCI has begun a Minority Accrual Initiative, whose goals
    include increasing the number of minority investigators and minority
    patients in cancer research. The University of Hawaii received funding
    to foster minority accrual to clinical trials through this initiative.
    Historically, the University of Hawaii and its affiliated hospitals
    have accrued large numbers of minority patients, both Asian-Americans
    and Native Hawaiians, to prevention and treatment trials.
        NCI has also encouraged collaborations between sites with
    relatively non-diverse populations (e.g., Rochester, Minnesota) and
    sites with large minority populations (e.g., Wayne State, Howard
    University) to increase minority accrual to early clinical trials where
    substantial data regarding variations in drug disposition can be
    acquired. Drug disposition data from all NCI's Cancer Therapy
    Evaluation Program trials is evaluated to determine whether any
    differences are evident for these subcategories of patients. In
    addition, Phase 3 clinical trials are analyzed for differences in
    outcome according to race and age among other factors and have resulted
    in publications in these areas and new research approaches to eliminate
    disparities. The bioinformatics infrastructure that supports these
    clinical trials will facilitate even greater data sharing across trials
    and more robust comparisons and data analysis in the future.
        In a public-private partnership, NCI has funded seven sites to
    explore approaches to improve accrual of minority and older patients to
    early clinical trials. In addition, for large clinical trials groups
    that accrue approximately 25,000 patients per year to NCI sponsored
    clinical trials, there are a number of specially funded programs that
    focus on increasing the accrual and evaluation of under-represented
    racial, ethnic, and demographic groups (elderly and rural) to clinical
    trials. These include supplements to specific programs in the NCI
    Clinical Cooperative Groups and the long-standing Minority-Based Cancer
    and Community Oncology Program. There is also a large program funded in
    collaboration with the National Institute of General Medical Sciences
    that supports a Pharmacogenetics Network. This Network evaluates
    pharmacogenomics in drug development which includes the study of the
    impact of race/ethnicity on drug efficacy.
        Question. How satisfied are you with the amount and quality of
    research done in this area?
        Answer. Preliminary findings from the Hawaii Tumor Registry show
    that foreign-born Asians, when compared to U.S.-born Asians and
    Caucasians, have a lower percentage of cancer diagnosed at an early
    stage, a higher percentage of cancer diagnosed at a late stage, and
    lower rates of cancer survival. In an effort to overcome these
    disparities, we have strengthened NCI community-based programs in
    Hawaii including the Community Network Program, Imi Hale Native
    Hawaiian Cancer Network, the American Samoa Community Cancer Network at
    the Lyndon B. Johnson Tropical Medical Center in American Samoa, and
    strengthening support for the Cancer Research Center of Hawaii, a NCI-
    designated cancer research center whose mission is to bring together
    researchers who focus on understanding the etiology of cancer and on
    reducing its impact on the people of Hawaii.
        NCI expects to continue to expand research in cancer health
    disparities to increase our understanding of why some populations
    experience greater incidence, mortality, and lower survival from cancer
    than the majority of Americans. In the NCI report, Making Cancer Health
    Disparities History, published in March 2004, a Trans-HHS Cancer Health
    Disparities Progress Review Group (PRG) comprised of leading cancer
    experts, researchers, patients, cancer survivors, and advocates in
    cancer and health disparities reviewed the status of cancer health
    disparities in the United States and forged a set of 14 priority
    recommendations for Department of Health and Human Services (HHS) to
    lead the Nation in eliminating cancer health disparities. On March 28,
    2005, the HHS Health Disparities Council established a Subcommittee on
    Cancer with NCI as its chair. The subcommittee will focus on six of the
    PRG's 14 recommendations that will address needs ranging from the
    planning and coordination of program efforts to discovery, development,
    and delivery of research advances to all Americans.
        Communities, caregivers, and researchers must form strong alliances
    and explore creative solutions for developing culturally competent
    venues for service delivery. Community-based participation must be an
    integral part of the planning, development, and implementation of
    solutions to bring research advances to all populations. This cross
    fertilization will build synergism and ensure stronger, more dynamic
    alliances for overcoming cancer health disparities.

                              BEHAVIORAL RESEARCH

        Question. Since 1999, the Committee's report has urged the National
    Institute of General Medical Sciences (NIGMS) to fund basic behavioral
    research. The legislative mandate for NIGMS specifically includes
    behavioral science research, yet I am not satisfied basic behavioral
    research has been adequately or even minimally addressed. I understand
    a working group was established as part of the NIH Advisory Committee
    to the Director on Research Opportunities in the Basic Behavioral and
    Social Sciences. I feel we have been extremely patient and sufficient
    time has elapsed to review this issue. Please provide a report to the
    Committee outlining the recommendations of the working group and your
    timeline for implementation.
        Answer. In keeping with the preferred approach of performing
    portfolio analysis across NIH rather than on an institute-by-institute
    basis, a working group of the Advisory Committee to the Director, NIH,
    was formed to examine basic behavioral research across NIH. The working
    group reported to the Advisory Committee on December 2, 2004. Their
    analysis revealed that the institutes and centers (including NIGMS)
    supported approximately $2.68 billion in behavioral research, including
    approximately $936 million in basic behavioral research, in fiscal year
    2003. In addition to this base, several components of the NIH Roadmap
    for Medical Research are directed toward basic behavioral research. In
    particular, several mechanisms are being used to stimulate
    interdisciplinary research at the interface of the behavioral/social
    and biological sciences, provide the interdisciplinary training
    necessary for postdoctoral investigators to work in these areas, and
    support development of innovative methods and technology that will
    facilitate research at the intersection of the behavioral, social and
    biomedical sciences.
        Following the submission of the working group report, NIGMS has
    taken several steps to more clearly articulate the basic behavioral
    research it supports, encourage the submission of more research
    applications in these areas, and increase the number of investigators
    who can work at the interface of the behavioral and biological
    sciences:
        Research Training at the Interface of the Behavioral and Biological
    Sciences.--Basic behavioral research is of critical importance to the
    mission of the NIH and can play a crucial role in understanding the
    etiology of disease and enhancing preventive and therapeutic
    inventions. Greater understanding of the molecular, genetic, and neural
    processes governing behavior, and the reciprocal effects of behaviors
    on physiological processes, is crucial for a complete understanding of
    human health and those diseases in which behavior is a risk factor,
    diagnostic indicator, or symptom. To advance our knowledge in these
    areas, researchers will need to integrate multiple disciplinary
    perspectives, methodologies, and levels of analysis. NIGMS has a strong
    background in developing and supporting such interdisciplinary research
    training. While some existing NIGMS training programs such as the
    Medical Scientist Training Program and the Systems and Integrative
    Biology program include elements of the behavioral sciences, there has
    not been a program dedicated to training at the basic behavioral
    science-biological science interface. NIGMS has developed a proposal
    for such a predoctoral. program and is coordinating its further
    development with other NIH Institutes having an interest in this area.
        Collaborative Research on Basic Mechanisms of Behavior.--To
    encourage the multidisciplinary research that is needed for a fuller
    understanding of the basic mechanisms of behavior, NIGMS has proposed
    an initiative to facilitate collaborations between basic behavioral
    scientists and investigators with expertise in state-of-the-art
    genetics, molecular biology, and genomics. It is anticipated that this
    collaborative research, performed with model organisms, will either
    enhance existing models or lead to the development of new models of
    normal or abnormal human behavior. The concept for this solicitation is
    to be presented for approval at the May 2005 meeting of the National
    Advisory General Medical Sciences Council.
        Assessing Interactions Among Social, Behavioral, and Genetic
    Factors in Health.--NIGMS is a major contributor to an Institute of
    Medicine committee examining the state of the science on gene-
    environment interactions that affect human health. The study will
    identify approaches and strategies to strengthen the integration of
    social, behavioral, and genetic research in this field as well as
    consider relevant training and infrastructure needs. The results of
    this study will be used by the NIH to guide its programs in these
    areas.
                                     ______

                   Questions Submitted by Senator Harry Reid

                            CHRONIC FATIGUE SYNDROME

        Question. Funding for research on chronic fatigue syndrome (CFS)
    has fallen to less than $5 million per year, at the same time national
    prevalence estimates for this serious condition have risen to nearly
    one million American adults and adolescents. In June 2003, Dr. Vivian
    Pinn announced plans to issue a Request for Applications (RFA) for
    research on CFS following an NIH workshop on neuro-immune mechanisms in
    CFS. Almost two years later this RFA has not been issued. What are
    NIH's immediate plans to stimulate research into CFS, a condition that
    CDC reports costs the U.S. economy $9.1 billion a year in lost
    productivity?
        Answer. Funding levels for CFS have remained at approximately $5-$6
    million a year without a significant decline in dollars in years. NIH
    continues to encourage an increase in the number of CFS research
    proposals that are submitted for review and funding each year.
    Applications to PA-02-034, The Pathophysiology and Treatment of Chronic
    Fatigue Syndrome, based on recommendations from an October 2000
    symposium, tripled from its release in December 2001 through fiscal
    year 2004. This PA was revised and reissued under the same title as PA-
    05-030 in December 2004 to include research ideas from the June 2003
    scientific workshop, Neuroimmune Mechanisms and Chronic Fatigue
    Syndrome: Will Understanding Central Mechanisms Enhance the Search for
    the Causes, Consequences, and Treatment of CFS? This program
    announcement specifically invites the submission of investigator-
    initiated grant applications to support research on the epidemiology,
    diagnosis, pathophysiology, and treatment of CFS in diverse groups and
    across the life span. Applications that address gaps in the
    understanding of the environmental and biological risk factors, the
    determinants of heterogeneity among patient populations, and the common
    mediators influencing multiple body systems that are affected in CFS
    are encouraged.
        The proceedings of this June 2003 workshop were recently published
    (NIH Publication No. 04-5497) and posted on the ORWH/CFS website
    (http://www4.od.nih.gov/orwh/cfs-newhome.html). Seven new projects
    related to CFS were funded in fiscal year 2004 and address topics
    raised at this workshop. One of these is an intramural project which
    reflects the impact of a new Trans- NIH Intramural Interest Group on
    Scientific Integrative Medicine that resulted from the June 2003 CFS
    Workshop. Also based on this workshop, the ORWH and the Trans-NIH
    Working Group for Research on Chronic Fatigue Syndrome will be issuing
    a new interdisciplinary Request for Applications (RFA) later in fiscal
    year 2005. This new RFA on CFS has progressed through the usual steps
    following the workshop when the intent was announced. In addition, NIH
    continues to plan relevant scientific activities and efforts on which
    to base future CFS research initiatives.
        Question. Last fall, an analysis of NIH funding for chronic fatigue
    syndrome (CFS) was presented to the DHHS CFS Advisory Committee by the
    CFIDS Association of America. This report documented that NIH had
    overstated its funding of CFS research for fiscal year 1999-fiscal year
    2003 by 19.6 percent through the inclusion of studies unrelated to CFS.
    Total funding of CFS research for this five-year period is just $26
    million--a very small amount given magnitude of the condition and the
    generous increases Congress provided to NIH during these same years.
    What efforts are being taken to ensure that spending figures issued by
    NIH are accurate and reliable and what is NIH doing to expand support
    of research on CFS?
        Answer. The funding figures provided by the NIH on expenditures
    related to CFS are based upon the best scientific and budgetary
    deliberations and are consistent and accurate. As with all scientific
    and budgetary data collections, these funding figures reflect projects
    designated as CFS research by Institute and Center (IC) staff, each
    utilizing his/her best scientific judgment. These figures include
    funding for basic and laboratory studies that are pivotal in the
    development of clinical and translational research; although such
    studies may not seem specific for CFS, they deal with the basic
    biologic processes that are fundamental to developing a better
    understanding of CFS and are thus integral to CFS research. The NIH
    continues to implement efforts to increase CFS research through an
    increase in funded proposals.
                                     ______

                    Questions Submitted by Senator Herb Kohl

                               EPILEPSY RESEARCH

        Question. As you know, epilepsy is a major public health problem,
    affecting 2.5 million Americans throughout their life spans. The impact
    of epilepsy--ranging from debilitating side-effects of treatment to
    brain damage and even death--has long been under-recognized. Epilepsy
    is a public health problem of major proportions.
        Because epilepsy may occur at any age and as a result of many
    different, poorly understood and complicated causes, Congress has
    encouraged the NIH to focus on this problem with a multi-disciplinary
    approach involving efforts by the NIMH, NIA, NICHD and NHGRI in
    coordination with the lead institute, NINDS.
        Epilepsy is the perfect model for a disease that will succumb to a
    coordinated, multi-disciplinary research effort such as you outlined in
    ``The NIH Neuroscience Blueprint''. A few of the above-mentioned
    Institutes have begun to address epilepsy, but coordination and
    communication between them is a necessity if this multi-disciplinary
    approach is to prove fruitful.
        It seems critically important to establish a working group to
    coordinate research efforts, clinical trials and learn from the co-
    morbidities which are so common in patients with epilepsy. Dr.
    Zerhouni, how do you intend to facilitate the coordination which needs
    to exist between these research efforts in order to reduce the burden
    of this all-too-common neurological disorder?
        Answer. The National Institute of Neurological Disorders and Stroke
    (NINDS) is the lead NIH Institute for epilepsy research and the primary
    funding source for studies of seizure disorders. Several other NIH
    Institutes and Centers also fund epilepsy related projects, including
    the National Institute of Child Health and Human Development (NICHD),
    the National Human Genome Research Institute (NHGRI), the National
    Institute of Mental Health (NIMH), and the National Institute on Aging
    (NIA). In order to better facilitate coordination of research efforts
    in this area, these Institutes formed an Interagency Epilepsy Working
    Group. Since its establishment in January 2003, several other NIH
    Institutes with an interest in epilepsy research have joined, including
    the National Institute of Biomedical Imaging and Bioengineering
    (NIBIB), the National Institute on Alcohol Abuse and Alcoholism
    (NIAAA), the NIH John E. Fogarty International Center (FIC), as well as
    a representative from the National Center for Chronic Disease
    Prevention and Health Promotion at the Centers for Disease Control and
    Prevention (CDC).
        The members of the Interagency Epilepsy Working Group are primarily
    extramural program staff who administer epilepsy research grants and
    develop program activities to facilitate research efforts. The purpose
    of this group is to increase communication among institutes and
    agencies supporting epilepsy related research and to explore
    opportunities for increased coordination. An example of these
    cooperative activities is a recent workshop sponsored by the NINDS and
    the NIMH on the treatment of non-epileptic seizures, held on May 1-3,
    2005. The goals of the workshop were to better define diagnostic
    criteria for non-epileptic seizures, develop outcome measures for
    clinical trials, and to discuss a research strategy for this condition.
        The Interagency Epilepsy Working Group meets on a regular basis,
    most recently in October 2004 and April 2005. The April Working Group
    meeting focused on the development of biomarkers for epilepsy related
    research. Working Group members presented examples of relevant
    Institute activities which could be adapted to epilepsy and discussed
    possible approaches to planning a workshop in this important area of
    research. In addition, members of the Working Group participated in the
    most recent meeting of the Epilepsy Benchmark Stewards in February
    2005. The Epilepsy Benchmarks are milestones developed by the epilepsy
    community in 2001 to measure progress in epilepsy research, and
    Stewards have been designated to monitor progress toward meeting each
    Benchmark goal. The purpose of the February meeting was to review
    Benchmark progress and to begin planning a large epilepsy conference
    for 2007 to assess and update the Epilepsy Benchmarks. Working Group
    members will continue to be involved as conference planning progresses.

                                K30 GRANT AWARDS

        Question. As you know, the K30 grant program supports the training
    of clinical researchers--health professionals who translate laboratory
    discoveries to improvements in the care of patients. It is my
    understanding that this year, funding was insufficient to accommodate a
    decision to increase the size of awards from $200,000 to $300,000,
    resulting in the University of Wisconsin losing their K30 award as of
    June. While I applaud your efforts to increase the award amount, I am
    concerned that programs like the one at Madison, who depend on K30
    grants, will be forced to close their doors.
        The shortage of clinical researchers trained to advance medical
    science and improve the care of patients has been well-documented in
    reports from the National Academy of Sciences and the NIH. The
    University of Wisconsin's program has trained 144 clinical researchers
    to date. What will you do to ensure the K30 grant program is funded at
    a level sufficient to restore and expand the program at the $300,000
    level?
        Answer. The NIH recognizes the need for clinical research training
    to ensure that the nation's needs for clinician researchers are met. As
    such we have a number of programs designed to create well-trained
    patient-oriented researchers. A major part of this effort is the
    Clinical Research Curriculum Award (K30). To help address the needs of
    this specific trans-NIH program, a decision was made to increase the
    total funds available from $10,958,000 in fiscal year 2004 to
    $14,700,000 in fiscal year 2005. Additionally, all Institutes and
    Centers funding clinical research will contribute to these awards and
    the size has been increased to $300,000. While we realize that we
    cannot fund all meritorious applications, we do expect to award 49
    grants out of the 81 applications received which is a 61 percent
    success rate.

                            IRRITABLE BOWEL SYNDROME

        Question. Dr. Zerhouni, for the last several years, my colleagues
    and I on the Appropriations Committee have asked NIDDK to develop a
    strategic plan for research into Irritable Bowel Syndrome (IBS), a
    chronic complex of disorders that malign the digestive system. Can you
    update this Committee on the timetable for development and
    implementation of a strategic plan for IBS at NIDDK?
        Answer. The NIH concurs that a strategic plan for IBS will identify
    areas of scientific opportunity and serve as a stimulus in the
    prevention, diagnosis, and management of this functional disorder. Due
    to recent Congressional interest, the NIH is in the early stages of
    creating a new Commission on digestive diseases, which will develop a
    long-range research plan for the entire spectrum of these diseases,
    including IBS.
        The congressional directive to establish the Commission is in the
    Senate report language accompanying the Labor/HHS appropriations bill
    (Senate Report 108-345, page 165). In documentation accompanying the
    President's Budget request for fiscal year 2006, the NIH has informed
    the Labor/HHS appropriations committees that it considers the
    establishment of the commission at this time to be both appropriate and
    useful (HHS fiscal year 2006 Justification of Estimates for
    Appropriations Committees, pp. OD 64-65).
        This Commission will perform an assessment of the state-of-the-
    science in digestive diseases and develop a Long-Range Research Plan
    for Digestive Diseases--with broad stakeholder input from scientific
    and lay experts. A parallel effort, under the leadership of the
    National Institute of Diabetes and Digestive and Kidney Diseases
    (NIDDK), will compile current data on the burden of digestive diseases,
    which would also feed into the Commission's planning process. As noted
    in the draft charter for the Commission, the Long-Range Research Plan
    would focus solely on research--consistent with the NIH mission.
        The Commission is important because the Long-Range Research Plan it
    develops will serve as a beneficial scientific guidepost to both the
    NIH and the digestive diseases community, and would serve the public
    health. According to recent estimates, the total costs associated with
    major forms of digestive diseases approach $43 billion annually. The
    Plan will focus on research in specific diseases, including IBS, and
    will also address the training and education of researchers in
    digestive diseases research; programs for the collection,
    dissemination, and exchange of information and resources in health and
    disease relevant to digestive diseases research; and identification of
    cross cutting, innovative research disciplines and technologies and
    opportunities for synergy in both basic and clinical research within
    the Institutes and Centers of the NIH. The inclusion of IBS as a part
    of a larger strategic planning effort, instead of conducting a stand-
    alone IBS planning effort, will provide greater opportunity to identify
    cross-cutting themes common to multiple digestive diseases and common
    hurdles shared by many.

                        AGE-RELATED MACULAR DEGENERATION

        Question. I understand that the rate of occurrence of age-related
    macular degeneration (AMD) will double over the next 15 years, robbing
    our seniors of their sight. Can you tell us about the research into
    this disease, and specifically, what therapies may be emerging to stop
    or reverse this trend?
        Answer. The National Institutes of Health strongly supports
    research for age-related macular degeneration (AMD) and has contributed
    greatly to the understanding of the disease and to the development of
    new therapies for the disease. Four recently published studies
    supported by the National Eye Institute report on the identification of
    inherited variations in a gene that greatly increase the risk of
    developing AMD. The gene, known as complement factor H, is involved in
    the body's immune defense system. These findings suggest a possible
    role for inflammation in the cascade of biological events that leads to
    AMD. This important discovery may lead to development of new approaches
    to preventing, diagnosing, and treating this disease.
        The National Eye Institute conducted Age-Related Eye Disease Study
    (AREDS) found that a daily high-dose specific formulation of
    antioxidants and zinc can slow the progression of AMD from intermediate
    to advances stages of the disease. Based on an analysis of prevalence
    data and the AREDS study findings, it is estimated that more than
    300,000 Americans could avoid developing advanced AMD and its
    associated vision loss over the next five years by taking this
    formulation.
        An advanced form of AMD called ``wet'' AMD develops as a result of
    new, abnormal blood vessels that grow beneath the retina, leak blood
    and fluid, and produce scar tissue. Left untreated, catastrophic loss
    of central vision may occur. The FDA has approved two new treatments,
    verteporfin and pegaptanib, for controlling ``wet'' AMD. These newly
    approved treatments were developed by industry, but benefited from
    early support for basic research that provided a better understanding
    of the underlying biology. A number of even newer treatments, also
    aimed at preventing or reducing this abnormal blood vessel growth in
    AMD, are being evaluated in ongoing clinical trials.
                                     ______

                Questions Submitted by Senator Richard J. Durbin

                         DRUG RESEARCH AND DEVELOPMENT

        Question. NIH has made tremendous contributions to the public good
    through investments in medical research and therapeutic clinical
    trials. I'm troubled, though, that U.S. citizens are paying twice for
    pharmaceuticals, once through taxpayer support for NIH-funded research
    and then again at the pharmacy when they purchase the drugs that NIH
    funding helped to develop.
        For example, I have a hard time believing that prices charged for
    drugs like Taxol, AZT, Gleevec, and others that are substantially
    funded by taxpayer money are fair.
        Is there anything NIH can do to retain or recoup some of the market
    value of these therapies that are developed based on NIH-funded
    research?
        Answer. Since 2003, NIH has executed 610 new licenses and has
    collected $112 million in royalty income from its intramural research
    program. This represents about two-thirds of the royalty income
    collected by all federal agencies. Most of NIH's licenses are executed
    for early-stage technologies with small companies that do not yet have
    product sales. NIH, however, carefully crafts its licensing terms so
    that it captures a reasonable share of the profits for those products
    that achieve commercialization. In addition, NIH has established a
    Monitoring and Enforcement Branch in the Office of Technology Transfer
    dedicated to monitoring the expeditious development of our licensed
    technologies and to ensuring that we receive the full return on our
    investment.
        In May 2000, the U.S. Congressional Joint Economic Committee issued
    The Benefits of Medical Research and the Role of NIH, which examined
    the role of federal funding for medical research and the benefits that
    derive from that research. The Committee report concluded that the
    benefit of increased life expectancy to the United States as a result
    of advances in health care from NIH-funded medical research results in
    a payoff of about 15 times the taxpayers' investment in NIH. Clearly,
    there are financial and public health related benefits of remarkable
    value that flow from NIH-funded biomedical research.
        The NIH contributes to affordability by conducting and funding
    research that leads to the development of a wider selection of drugs or
    new drugs, where no drugs were available. More alternatives can
    translate into more choices for the public, greater market competition,
    affordability and, ultimately, overall return to society by the
    improvement of the quality of life. Thus, as long as NIH continues to
    focus on its core mandate, namely conducting and funding broad-based
    research that could lead to the development of new drugs and therapies
    in the future, we believe that NIH is acting as a responsible partner
    in the national enterprise to improve the quality of life for the
    public and to make drugs more affordable.

                                 PUBLIC ACCESS

        Question. Your first steps toward more readily accessible research
    information for the public are commendable and appropriate. As I
    understand the process, the results of NIH-funded research should be
    available 12 months after it is published.
        But why are you proposing that making research results accessible
    to the public is ``recommended?'' If this is such a good idea--and I
    think it is--why isn't it required?
        Answer. The voluntary nature of the Policy was established to
    encourage investigators to deposit their manuscripts in NIH's public
    archive. We believe this approach will ultimately result in broader
    participation. The Policy-related submissions will directly benefit
    NIH-supported investigators because recent studies have shown that
    freely available articles get cited more in other research
    publications. An increase in the number of citations helps improve the
    professional standing of investigators. Due to these benefits we
    anticipate that authors will decide to participate and to choose the
    earliest release dates.
        I also believe that the voluntary nature of the final policy
    permits sufficient flexibility to accommodate the needs of different
    stakeholders and leaves the ultimate decision in the hands of
    scientific investigators who are in the best position to judge the
    circumstances and the time frame under which their work may be made
    accessible to the public at large. Therefore, we believe that by having
    a Policy that provides maximum flexibility, authors will respond with
    maximum participation.
        Question. A year's delay after publication in a journal strikes me
    as a very long time, given the pace of biomedical developments today.
    How much time do you expect most participating researchers to let go by
    between publication and release of the study publicly?
        Answer. The Public Access Policy strongly encourages all NIH-funded
    researchers to make their peer-reviewed author's final manuscripts
    available to other researchers and to the public at the National
    Library of Medicine's (NLM) PubMed Central (PMC) immediately after the
    official date of final publication. At the time of submission, authors
    are also given the option to release their manuscripts at a later time,
    up to 12 months after publication. NIH expects that only in limited
    cases will authors deem it necessary to select the longest delay
    period.
        The Policy-related submissions will directly benefit NIH-supported
    investigators by offering an alternate means by which they can fulfill
    the existing requirement to provide publications as part of progress
    reports. It is anticipated that, in the future, investigators applying
    for new and competing renewal support from the NIH will also utilize
    this resource by providing links in their applications to their PubMed
    Central-archived information. Further, recent studies have shown that
    freely available articles get cited more in other research
    publications. Increased citations help improve the professional
    standing of investigators. Due to these benefits we anticipate authors
    will choose the earliest release dates.
        Question. What rates of participation and time delays would you
    consider a success?
        Answer. Our goal is to build a comprehensive archive of the results
    of research that NIH funds. Rather than specifying a particular target
    number, we will be looking for an increasing number of manuscripts to
    be submitted over time and a decreasing delay period. Issuance of this
    policy is the beginning of a process that will include refinements as
    experience develops, outcomes are evaluated, and public dialogue among
    all the stakeholders is continued. An NIH Public Access Working Group
    of the NLM Board of Regents has been established. The Working Group
    includes representatives of the various stakeholder groups and will
    advise the NLM Board of Regents on implementation and assess progress
    in meeting the goals of the NIH Public Access Policy. Once the system
    is operational, modifications and enhancements will be made as needed
    based on the recommendations of the Working Group, or a permanent
    subcommittee of the Board, providing ongoing advice on improvements.
        We hope that secondary effects of the Policy might also be viewed
    in terms of ``success.'' Since the Proposed Policy's release in
    September 2004, we have heard that an increasing number of publishers,
    within and outside of the United States, are considering changes to or
    adoption of Open Access publishing models. For example, in January the
    Nature Publishing Group altered its open access model to increase
    accessibility to its publications. We are optimistic that these changes
    will provide the public with free electronic access to Journal
    articles, through the publisher's web site, on a faster time scale or
    for the first time. This ``change in the landscape'' complements the
    benefits of the NIH Policy since the majority of articles in Journals
    (approximately 90 percent) do not result from NIH-funded research.

                              SUBCOMMITTEE RECESS

        Senator Harkin. Thank you very much.
        The subcommittee will stand in recess to reconvene at 9:30
    a.m., on Monday, July 11 in room SD-192. At that time we will
    hear testimony from the Honorable Patricia Harrison, President
    and CEO, Corporation for Public Broadcasting.
        [Whereupon, at 11:18 a.m., Wednesday, April 6, the
    subcommittee was recessed, to reconvene at 9:30 a.m., Monday,
    July 11.]

    DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED
                  AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2006

                                  ----------

                             MONDAY, JULY 11, 2005

                                           U.S. Senate,
               Subcommittee of the Committee on Appropriations,
                                                        Washington, DC.
        The subcommittee met at 11 a.m., in room SD-192, Dirksen
    Senate Office Building, Hon. Arlen Specter (chairman)
    presiding.
        Present: Senators Specter, Stevens, Inouye, and Durbin.

                      CORPORATION FOR PUBLIC BROADCASTING

    STATEMENT OF KENNETH Y. TOMLINSON, CHAIRMAN, BOARD OF
                DIRECTORS

                   OPENING STATEMENT OF SENATOR ARLEN SPECTER

        Senator Specter. Good morning, ladies and gentlemen. The
    hour of 11 o'clock having arrived, the Appropriations
    Subcommittee on Labor, Health, Human Services, and Education
    will now proceed. This morning's hearing will focus on the
    funding for public broadcasting. The subcommittee is now in the
    final phases of preparing our submission to the full committee,
    which will be done later this week, and I thought it would be
    useful to consider the issue which has received public
    attention as to the appropriate level of funding for public
    broadcasting.
        There has been some concern expressed as to whether there
    is sufficient balance on public broadcasting. The subcommittee
    thought it would be useful to have this hearing to explore
    these issues before we make our final recommendations before
    the subcommittee meeting tomorrow and the full committee on
    Thursday. Then of course, there is floor action. So we think
    this would be helpful as a prelude what committee action on the
    appropriate level of funding should be. Congress likes to keep
    its hands off of these matters to avoid any politicization at
    all, but we do have the oversight responsibility and we have
    the appropriations function, so we are going to proceed with
    this hearing.
        I would like to call the witnesses at this time: Ms.
    Patricia Harrison, President and CEO of the Corporation for
    Public Broadcasting; Mr. Ken Tomlinson, Chairman of the Board
    of Directors; Mr. Pat Mitchell, President and CEO of Public
    Broadcasting Service; Mr. John Lawson, President and CEO of the
    Association of Public Television Stations; Mr. David Boaz,
    Executive Vice President of the Cato Institute.
        Well, welcome, ladies and gentlemen. Thank you for coming
    in on a Monday hearing. Monday morning activities in the
    Congress are somewhat limited by tradition, but it is a very,
    very busy week with a great many items on our Congressional
    agenda.
        Our first witness is Mr. Ken Tomlinson, Chairman of the CPB
    Board of Directors. First elected to the board in 1993, he
    began his career as a journalist with the Richmond Times-
    Dispatch in 1965; was a correspondent in Vietnam and was
    Director of the Voice of America for 2 years. Mr. Tomlinson was
    Editor in Chief of the Reader's Digest until he retired in
    1996.
        Our practice, ladies and gentlemen, as I think you have
    already been advised, is to have 5-minute opening statements,
    leaving the maximum amount of time for questions and answers
    following the opening statements.
        Mr. Tomlinson, thank you for joining us and we look forward
    to your testimony.

                   SUMMARY STATEMENT OF KENNETH Y. TOMLINSON

        Mr. Tomlinson. Thank you, Mr. Chairman. I did submit my
    testimony for the record so that we could preserve as much time
    as possible.
        I am proud to be here in support of Federal funding for
    public broadcasting. I happen to believe that increasing the
    education basis of our children's programming alone merits a
    great deal of focus in terms of what we do in the coming weeks
    and months. As you well know, it is easier to show cartoons
    than to produce programming that has an education basis. We
    should be working so that our education-based programming helps
    young people learn how to read, but also helps people become
    interested in civic responsibility and, in the tradition of Tom
    Friedman, in math and science as well.
        We have a rich history of cultural programs coming out of
    WNET in New York that I would like to see us be able to
    continue and expand. Obviously, across the river at WETA we
    have the great tradition of the ``Jim Lehrer News Hour.'' This
    is journalism dating back to the original ``McNeil-Lehrer
    Report,'' journalism that represents the highest standard.
    There has never been any question of balance on that program.

                               PREPARED STATEMENT

        We look at the importance of the digital conversion. We
    look at the demands we face in terms of the need for a new
    interconnection system. I have brought the issue of the
    importance of political balance, common sense political
    balance, to the public debate. This should not overshadow the
    needs that public broadcasting has, and I am very pleased to be
    here to support those needs.
        Thank you.
        [The statement follows:]
                   Prepared Statement of Kenneth Y. Tomlinson
        I come to you this morning as an individual who supports Federal
    funding for public broadcasting.
        I believe that education-based children's programming represents
    one of the most critical responsibilities for public broadcasters. We
    need to produce programming that will inspire children from all walks
    of life to want to read--to want to acquire knowledge about our
    nation's history and our own civic responsibilities. Taking a cue from
    Tom Friedman, we also should be inspiring interest in math and science,
    because surely we must recognize we live in a world that is flat.
        The cultural programs--the great performances that in recent years
    have been produced by WNET in New York--are an important part of the
    mandate of public broadcasting. The current affairs programs coming
    from WETA--I speak specifically for the tradition of journalistic
    excellence that is the history of the NewsHour with Jim Lehrer--merit
    our support. So, too, is the excellent programming that has come to us
    over the years from WGBH in Boston.
        The clock is ticking on the deadline for funding a new
    interconnection system for public broadcasting. The opportunities
    presented by a transition to digital broadcasting will open exciting
    new doors for the public broadcasting system.
        In recent months I have asserted over and again that you cannot
    understand the case for federal support of public broadcasting until
    you see the fruits of these services in states like North Carolina,
    Kentucky, and South Dakota. If you want to get an idea of the digital
    future of public broadcasting, go to North Carolina and see, thanks to
    public support for a bond issue, four channels that make public
    broadcasting far more relevant and far more valuable to the people of
    that state.
        I would be remiss this morning, however, if I failed to address
    issues surrounding my work to meet the legal mandate that Congress
    placed on CPB to require political balance. Listen to Section 19 of the
    law that governs what we do: CPB shall facilitate the development of
    programs ``of high quality, diversity, creativity, excellence, and
    innovation, which are obtained from diverse sources, will be made
    available to public telecommunications entities, with strict adherence
    to objectivity and balance in all programs or series of programs of a
    controversial nature . . .''
        I did not initiate the controversy over balance, and I am the first
    to recognize this controversy has not been good for the health of
    public broadcasting. So allow me to review the actions that I have
    taken to encourage political balance for the sake of encouraging a wide
    base of support for what we do.
        In late 2003, I went to the leadership of PBS to make the point
    that NOW with Bill Moyers had become a symbol of our ignoring our legal
    mandate to require balance. It was not that Bill Moyers work does not
    represent outstanding political advocacy broadcasting. I did not ask
    for a moment of the show to be removed from public broadcasting
    schedules. My point was that law requires a diversity of opinions, and
    on Friday evenings, public broadcasting would do well to reflect
    conservative points of view as it did so eloquently liberal points of
    view.
        When PBS leadership asserted NOW to be balanced, I asked that a
    consultant review six months of the program and assess the political
    direction of the program's content. Later, I would ask the consultant
    to review other programs on public broadcasting to illustrate that
    unlike NOW they reflected diverse political opinions. The contract for
    this consultant was processed under the supervision of CPB staff and
    our General Counsel according to CPB rules and regulations. I had never
    known CPB board members to be involved in approving contracts with
    consultants--and I had observed any of a number of consultants brought
    in by CPB executive leadership to do similar tasks--so I did not run
    this issue by the board. At no time did I make any effort to keep the
    contract secret from my fellow board members.
        Much has been made in recent days over the classifications of
    viewpoints expressed by Senator Chuck Hagel and former Congressman
    Robert Barr. As the researcher's work illustrates, Bill Moyers did not
    invite Senator Hagel on his show to give him a platform for advocating
    his belief that free trade is critical to the success of U.S. foreign
    policy. That would have run counter to Bill Moyers' deeply held beliefs
    that, by the way, were frequently given time on his program. No,
    Senator Hagel was asked to come to the Moyers show to talk about
    aspects of the war in Iraq that differed from the positions of
    President Bush.
        Bob Barr was not invited on NOW to discuss his political philosophy
    that largely is in conflict with Mr. Moyers' position. Bob Barr was on
    the Moyers program to attack the Patriot Act, which not coincidentally,
    Bill Moyers questioned.
        Again, there is an important audience for the liberal advocacy
    journalism that is Bill Moyers. The law, however, requires CPB to
    encourage balance when such programming is presented.
        Fortunately the board leadership of PBS recognized that Friday
    evening programming should reflect diverse points of view. When it was
    clear that PBS was following through on this commitment, I ended the
    study and did not make it public because to do so would have called
    attention to the fact that for nearly two years public broadcasting
    ignored our legal responsibility for presenting diverse viewpoints on
    controversial issues.
        All of this occurred more than a year ago. So why did the issue
    become a staple in certain press venues in recent months? The answer to
    that question lies in the politics of public broadcasting--as well as
    the politics of year 2005. But one thing is certain. The more this
    debate continues, the more we jeopardize future public support for
    public broadcasting.
        Clearly, it is time for us to lay aside partisanship, seek popular
    consensus for what public broadcasting should be doing, and go forward
    to meet the challenges that lie ahead.
        I look forward to responding to any questions that the Senators
    might have.

        Senator Specter. Thank you very much, Mr. Tomlinson.
        We now turn to--you had concluded your verbal presentation?
        Mr. Tomlinson. Yes, sir.
        Senator Specter. Thank you.
        We turn now to Ms. Patricia Harrison, President and CEO of
    the Corporation for Public Broadcasting. Prior to taking her
    current position, she served as Assistant Secretary of State
    for Education and Cultural Affairs. In 1997 she was elected Co-
    Chairman of the National Republican Committee, serving there
    until January of 2001, a graduate of American University.
        Thank you for joining us, Ms. Harrison, and we look forward
    to your testimony.

    STATEMENT OF PATRICIA HARRISON, PRESIDENT AND CHIEF
                EXECUTIVE OFFICER, CORPORATION FOR PUBLIC
                BROADCASTING
        Ms. Harrison. Thank you, Mr. Chairman. I too have submitted
    my written testimony----
        Senator Specter. All written testimony will be made a part
    of the record in full.
        Ms. Harrison. I would like, with your permission, to use my
    time just to make a few brief remarks.
        Senator Specter. That is fine.
        Ms. Harrison. Thank you. First let me express my strong
    commitment to and belief in the mission of public broadcasting.
    Although I have been in the position of President and CEO of
    CPB for only 5 working days, it is a belief I have long held.
    It began when I served as an intern at WAMU as a student at
    American University. It continued when my children were small
    and we all watched ``Sesame Street'' together, and then much
    later ``Masterpiece Theater.'' It grew as I listened to NPR in
    the morning before I began my day as Assistant Secretary at the
    State Department.
        I believe that public broadcasting is in the public
    interest, that it furthers the general welfare of all our
    citizens, that it is a vital connection to community for
    millions of Americans, all races, all ages, urban and rural,
    and for new Americans and their children. Public broadcasting
    strengthens our civil society and it merits the investment of
    monies represented by our budget request for 2006 and 2008.
        My second point: I am committed to protecting the
    nonpartisan nature of public broadcasting. As you said, I come
    to CPB after almost 4 years as Assistant Secretary of State,
    managing a bureau of hundreds of people, civil servants,
    Foreign Service officers, working with 1,500 public and private
    organizations and 80,000 volunteers to facilitate 30,000
    nonpartisan educational, cultural, and professional exchanges
    annually.
        I am ready to work with Congress, the CPB Board, staff, the
    public broadcasting stations, national organizations, public
    and private funders in an open and transparent way in order to
    serve the millions of Americans who turn to public broadcasting
    each week.
        Now let me turn to the budget. CPB is requesting $430
    million in advance appropriations for fiscal year 2008, the
    vast majority of which will go directly to local television and
    radio stations for locally based, locally relevant operations.
    The corporation requests $45 million in fiscal year 2006 for
    the ongoing conversion to digital technology. We are requesting
    $40 million in 2006 to fund the replacement of the public
    television interconnection system.
        Mr. Chairman, I recognize that we make these requests at a
    time of great pressure on the Federal budget. But when we
    appeal to Congress for funds, we should recognize that hundreds
    of thousands of Americans are already including public
    broadcasting support in their personal budgets by writing
    checks to support these programs, and the fact is that every
    dollar of Federal funding is matched six times over by
    voluntary contributions from viewers, foundations,
    universities, State and local governments, corporations, and
    small business owners, and of every dollar of Federal funding
    we receive 95 cents of that dollar goes to the local stations
    and services they provide. Public broadcasting really
    represents the best example of public-private partnerships.
        We have all read the research on the importance of early
    learning and, though ``Sesame Street'' showed us the way 37
    years ago, the need is even greater today. Public television is
    responding to that need and in fact it is public television's
    responsibility. Whether we are talking about ages 2 through 8
    and early learning programs or middle school to high school
    with a focus on history and civics, the aim is to ensure our
    country's successor generation is prepared for the future.
        For those who have questioned the relevance of public
    broadcasting in a multi-channel world, the answer is that
    public broadcasting is more relevant than ever. We address
    community needs, we provide entertainment, education,
    information programming, and none of this is matched anywhere
    else in the 500-channel universe. That is just one of the
    reasons more than 100 million Americans tune in every week for
    uninterrupted programs where they are treated as citizens, not
    just as consumers.

                               PREPARED STATEMENT

        Mr. Chairman, members of the committee, on behalf of my new
    colleagues in public broadcasting let me say how much we
    appreciate the vital support Congress continues to provide. I
    look forward to working with the committee on behalf of public
    broadcasting in the public interest.
        Thank you and I will be happy to address any questions you
    may have.
        [The statement follows:]

                   Prepared Statement of Patricia S. Harrison

        Mr. Chairman and members of the subcommittee, thank you for this
    opportunity to discuss with you the Corporation for Public
    Broadcasting's funding requests for fiscal year 2006 and fiscal year
    2008. Although I became CPB's President only 1 week ago, I have long
    understood and appreciated the vital role that public broadcasting
    plays in the lives of so many Americans.
        I accepted the challenge of leading CPB because I believe that
    public broadcasting serves as a vital connector to community for so
    many Americans rural and urban. Public broadcasters offer television
    and radio worth watching and listening to, and that is why so many of
    us spend our most precious resource--our time--on public broadcasting.
    I believe public broadcasting is a unique source of education,
    information, and entertainment that fully deserves strong, continuing
    congressional support.
        There is another reason I wanted to lead CPB. It is based on my
    almost 4 years serving as Assistant Secretary of State for Educational
    and Cultural Affairs. In that capacity, I managed a bureau of hundreds
    of people, worked with 1,500 public/private partnerships and 80,000
    volunteers to conduct 30,000 cultural, professional and educational
    exchange programs annually, including the prestigious Fulbright and
    International Visitor programs.
        These vital programs were also connectors between the American
    people and citizens from other countries. In the early 1990's, the
    budget was cut for exchanges and just when we needed to have this
    critical outreach after September 11, 2001, the resources were not
    there. I am very proud that I was able to increase our budget with the
    help of Congress. My goal was to reach out beyond the elites to
    younger, more diverse audiences, and to affirm and connect with what we
    have in common as opposed to our differences. One example--with the
    strong support of Senators Kennedy and Lugar, we were able to create
    the first high school program for boys and girls from the Arab Muslim
    world.
        I see a similar challenge facing public broadcasting today. This is
    an important time to affirm what we have and to work to make it better,
    to reinvigorate public broadcasting and underscore its unique relevance
    in the multi-channel world.
        I have a proven track record of leadership, and I am ready, willing
    and eager to help lead this organization into a strengthened
    relationship with public broadcasting stations, national organizations,
    public and private funders, and the millions of Americans who turn to
    public broadcasting each week.
        As I begin my tenure at CPB, I am particularly fortunate to be able
    to build on what the corporation's staff and their colleagues
    throughout the public broadcasting community have already done. Mr.
    Chairman, today I will mention just a few of these initiatives--work
    that is possible, Mr. Chairman, because of the commitment made by
    Congress and so many others in the public interest, and work that I
    believe will help us leverage an even greater return on the public's
    investment.
        As the distinguished committee knows, public broadcasting is a
    collection of locally based stations that serve both local and national
    needs.
        Public broadcasters offer coverage of national news--and of local
    high school and college sports. They bring the world's greatest artists
    and performances into our living rooms, and they collaborate with local
    arts and cultural institutions. Public broadcasting reaches children
    just learning to read, and often these children are sitting in front of
    the television with parents who are themselves learning to read in a
    new language.
        Public broadcasting is not one size fits all. What you see and hear
    depends upon where you live and what the communities needs are.
      --in Pennsylvania, you can explore your state's history with Marking
            Pennsylvania History on WHYY;
      --in Iowa, you can tune in to Living in Iowa, a monthly statewide
            magazine show;
      --and in North Dakota, you can keep up on all the doings with Dakota
            Datebook, daily on North Dakota Public Radio.
        All across the country, stations are bringing different services
    and programming, informed by community attitudes and concerns, to their
    audiences. They are able to do this so effectively because they are
    locally owned and operated. They know their communities, what their
    neighbors want in terms of programming, what their local organizations
    need in terms of support. In a word, they are connected. And that
    connection is one that distant commercial media simply can't or won't
    provide.
        Mr. Chairman, with your permission, I'd like to turn now to our
    funding requests and the ways in which those federal dollars benefit
    citizens and communities across the country.
        These requests were of course submitted before I came aboard last
    week, but I have had the opportunity to review them with staff and
    believe they merit strong support.
        CPB is requesting $430 million in advance appropriations for fiscal
    year 2008, the vast majority of which will flow directly to local
    public television and radio stations for locally based, locally
    relevant operations.
        Additionally, the corporation requests $45 million in fiscal year
    2006 for the ongoing conversion to digital technology. Mr. Chairman,
    this is so important. As the result of the investment made by Congress
    so far, hundreds of public television and radio stations are offering
    digital signals, and we have recently begun making grants to develop
    new digital services for local communities.
        Digital is the future of broadcasting and the future is here. Mr.
    Chairman and members of the Committee, public broadcasting must be
    enabled to participate fully in that future, and thanks to your ongoing
    support, it is well on the way.
        Finally, CPB is requesting $40 million in fiscal year 2006 to fund
    replacement of the public television interconnection system. Given the
    scheduled expiration of public television's satellite leases, we must
    not miss this opportunity to develop a system that is both more
    efficient and compatible with the new digital technologies.
        Mr. Chairman, I recognize that we make these requests in a time of
    great pressure on the federal budget. The requested funds, however,
    represent an investment of only about $1.75 per American--and the
    return on investment is far greater in terms of value to older
    citizens, urban and rural residents, and minority audiences. If this
    were a stock, I would argue it is one of the best investments the
    American people have ever made.
        Public broadcasting serves every one. There are no qualifications
    of age and income; no requirements for matching funds; no copays.
    Instead, public broadcasting is available to virtually every American,
    free of charge, in every community across the country. And every week,
    more than 100 million of our fellow citizens take advantage of the
    opportunity to tune in.
        In fact, this July 4th I began my day in Washington, D.C. listening
    to Morning Edition and the reading of the Declaration of Independence.
    My day ended at the Capitol Fourth concert and fireworks on the Capitol
    steps. Public television covered this event, which meant that my 90-
    year-old mother and so many others like her throughout the country
    could share in the celebration of America's birthday without leaving
    home.
        Of every dollar CPB receives from the federal government, 95 cents
    goes to local stations, either directly, or indirectly to support
    radio, television and on-line programming, research and technology.
        The largest amount by far--72 cents of every dollar--goes directly
    to local public television and public radio stations. As I said, these
    stations are uniquely connected to their communities. They determine
    their own program schedules, and often produce their own programming;
    they respond to community needs and leverage local support.
        CPB also supports the creation of programming for radio,
    television, and new media. Probably every American is familiar with
    signature programs like Masterpiece Theater and Sesame Street, but
    today, we're funding tomorrow's classics. If you've heard any of the
    new StoryCorps or This I Believe segments on public radio or listened
    to Philadelphia's own Terry Gross, you know what I mean. And we have
    similarly high hopes for our newly announced children's programming
    initiative, which will continue public broadcasting's leadership in
    high-quality, non-commercial, educational programming for children; for
    America at a Crossroads, which will explore the issues facing us in the
    wake of the 9/11 attacks; and for the American History and Civics
    Initiative, which will capitalize on today's technology to reach and
    teach middle and high school students.
        To carry out its mandate to serve the underserved, CPB provides
    support to five minority consortia--representing the unique points of
    views of Latinos, African-Americans, Native Americans, Asian Americans,
    and Pacific Islanders. We also fund the Independent Television Service,
    through which the work of innovative, independent filmmakers is made
    available to the public television audience.
        And we also work to ensure that the programs we support have a life
    long after the television and radio are turned off. Materials are
    available on website and for classroom use and often prove enduringly
    popular as the years go on. Radio material, too, is available for
    download or web-based listening. And programming is frequently
    supported with direct, person-to-person outreach, something
    distinguishes public broadcasting from our commercial counterparts. In
    other words, our impact resonates well beyond the broadcast.
        Another six cents of every dollar go to projects that benefit the
    entire public broadcasting community. We negotiate and pay music
    royalties for all of public broadcasting, for example, allowing
    audiences nationwide to enjoy new and classic recordings, and we
    recently completed the most comprehensive audience research project in
    public television history, information that producers and broadcasters
    will use to guide programming decisions for years to come.
        With special appropriations from Congress, CPB helps local public
    broadcasters provide the advanced public service digital technology
    makes possible. We are funding the upgrade of the public television
    interconnection system that delivers programming to stations. And we
    are funding station purchases of digital equipment that they will use
    to provide new and needed streams of news, music, and public service
    programming. From homeland security information to special streams of
    programming for kids, the public investment is creating a deeper,
    richer mix of services available to people across the country.
        CPB's administrative expenses are limited by law to five percent,
    but we normally hold them even lower. Less than a nickel of every
    federal dollar stays in Washington; the rest is spent to benefit
    stations across the country.
        The Federal appropriation accounts for only about 15 percent of the
    entire cost of public broadcasting, and stations and other
    organizations must work very hard to raise the money to fund their
    activities. In fact, CPB funded the Major Giving Initiative, which has
    helped stations sharpen their community-based fundraising skills and
    improve their balance sheets.
        The Federal dollars are critically to leveraging all the other
    resources. It opens the door for funding from state and local
    governments, universities, businesses, foundations, by providing a
    ``seal of approval'' from the Federal Government.
        The funding we receive from Congress ensures that public
    broadcasting continues to offer programming and services that are
    superior across the board to those offered by commercial competitors.
    As Ken Burns has said, ``The programming on PBS, in all of its splendid
    variety, offers the rarest treat amidst the outrageous cacophony of our
    television marketplace--it gives us back our attention and our memory.
    And by so doing insures that we have a future.''
        Public broadcasting attracts the support of viewers and listeners
    nationwide--people from all walks of life, who add their dollars to the
    vital core of Federal support, writing the checks to fund programs and
    services that are important to their lives, leisure, and careers.
        The Public Broadcasting Act describes public television and radio
    stations as ``valuable community resources'' that can help address
    local concerns. The American public has already invested a great deal
    in creating, preserving and now modernizing these resources. With the
    requested funding, we will work to fulfill their hopes and expectations
    by continuing to deliver high quality, high value services.
        Mr. Chairman, members of the subcommittee, on behalf of all my
    colleagues in public broadcasting, let me say how much we appreciate
    the vital support Congress continues to provide. And let me say
    personally that I understand how valuable public broadcasting is. Plain
    and simple, strong public broadcasting means a stronger democracy. I
    take that responsibility extremely seriously. Thank you, and I will be
    happy to try to answer any questions you may have.

        Senator Specter. Thank you very much, Ms. Harrison.
        We have been joined by the distinguished Senator from
    Hawaii, Senator Inouye, who has been in the Congress as long as
    Hawaii has been a State, initially in the House of
    Representatives and in the Senate, 1960?
        Senator Inouye. 1963.
        Senator Specter. 1963.
        Would you care to make an opening statement, Senator?
        Senator Inouye. I thank you very much, Mr. Chairman. But at
    this moment I would prefer just to ask questions.
        Senator Specter. Thank you. Thank you very much.
        Our third witness is Ms. Pat Mitchell, President and CEO of
    Public Broadcasting Service. She has a broad and distinguished
    background as a journalist, television executive, and educator.
    During her 3-decade career, she has been recognized at her work
    at NBC, CBS, ABC, and CNN; a graduate of the University of
    Georgia.
        Thank you for joining us, Ms. Mitchell. We look forward to
    your testimony.

    STATEMENT OF HON. PAT MITCHELL, PRESIDENT AND CHIEF
                EXECUTIVE OFFICER, PUBLIC BROADCASTING
                SERVICE
        Ms. Mitchell. Thank you very much, Mr. Chairman, and I
    welcome Senator Inouye on behalf of the PBS Board Chair Mary
    Bidderman, who hails from Hawaii, as you know.
        I am very grateful for this opportunity to be here to
    support the appropriations request for the Corporation for
    Public Broadcasting. Mr. Chairman, allow me to welcome Pat
    Harrison to the community of public broadcasting. Last week Pat
    and I shared the PBC Fourth of July Concert and we celebrated
    both our country's independence and also the value of a Public
    Broadcasting Service who can independently bring such a
    celebration through our local station, WETA, and its leader,
    Sharon Rockefeller, who is with us as well, into every American
    home.
        We understand the enormous responsibilities we all have in
    leading such a valued media enterprise at such a time of
    transformational change, a time when our mission, which is to
    use the power of media to serve the public good, is more needed
    than ever. And we are grateful, Mr. Chairman, that in such a
    time when you have such challenging choices to appropriate
    public funds that you continue to appropriate them for public
    media.
        Public media must have the public's trust. It is our rating
    system, our currency, our measure of achievement. In a recent
    Roper poll, Americans named public broadcasting the most
    trusted national institution in this country. The result of
    this trust is the collective good work of public broadcasting
    producers, stations, and the collective goodwill of the
    American people we serve. It is also, Mr. Chairman, the result
    of a collaborative, constructive relationship between the
    management of the public broadcasting organizations seated at
    this table.
        It is a great affirmation to know that Americans indicate
    in independent surveys they consider public television to be
    their best value for their tax dollars, second only to military
    defense.
        So what is PBS's role, then, in using these funds? We are
    not a network like ABC or CBS, but we do provide nearly 3,000
    hours of top-quality educationally-based programs to 170 public
    television stations, who distribute them to 350 communities.
    These are the programs that define public television, but they
    come through essentially local institutions, built on local
    values, serving public and local community interests.
        During my tenure at PBS, I have visited more than 100 of
    these stations and on these visits I have seen the positive
    results of public service media in our communities up close and
    personal. I wish I had the time to share the smiles and
    appreciative thank-you's that have come from parents and
    caregivers and teachers and home schoolers in every community.
    I meet these people and for them PBS is not a luxury or a
    burden; it is an important part of their lives.
        Let us not forget the 40 million Americans without cable or
    satellite. It also matters that, even in homes where there are
    300 channel choices, PBS is still among the top six media
    choices, viewed by more than 70 percent of Americans every
    month. Add to that the millions of visitors to pbs.org and
    station websites every day, learners of all ages, taking
    advantage of 175,000 pages of educational content. Then add the
    millions more that are reached through educational services and
    community partnerships, and you begin, Mr. Chairman, to get a
    picture of the true scale, the unparalleled power of reach and
    power that PBS and our stations in our community are bringing
    to communities in this country.
        We do it in ways that have earned the public's trust:
    children's programs that educate, science programs that
    illuminate, history that is definitive, memorable, news and
    documentaries that are trustworthy and reliable, because of the
    editorial standards that ensure accuracy, fairness, and balance
    across our schedule, all of our programs produced in the public
    interest, not to motivate consumers.
        PBS's management, Mr. Chairman, not the PBS board or any
    other party, is ultimately responsible for ensuring these
    standards guide our decision-making and public opinion polls
    verify that the public perceives we are doing it, free of bias
    and any undue influence from any source.
        Then beyond being a broadcaster that is so valued, we are
    also this Nation's largest educational service, the leading
    source of online lesson plans, 3,500 free on-line, the number
    one choice of educational content in classrooms. More than 5
    million adults receive their GEDs through public television
    stations; workplace essential training; and over the past 10
    years a partnership with the Department of Education has
    changed the lives of hundreds of millions of parents and
    caregivers through Ready To Learn and Ready To Teach. We have
    prepared children for school achievement and we have prepared
    teachers to use the latest technology to meet today and
    tomorrow's learners.

                               PREPARED STATEMENT

        With your support, we will continue to build on this
    foundation of trust and use all the new technologies to deliver
    even more public service.
        Thank you, Mr. Chairman. I look forward to your questions.
        [The statement follows:]

                       Prepared Statement of Pat Mitchell

        Mr. Chairman, members of the Subcommittee: I welcome this
    opportunity to be a witness on behalf of the Public Broadcasting
    Service, this country's largest public service media enterprise, which
    is also this country's most trusted national institution, according to
    a recent Roper Poll.
        Public media must have the public's trust. Trust is our ratings
    system. Our currency. Our measure of achievement.
        And like public education, public health programs, and public
    libraries, public broadcasting is supported by public funds--another
    reason why it is essential to be sure that we have earned the public's
    trust.
        I am pleased to share that Americans have said in independent
    surveys that public television is the best value for their tax dollars,
    second only to military defense. This may surprise some, just as many
    are surprised to learn that the amount of those tax dollars is about
    one tax dollar per citizen per year, totaling less than 20 percent of
    the costs of operating public radio and television stations in
    communities across the country.
        This investment of public funds is the foundation upon which public
    broadcasting has built a national/local, public/private partnership
    that is unique in the world, and it is crucial that we maintain that
    foundation. Therefore, we are asking this committee to fund $430
    million to the Corporation for Public Broadcasting for fiscal year 2008
    to support local stations' operations and public broadcasting
    programming.
        Only in America with our strong philanthropic culture would a media
    enterprise such as PBS meet its mission year after year by leveraging
    every tax dollar with three or four private dollars from foundations,
    corporations, and yes, viewers like you, voluntarily adding their
    personal dollars to ensure that the programs and services of public
    broadcasting continue in their communities.
        Those viewers come from every sector of our communities, closely
    aligned in age, ethnicity, education and income with the overall
    demographic picture of this country. It is a committed constituency who
    believes--as Congress has historically indicated through its
    appropriations votes--that in a media landscape of hundreds of media
    businesses with fewer and fewer owners, with more choices than ever but
    fewer real options, that this country needs, perhaps more than ever,
    one media enterprise that resists the race to the bottom for profits
    and popularity, that respects the intelligence of its audience and
    responds to the need for programs that reflect our values and both
    celebrate and document the best of our history and culture.
        We need one media enterprise, as originally conceived over 35 years
    ago, that is not using its power to sell, cannot be bought or
    influenced and that truly does belong to all of the American people. It
    is those people's voices that have been heard in these halls and around
    the country to protect a service that is open to voices from every
    perspective, that tackles the tough, complex issues they want and need
    to understand, that puts them on the frontlines of the news and in the
    front rows of the theatre and that teaches their children letters and
    numbers as well as respect and other pro-social behavior.
        Those are the ``viewers like you'' who never ask the question,
    ``Who needs PBS in today's media landscape?'' And yes, among them, are
    the often forgotten 40 million Americans who cannot afford or do not
    choose the options of cable or satellite. For them and for most rural
    communities, the funds to support a new interconnection system are
    critical to the sustainability of the national public broadcasting
    service that connects all 348 member stations to PBS and to each other.
        Because of their unique national/local structure, PBS and its
    member stations also offer a unique and important means of
    communicating during a crisis. Trials are under way to determine how
    best to serve first responders and how to ensure communities get what
    they need in times of disaster. The interconnection system must be
    updated to fully optimize this additional service for Americans.
        Therefore, we are asking that this committee fund the $40 million
    needed to build out the interconnection system so that we can ensure
    the universal reach that is our mandate and the delivery of national
    and local programs that serve our mission.
        ``Serve'' is the operative word because PBS and its 348 member
    stations have a mission to serve, not to sell, to inform and engage
    citizens, not to motivate them as consumers.
        This is a distinction with a big difference and the difference can
    be measured by results. I'd like to share a few of them with you today.
        The most obvious and most celebrated are the programs, consistently
    among the most honored for educational value, excellence in quality and
    journalistic standards, and--even in the midst of 300 media choices--
    still among the top choices every week in most households and still
    viewed by nearly 70 percent of American households. In addition, PBS
    was chosen again this year as the number one television and video
    resource for classrooms by teachers across the country.
        Those who question whether there is still a need for PBS when there
    are so many other choices need to take a closer look at those other
    choices. I think you would agree that ``Monster Garage'' is not really
    a substitute for ``Masterpiece Theatre.'' And while distracting and
    amusing, ``Dancing with the Stars'' will not have the long lasting
    value of PBS' series on Broadway, a Ken Burn's history of jazz or
    baseball or the upcoming World War II program.
        At PBS, we do not begin with questions like, Will this program sell
    a product? We begin with questions like, What's the educational value
    of the content? How can teachers use it? Will it have lasting value to
    learners of all ages? Is it comprehensive, well researched? Does it
    contribute to a diversity of perspectives on the subject? Does it add
    to the understanding of our community, our country and our world? Will
    it open a mind, change a life, strengthen a family, teach a skill,
    connect a community? Will it comply with PBS's editorial standards for
    reliability, transparency, objectivity and balance?
        PBS recently updated its editorial standards with the help of a
    blue ribbon panel of journalism experts and also created the position
    of PBS ombudsman to ensure both transparency and responsiveness to the
    public. A search is under way to fill that new role.
        Every year, PBS distributes almost 3000 hours of programs that meet
    our high standards:
      --Children's programs that teach the concepts of literacy and math,
            which foster respect and pro-social behavior, which get our
            youngest and most disadvantaged ready to learn and prepared for
            school.
      --Science and history programs that set the standard for accuracy and
            comprehensiveness and are, along with the rest of our
            programming, the most used TV and video curricula in American
            schools.
      --Drama and performance programs that celebrate our country's great
            cultural diversity and inspire the artists, the dancers, the
            writers and musicians of tomorrow.
      --News and investigative journalism programs that Americans turn to
            for an understanding of the complex issues of our times.
        And this is just the tip of the iceberg.
        Many of these programs and additional educational content go to
    PBS.org, which learners of all ages visit more than one million times a
    day to view 175,000 pages of content--web sites that extend the value
    of PBS and that link users seamlessly to their local PBS station web
    sites for local information, programs and educational services.
    Teachers across the country use nearly 4,000 highly credible, freely
    available lesson plans and study guides based on PBS content in their
    classrooms, all customized to national and state curriculum standards.
        Beyond broadcast and the Internet are the extensive and diverse
    outreach activities that engage PBS and stations in additional
    community service for which our content is perfectly suited: Through a
    Department of Education grant, Ready To Teach, our PBS TeacherLine
    service has been training teachers in reading, math, science,
    curriculum & instruction and technology integration. Everywhere I go
    around this country, teachers express appreciation for this
    professional development training, which is available through online
    courses, videoconferencing and face-to-face workshops, and for the
    state-of-the art digital technology PBS and its member stations are
    deploying to America's classrooms and school systems. The committee's
    support of these programs is essential, and we are requesting that this
    committee fund $17 million to enable PBS and its member stations to
    continue providing this critical service.
        In addition to providing teachers with access to training, PBS and
    its stations are meeting another community need, offering training to
    workers who have faced layoffs or hold jobs in industries in
    transition. KET, a statewide network of PBS member stations in
    Kentucky, is addressing the need to keep Americans fully engaged in the
    economic lives of their communities by offering through PBS
    distribution and to other stations a program that teaches workplace
    skills.
        Together with stations and partnerships with institutions of
    learning, PBS also offers video curriculum and materials for Americans
    seeking to complete their high school education and take college
    classes. More than 2 million Americans have received their GED
    certificates through PBS programs, and PBS and its local stations have
    helped more than 6 million adults earn college credit using PBS
    courses.
        When he signed the law creating public broadcasting in 1967,
    President Johnson said we should ``use the miracles of communication to
    create the miracles of learning.'' PBS and its member stations are
    doing this every day in every community, making us the single largest
    educational institution in the country.
        Education is a significant part of what we do, and the return on
    investment of tax dollars can be measured in the number of children
    better prepared to read and to succeed in school and in the number of
    Americans in every community who are being informed and educated
    through public service media.
        Traveling the country as the president and CEO of PBS, I have seen
    these results up close and personal.
        In rural Pennsylvania, I spoke with a young woman who thanked me
    for her high school diploma and the college degree she expects to earn
    through her PBS station.
        I have met teachers in Iowa who use our videos and DVDs who look to
    us to train all teachers in the best uses of technology.
        I have visited kindergartens and have seen caregivers in
    Mississippi, some with few educational resources, put in a DVD of our
    PBS KIDS program ``Between the Lions'' and I have watched the joy on
    children's faces when they used that program to connect the letters to
    a word they're learning.
        I have been in homes in Texas where there were no books until our
    Ready To Learn program provided books for the children learning to read
    and taught the parents how to support literacy in the home.
        And I have talked with hundreds of homeschoolers for whom PBS
    content comprise their core curriculum.
        Education is our mission and we need your support to ensure that we
    can sustain this service, particularly through Ready To Learn, for
    which we are asking this committee to fund $32 million for programs and
    community outreach. Developed in cooperation with the Department of
    Education, Ready To Learn has helped nearly one million parents and
    teachers prepare eight million children for success in school using
    local public television stations as outreach partners.
        We are working to strengthen our educational offerings in the
    future through an effort called the Digital Future Initiative (DFI),
    led by former Netscape Chairman Jim Barksdale and former FCC Chair Reed
    Hundt. The panel, made up of experts from inside and outside public
    broadcasting, is examining the future of learning and technology, and
    analyzing where PBS and its member stations fit into that future.
        The DFI will recommend new services we can deploy in the digital
    future for learners of all ages, but nothing will be possible without
    current funding, which we hope you will support. With that, we will
    solicit new partners who share our education mission, once again
    leveraging the private funds to make the public funds go even further.
        With your help in securing the foundation of public funds--the all-
    important investment of public dollars--PBS and its member stations are
    the best positioned media enterprise to succeed in the digital future--
    in fact, to lead it. Eighty-nine percent of our stations have converted
    at least their transmission facilities, but some remain in need and
    cannot be left behind. We are asking this committee for $45 million to
    help stations fund the conversion to digital broadcast technology.
        For PBS and for those stations that have converted, the transition
    to digital means a transition to a new way of serving the American
    people by deploying our already considerable offerings across platforms
    that respond to our audience's needs in this media landscape. And that
    is what this is all about. Harnessing the current power of media--
    unprecedented in its capability to do good--on behalf of the American
    people.
        In a media landscape transformed by technology, consolidating in
    ownership and power, this country needs one media enterprise:
        --where education comes first;
      --where partisanship is checked at the newsroom door;
      --where editorial guidelines ensure that all content produced for us
            is fair, transparent in the process and accurate. We have
            recently updated our editorial guidelines to ensure that we
            continue to achieve these goals at every level.
        In a media landscape where fewer and fewer Americans trust the
    press, we maintain our high level of trust because the public believes
    that we are independent of pressures that come from the marketplace and
    the influence of any funding source.
        And in a media environment where our children are spending 4 to 6
    hours a day interacting and engaged with media of some sort, we offer a
    media experience that is committed to the values of family and the
    values of this democracy.
        We are this country's only media enterprise that invests public
    funds in a public-private partnership through a strong national program
    service and an interconnected community of locally owned media
    institutions, public radio and public television stations. And we are
    this country's only media enterprise that delivers programs and
    services that meet community needs and that measures our value and
    relevancy by how many minds we open, how many lives we change, how many
    ways we strengthen communities and how well we serve this democracy.

        Senator Specter. Thank you. Thank you very much, Ms.
    Mitchell.
        Our next witness is Mr. John Lawson, President and CEO of
    the Association of Public Television Stations. He served on the
    board of the National Coalition for Technology in Education and
    Training, was appointed to the Federal Communications
    Commission's Media Security and Reliability Council in 2002, a
    graduate of the University of South Carolina.
        Thank you for coming in this morning, Mr. Lawson, and the
    floor is yours.

    STATEMENT OF JOHN M. LAWSON, PRESIDENT AND CHIEF
                EXECUTIVE OFFICER, ASSOCIATION OF PUBLIC
                TELEVISION STATIONS
        Mr. Lawson. Thank you, Mr. Chairman and Senator Inouye.
    Thanks for inviting me to testify on behalf of America's 356
    local public training stations. In an era of media
    consolidation, our stations are among the last of the locally
    controlled media and that fact alone makes them vital to our
    democratic society.
        With all that has been said and written about public
    broadcasting, especially over the past few weeks, my concern is
    that we not lose sight of who we really are and, more to the
    point, who we really serve. It is not the media, it is not the
    pundits, and it is not us here in this room. It is viewers and
    listeners who turn to public TV and radio as their most trusted
    source for news and public affairs. It is children, whose
    public education is improved by programs in reading, math, and
    science. It is parents, who depend on public television for
    home schooling and for family-friendly and non-violent
    programming. And it is people living in Russell, Kansas, and
    Cumming, Iowa, Hooper Bay, Alaska, and other rural communities
    who depend on public TV and radio as information lifelines.
        Senator Specter. Why special concern about Russell, Kansas?
        Mr. Lawson. I understand that is where you were born, sir.
        Senator Specter. Close. Bob Dole was born there. I was born
    in Wichita, moved there when I was 12.
        Mr. Lawson. Okay, where you grew up.
        Senator Specter. Glad to have Russell included. You can
    have some extra time for mentioning that.
        Mr. Lawson. I will take it.
        So these are the real people, Senator, that public
    broadcasting serves. But make no mistake, our viewers challenge
    us and we challenge ourselves to keep pace with a changing
    society. With the support of this subcommittee, we are
    converting to digital, DTV. In practical terms, that means
    that, instead of broadcasting a single program, stations can
    reach nontraditional learners, kids, the elderly, Spanish
    speakers, and rural Americans with multiple news services
    simultaneously.
        I am also pleased to report that the Department of Homeland
    Security has turned to our stations as the backbone for
    upgrading the Cold War-era emergency alert system and
    overcoming the communications bottlenecks we saw on 9-11 both
    here and in New York City.
        Mr. Chairman, just over 2 weeks ago the House of
    Representatives voted by a two to one margin to restore $100
    million that the House Appropriations Subcommittee cut from
    CPB. While we are grateful for that bipartisan vote of
    confidence, funding for four critically important programs
    still was completely eliminated in the House bill. Tomorrow
    this subcommittee will take on the different task of allocating
    scarce resources.
        So please let me summarize what our stations believe is
    needed to continue serving their communities. First and
    foremost, CPB funding is irreplaceable for our stations. It is
    the foundation. It is the seed money on which all the other
    money we raise stands.
        Also very important is the longstanding practice of this
    subcommittee to provide these funds 2 years in advance. This
    allows for good planning, provides a buffer from politics, and
    does not cost the Federal Government any more than a current
    year appropriation.
        For CPB, we urge you to appropriate $430 million for fiscal
    year 2008, an increase of $30 million over what was
    appropriated last year and the year before. These additional
    funds are needed, among other reasons, because stations are
    required to transmit both analog and digital signals and added
    cost for electricity alone is $30 million per year.

                     NEXT GENERATION INTERCONNECTION SYSTEM

        Two years ago, this subcommittee recognized that our
    current satellite system is wearing out. We have planned a 4-
    year phase-in of a new system that will allow local stations,
    wherever they are, to share programming with one another across
    their State and across the country. For this year's installment
    we are requesting level funding, $40 million.

                          CPB DIGITAL TRANSITION FUNDS

        This is another temporary line item. Next year the FCC
    requires stations to deliver full power digital signals and
    have their final DTV channel allocations in place. To help
    stations meet these Federal mandates and complete their digital
    buildup, we are requesting $45 million. This augments State and
    private funding.

                         READY TO LEARN, READY TO TEACH

        If I can characterize CPB funds as the foundation for our
    stations, I would describe these programs as the crown jewels.
    Ready to Learn provides educational programming for tens of
    millions of American children and its outreach component has
    helped to further prepare eight million children to enter
    school. Ready to Teach uses technology to help train teachers
    in core subjects and provides grants to stations to create
    world-class curriculum content. We are requesting $32 million
    for Ready to Learn and $17 million for Ready to Teach.

                               PREPARED STATEMENT

        In conclusion, Mr. Chairman, Senator Inouye, you and
    ranking member Harkin and Chairman Cochran and Stevens and your
    colleagues on this subcommittee have provided steadfast support
    for public broadcasting. Through good times and bad, you have
    made it possible for public stations to serve uniquely their
    local communities. We are deeply grateful for your lifetime
    support.
        Thank you.
        [The statement follows:]

                      Prepared Statement of John M. Lawson

        Mr. Chairman and members of the Subcommittee: Thank you for the
    opportunity to testify on behalf of our members--representing the 356
    local public television stations across the nation. In an era of
    mergers and acquisitions, our stations are among the last of the
    locally-controlled media and, in that regard, perhaps best reflect one
    of the central tenets of our democratic society.
        With all that's been said and written about public broadcasting,
    especially over the past several weeks, my concern is that we not
    become distracted from our core issues. More to the point, I think it's
    important that we not lose sight of who we serve.
        It's not the media. It's not the pundits. And it's not really us in
    Washington.
      --It's the viewers and listeners who turn to public TV and radio as
            their most trusted source for news and public affairs.
      --It's the children whose public education is improved by programs in
            reading, math and science.
      --It's the parents who depend on public television for home-
            schooling, and who want to be assured that what their children
            watch on TV is family-friendly and non-violent.
      --And it's the people living in Russell, Kansas, Cumming, Iowa,
            Tunica, Mississippi, Hoppers Bay, Alaska and other rural
            communities, who depend on public TV and radio as a lifeline
            for news and weather alerts.
        These are the real people public broadcasting serves.

                                THE DIGITAL AGE

        But make no mistake. We are not resting on our laurels. Our viewers
    challenge us--and we challenge ourselves--to keep pace with a changing
    society.
        With the support of this subcommittee, we are converting to digital
    television broadcasting [DTV]. In practical terms, this means that
    instead of transmitting a single program over the airwaves, stations
    can now broadcast a wide range of new services, including standards-
    based education, all-day channels for kids, and expanded public affairs
    and local programming, simultaneously. DTV means we can reach non
    traditional learners, the elderly, Spanish language speakers and Rural
    Americans as never before.
        I'm also pleased to report that the Department of Homeland Security
    has turned to our stations for help with upgrading the aging Emergency
    Alert System [EAS]--using our digital signals to overcome the
    communications bottlenecks we saw on 9/11, both here and in New York
    City.
        Last year, in fact, my association and DHS signed a cooperative
    agreement to begin a pilot project in the National Capital Region to
    demonstrate the capabilities of public television's infrastructure to
    support the distribution of digital EAS messages. The goal was to prove
    that we could distribute digital EAS messages (such as audio, video,
    and/or data messages) wirelessly to any number of communications
    devices: TVs, radios, PCs, cell phones, pagers and wireless networks.
        The pilot has been a success, and I am gratified to make an
    important announcement today. Building upon the success of this pilot
    project here in the National Capital Region, DHS has signed a new
    cooperative agreement with APTS to plan the national roll-out of the
    Digital Emergency Alert System. We will use the PBS satellite system
    and the local public television stations as the backbone for this
    significantly upgraded public warning system.

                                  HOUSE ACTION

        Just over two weeks ago, the House of Representatives voted--by a 2
    to 1 margin--to restore $100 million cut from the Corporation for
    Public Broadcasting by the House Appropriations Committee. While we are
    grateful for that bipartisan vote of confidence, unfortunately, the
    House bill still fails to fund four critically important programs: next
    generation interconnection, digital conversion, ready to learn and
    ready to teach. In other words, the bill sent by the House to the
    Senate falls more than $103 million short of what is required to
    sustain public broadcasting's mission in the 21st century.
        Moreover, we believe the House cuts presented a great fiscal
    contradiction. On the one hand, two authorizing committees--Budget and
    Commerce--have made the digital conversion of the television industry a
    major priority. This is because the Federal Government can recover and
    auction off the nation's analog television spectrum for billions of
    dollars in new revenue, without raising taxes. Some of these channels
    have already been promised to public safety. On the other hand, this
    will occur only when consumers all make the switch and broadcasters
    cease analog transmission.
        Public television has clearly led the broadcasting industry in
    driving the digital conversion. Yet the House cuts would severely
    damage our digital transition at precisely the moment in history when
    Public Television is doing the most to make the auctions feasible by a
    date certain. In purely financial terms, cuts to public television are
    penny-wise and pound foolish.
        Tomorrow, this subcommittee will take on the difficult task of
    allocating scarce resources across a range of important programs. So,
    if I may, I'd like to briefly review what our local stations believe is
    needed to continue serving their communities.

                              CPB ADVANCE FUNDING

        First and foremost, the Corporation for Public Broadcasting is the
    lifeblood of funding for our stations. Federal funding is the
    foundation, the seed money on which we raise all other money.
        As you know, there has been a long-standing practice of providing
    CPB funds two years in advance, so that stations can more effectively
    plan and manage their operations, as well as leverage non-Federal
    funds. Doing so does not cost the Federal Government any more than a
    current-year appropriation would.
        For CPB, we ask that no funds previously appropriated for fiscal
    year 2006 be rescinded. We suggest that the outpouring of popular
    support for public broadcasting that compelled the full House to
    restore a $100 million cut by the House Appropriations Committee is the
    clearest expression of opposition to any rescission.
        We further urge you to appropriate $430 million for fiscal year
    2008, an increase of $30 million over what was appropriated last year.
    This represents an annualized increase over two years of three and
    three-quarters percent. These additional funds are needed because
    stations are required to transmit both analog and digital signals. Just
    the added cost for electricity amounts to $30 million--annually.

                     NEXT GENERATION INTERCONNECTION SYSTEM

        Two years ago, this subcommittee recognized that our current
    satellite interconnection system is wearing out and badly in need of
    replacement. We set out a four-year phase-in of a new system that will
    allow local stations--wherever they are--to share programming with one
    another, across their state, and across the country.
        For this year's installment, we are requesting level funding--$40
    million.
        We call this system the Next Generation Interconnection System, or
    NGIS. Like its predecessors, NGIS will serve as a distribution system
    linking PBS to local stations. Yet this time, stations will be equipped
    with servers that will store programming, digitally, to be aired--or
    shared--at the station's discretion.
        In engineering-speak, NGIS will give public broadcasters station-
    to-station connectivity, on demand. Let me give you an example of what
    that capability means in the real world.
        Let's assume that WHYY in Philadelphia has produced a program on
    the history and preservation of the Liberty Bell. In the NGIS world,
    WHYY will be able to distribute the program to any station in the
    country that wants it with the ease of a few clicks of a mouse. But
    that's just the beginning. Perhaps a station in say, Bethel, Alaska, is
    working with their local school district to put together some multi-
    media history content. A station employee in Alaska gets online to
    search public television archives and, lo and behold, not only finds
    what WHYY has produced on the Liberty Bell, but can choose just a small
    segment of that program--whatever works best for them. Think of this
    station-to-station sharing feature as connecting hundreds of local
    digital libraries that house local content.

                                  CPB DIGITAL

        Next year, the Federal Government requires that public television
    stations deliver a full digital signal to their entire viewing area,
    and that the final digital channel selection for stations be in place.
    To help meet these Federal mandates, we are requesting $45 million to
    help stations complete their digital build-out. This augments the DTV
    conversion funds that have come from State governments and private
    fundraising. With funding for fiscal year 2006, our request will ramp
    down to zero over the next few years. Without this funding, rural and
    smaller public television stations are at real risk of going dark when
    the digital clock strikes 12:00.

                         READY TO LEARN/READY TO TEACH

        If I can characterize CPB as the lifeblood of our stations, I would
    describe the Ready To Learn and Ready To Teach programs as the crown
    jewel in public broadcasting. These programs are what the term
    ``educational'' in our governing statute are all about.
        Ready To Learn provides educational programming for tens of
    millions of American children, including Between the Lions,
    DragonTales, Clifford, and Sesame Street. The unique national-local
    partnership between PBS and local stations supports both the
    development and distribution of educational programming and the
    extension of this programming into the community, using specially
    developed curriculum and community outreach activities. The Ready To
    Learn service is designed to build partnerships with local community
    organizations such as childcare centers, schools, libraries,
    businesses, civic groups, and government agencies facilitated through
    local public television stations.
        Through this extensive national-local partnership, approximately
    eight million children have benefited from the outreach component of
    the program, better prepared to enter school ready to succeed. This
    year, Public Television is requesting $32 million in fiscal year 2006
    to expand the reach and programming supported by Ready To Learn.
        Ready To Teach uses technology to help train elementary and
    secondary school teachers in core curriculum subjects. It is a teacher
    professional development program that joins the power of multimedia
    content with facilitated training modules in conjunction with local
    accredited higher ed institutions. To date, the 80 Ready To Teach
    stations have reached tens of thousands of teachers. Ready To Teach
    continues to grow in terms of both station and teacher participation;
    thus for fiscal year 2006, we request $17 million to continue this
    effective program.
        In conclusion, Mr. Chairman, I want to thank you, Senator Cochran,
    Senator Stevens, Senator Harkin, and your colleagues on this
    subcommittee for your unswerving support of public broadcasting. Time
    and again--through good times and bad--you have made it possible for
    public television and radio to fulfill their role to the local
    communities they serve. Thank you.

        Senator Specter. Thank you very much, Mr. Lawson.
        The final witness on this panel is Mr. David Boaz,
    Executive Vice President of the Cato Institute. Prior to
    joining Cato in 1981, he was Executive Director of the Council
    for a Competitive Economy. He has played a key role in the
    development of the Cato Institute and the libertarian movement,
    a graduate of Vanderbilt University.
        We appreciate your coming in this morning, Mr. Boaz, and we
    look forward to your testimony.

    STATEMENT OF DAVID BOAZ, EXECUTIVE VICE PRESIDENT, CATO
                INSTITUTE
        Mr. Boaz. Thank you, Mr. Chairman. Mr. Chairman and Senator
    Inouye. Thank you for the opportunity to provide a little
    diversity on this table and to explain why I think taxpayer
    funding for the Corporation of Public Broadcasting should be
    eliminated. I will touch briefly on several arguments in my
    oral discussion and I will save the most important for last.
        First, we have a $400 billion deficit and Congress and the
    Appropriations Committees should be looking for opportunities
    to cut nonessential spending. In a world of 500 channels and
    the World Wide Web, government-funded radio and training
    networks are nonessential.
        Second, public broadcasting is welfare for the rich. In
    their public defenses, officials of CPB wax eloquent about
    bringing ``Sesame Street'' and Shakespeare to poor and isolated
    children. In talking to their advertisers, however, they are
    more candid. The audiences for PBS and NPR are the best
    educated, most professional, and richest audiences in
    broadcasting. Their cultural programming reflects elite tastes
    and I like a lot of it myself. But I think that we upper middle
    class people should pay for our own art and entertainment.
        Third, NPR and PBS can survive privatization. As they often
    remind us, they get only 15 percent of their revenue from the
    Federal Government. Mr. Chairman, families and businesses in
    Pennsylvania often deal with 15 percent losses in their income.
    It is not fun, but they do it. The $2.5 billion public
    broadcasting complex can survive and prosper without Federal
    tax dollars.
        Fourth, in news and public affairs programming, bias is
    inevitable. Any reporter or editor has to choose what is
    important. It is impossible to make such decisions without a
    framework, a perspective, a view of how the world works. A
    careful listener to NPR would notice a preponderance of reports
    on racism, sexism, and environmental destruction, reflecting a
    particular perspective on what is most important in our world.
    David Fanning, the executive producer of PBS's ``Front Line,''
    responds to questions of bias by saying: ``We ask hard
    questions to people in power. That is anathema to some people
    in Washington these days,'' unquote. But there has never been a
    ``Front Line'' documentary on the burden of taxes of the number
    of people who have died because Federal regulations keep drugs
    off the market, or the way that State governments have abused
    the rule of law in their pursuit of tobacco companies, or the
    number of people who use guns to prevent crime. Those hard
    questions just do not occur to liberal journalists.
        Anyone who got all his news from NPR would never know that
    Americans of all races live longer, healthier, and in more
    comfort than ever before in history or that the environment has
    been getting steadily cleaner.
        That brings me to my major concern. We would not want the
    Federal Government to publish a national newspaper. Neither
    should we have a government television network and a government
    radio network. If anything should be kept separate from
    government and politics, it is the news and public affairs
    programming that informs Americans about government and its
    policies. When government brings us the news, with all the
    inevitable bias and spin, the government is putting its thumb
    on the scales of democracy.
        Journalists should not work for the Government. Journalists
    should not have officials of the Government looking over their
    shoulders. And taxpayers should not be forced to subsidize news
    and public affairs programming.
        Therefore I urge you, not merely to reduce, but to
    eliminate taxpayer funding for public broadcasting. Now, even
    if this committee comes to my conclusion that taxpayer funding
    for radio and television networks is imprudent and
    constitutionally unfounded, I recognize that you may hesitate
    to withdraw a funding stream that stations count on. Even
    though Federal funding is only about 15 percent of public
    broadcasting revenues, you might choose to phase out the
    funding, perhaps on a 5-year schedule.

                               PREPARED STATEMENT

        The total funding request for this year is about $500
    million. Congress could reduce it by $100 million a year,
    leaving the CPB entirely free of taxpayer funding and of
    Federal intervention in what journalists do at the end of 5
    years.
        Thank you for your attention, Senators.
        [The statement follows:]

                        Prepared Statement of David Boaz

        Thank you for the opportunity to testify on taxpayer funding for
    the Corporation for Public Broadcasting and by extension for National
    Public Radio and the Public Broadcasting System. I shall argue that
    Americans should not be taxed to fund a national broadcast network and
    that Congress should therefore terminate the funding for CPB.
        We wouldn't want the Federal Government to publish a national
    newspaper. Neither should we have a government television network and a
    Government radio network. If anything should be kept separate from
    Government and politics, it's the news and public affairs programming
    that informs Americans about Government and its policies. When
    Government brings us the news--with all the inevitable bias and spin--
    the Government is putting its thumb on the scales of democracy.
    Journalists should not work for the Government. Taxpayers should not be
    forced to subsidize news and public-affairs programming.
        Much of the recent debate about tax-funded broadcasting has
    centered on whether there is a bias, specifically a liberal bias, at
    NPR and PBS. I would argue that bias is inevitable. Any reporter or
    editor has to choose what's important. It's impossible to make such
    decisions without a framework, a perspective, a view of how the world
    works.
         As a libertarian, I have an outsider's perspective on both liberal
    and conservative bias. And I'm sympathetic to some of public
    broadcasting's biases, such as its tilt toward gay rights, freedom of
    expression, and social tolerance and its deep skepticism toward the
    religious right. And I share many of the cultural preferences of its
    programmers and audience, for theater, independent cinema, history, and
    the like. The problem is not so much a particular bias as the existence
    of any bias.
        Many people have denied the existence of a liberal bias at NPR and
    PBS. Of course, the most effective bias is one that most listeners or
    viewers don't perceive. That can be the subtle use of adjectives or
    frameworks--for instance, a report that ``Congress has failed to pass a
    health care bill'' clearly leaves the impression that a health care
    bill is a good thing, and Congress has ``failed'' a test. Compare that
    to language like ``Congress turned back a Republican effort to cut
    taxes for the wealthy.'' There the listener is clearly being told that
    something bad almost happened, but Congress ``turned back'' the threat.
        A careful listener to NPR would notice a preponderance of reports
    on racism, sexism, and environmental destruction. David Fanning,
    executive producer of ``Frontline,'' PBS's documentary series, responds
    to questions of bias by saying, ``We ask hard questions to people in
    power. That's anathema to some people in Washington these days.'' But
    there has never been a ``Frontline'' documentary on the burden of
    taxes, or the number of people who have died because federal
    regulations keep drugs off the market, or the way that state
    governments have abused the law in their pursuit of tobacco companies,
    or the number of people who use guns to prevent crime. Those ``hard
    questions'' just don't occur to liberal journalists.
        Anyone who got all his news from NPR would never know that
    Americans of all races live longer, healthier, and in more comfort than
    ever before in history, or that the environment has been getting
    steadily cleaner.
        In Washington, I have the luxury of choosing from two NPR stations.
    On Wednesday evening, June 29, a Robert Reich commentary came on. I
    switched to the other station, which was broadcasting a Daniel Schorr
    commentary. That's not just liberal bias, it's a liberal roadblock.
        In the past few weeks, as this issue has been debated, I've noted
    other examples. A common practice is labeling conservatives but not
    liberals in news stories--that is, listeners are warned that the
    conservative guests have a political agenda but are not told that the
    other guests are liberals. Take a story on the Supreme Court that
    identified legal scholar Bruce Fein correctly as a conservative but did
    not label liberal scholars Pamela Karlan and Akhil Amar. Or take the
    long and glowing reviews of two leftist agitprop plays, one written by
    Robert Reich and performed on Cape Cod and another written by David
    Hare and performed in Los Angeles. I think we can be confident that if
    a Reagan Cabinet official wrote a play about how stupid and evil
    liberals are--the mirror image of Reich's play--it would not be
    celebrated on NPR. And then there was the effusive report on Pete
    Seeger, the folksinger who was a member of the Communist Party,
    complete with a two-hour online concert, to launch the Fourth of July
    weekend.
        And if there were any doubt about the political spin of NPR and
    PBS, it was surely ended when a congressional subcommittee voted to cut
    the funding for CPB. Who swung into action? Moveon.org, Common Cause,
    and various left-wing media pressure groups. They made ``defending
    PBS'' the top items on their websites, they sent out millions of
    emails, they appeared on radio and television shows in order to defend
    an effective delivery system for liberal ideas. Public broadcasters
    worked hand in glove with those groups, for instance linking from the
    NPR website to those groups' sites.
        There are many complaints today about political interference in
    CPB, PBS, and NPR. I am sympathetic to those complaints. No journalist
    wants political appointees looking over his shoulder. But political
    interference is entirely a consequence of political funding. As long as
    the taxpayers fund something, their representatives have the authority
    to investigate how the taxpayers' money is being spent. Recall the
    criticism directed at PBS in 1994 for broadcasting Tales of the City,
    which has gay characters. Because of the political pressure, PBS
    decided not to produce the sequel, More Tales of the City. It appeared
    on Showtime and generated little political controversy because Showtime
    isn't funded with tax dollars. Remove the tax funding, and NPR and PBS
    would be free from political interference, free to be as daring and
    innovative and provocative as they like.
        One dirty little secret that NPR and PBS don't like to acknowledge
    in public debate is the wealth of their listeners and viewers. But
    they're happy to tell their advertisers about the affluent audience
    they're reaching. In 1999 NPR commissioned Mediamark Research to study
    its listeners. NPR then enthusiastically told advertisers that its
    listeners are 66 percent wealthier than the average American, three
    times as likely to be college graduates, and 150 percent more likely to
    be professionals or managers.
        But perhaps that was an unusual year? Mediamark's 2003 study found
    the same pattern. As NPR explained, based on the 2003 study:
        Public radio listeners are driven to learn more, to earn more, to
    spend more, and to be more involved in their communities. They are
    leaders and decision makers, both in the boardroom and in the town
    square. They are more likely to exert their influence on their
    communities in all types of ways--from voting to volunteering.
        Public radio listeners are dynamic--they do more. They are much
    more likely than the general public to travel to foreign nations, to
    attend concerts and arts events, and to exercise regularly. They are
    health conscious, and are less likely to have serious health problems.
    Their media usage patterns reflect their active lifestyles, they tend
    to favor portable media such as newspapers or radio.
        As consumers, they are more likely to have a taste for products
    that deliver on the promise of quality. Naturally, they tend to spend
    more on products and services.
        Specifically, the report found, compared with the general public,
    NPR listeners are
      --55 percent less likely to have a household income below $30,000
      --117 percent more likely to have a household income above $150,000
      --152 percent more likely to have a home valued at $500,000 or more
      --194 percent more likely to travel to France
      --326 percent more likely to read the New Yorker
      --125 percent more likely to own bonds
      --125 percent more likely to own a Volvo.
        PBS has similar demographics. PBS boasts that its viewers are:
      --60 percent more likely to have a household income above $75,000
      --139 percent more likely to have a graduate degree
      --98 percent more likely to be a CEO
      --132 percent likely to have a home valued at $500,000 or more
      --315 percent more likely to have stocks valued at $75,000 or more
      --278 percent more likely to have spent at least $6000 on a foreign
            vacation in the past year.
        Tax-funded broadcasting is a giant income transfer upward: the
    middle class is taxed to pay for news and entertainment for the upper
    middle class. It's no accident that you hear ads for Remy Martin and
    ``private banking services'' on NPR, not for Budweiser and free
    checking accounts.
        Defenders of the tax-funded broadcast networks often point out that
    only about 15 percent of their funding comes from the Federal
    Government. Indeed, NPR and PBS have been quite successful at raising
    money from foundations, members, and business enterprises. Given that,
    they could certainly absorb a 15 percent revenue loss. Businesses and
    nonprofit organizations often deal with larger revenue fluctuations
    than that. It isn't fun, but it happens. In a time of $400 billion
    deficits, Congress should be looking for nonessential spending that
    could be cut. Tax-funded broadcasting is no longer an infant industry;
    it's a healthy $2.5 billion enterprise that might well discover it
    liked being free of political control for a paltry 15 percent cut.
        Finally, I would note that the Constitution provides no authority
    for a Federal broadcasting system. Members of Congress once took
    seriously the constraints imposed on them by the Constitution. In 1794
    James Madison, the father of the Constitution, rose on the floor of the
    House and declared that he could not ``undertake to lay his finger on
    that article of the Federal Constitution which granted a right to
    Congress of expending, on objects of benevolence, the money of their
    constituents.'' In 1887, exactly 100 years after the Constitution was
    drafted, President Grover Cleveland made a similar point when he vetoed
    a bill to buy seeds for Texas farmers suffering from a drought, saying
    he could ``find no warrant for such an appropriation in the
    Constitution.'' Things had changed by 1935, when President Roosevelt
    wrote to Congress, ``I hope your committee will not permit doubts as to
    constitutionality, however reasonable, to block the suggested
    legislation.'' I suggest that this committee take note of the fact that
    no article of the Constitution authorizes a national broadcast network.
        Even if this committee comes to the conclusion that taxpayer
    funding for radio and television networks is imprudent and
    constitutionally unfounded, I recognize that you may hesitate to
    withdraw a funding stream that stations count on. In that regard, I
    would note again that federal funding is only about 15 percent of
    public broadcasting revenues. But you might also phase out the funding,
    perhaps on a 5-year schedule. The total funding request for this year
    is about $500 million. Congress might decide to reduce it by $100
    million a year, leaving the CPB entirely free of federal taxpayer
    funding at the end of 5 years.
        But Congress's resolve in such matters is not trusted. Recall the
    1996 Freedom to Farm Act, which likewise promised to phase out farm
    subsidies. Barely two years had passed when Congress began providing
    ``emergency relief payments'' to make up for the scheduled reductions.
    This time, if Congress pledges to phase out broadcasting subsidies, it
    needs to make sure that its decision sticks.
        A healthy democracy needs a free and diverse press. Americans today
    have access to more sources of news and opinion than ever before.
    Deregulation has produced unprecedented diversity--more broadcast
    networks than before, cable networks, satellite television and radio,
    the Internet. If there was at some point a diversity argument for NPR
    and PBS, it is no longer valid. We do not need a government news and
    opinion network. More importantly, we should not require taxpayers to
    pay for broadcasting that will inevitably reflect a particular
    perspective on politics and culture. The marketplace of democracy
    should be a free market, in which the voices of citizens are heard,
    with no unfair advantage granted by Government to one participant.

        Senator Specter. Thank you very much, Mr. Boaz.
        We have been joined by Senator Durbin. Would you care,
    Senator Durbin, at this point to make an opening statement?
        Senator Durbin. I can put it in the record. I would just
    like to ask some questions.
        Senator Specter. Without objection, his statement will be
    put in the record.
        [The statement follows:]
                Prepared Statement of Senator Richard J. Durbin
        Thank you, Mr. Chairman, for holding this hearing today. I want to
    welcome all the witnesses, and look forward to their testimony.
        Like millions of parents around the nation, I am a strong supporter
    of public broadcasting for all the great educational opportunities it
    provides to our children. Over one third of all public broadcasts aired
    on weekdays are dedicated to children's programming. More important
    than what children see on public television is what they don't see--
    commercials about junk food and toys, interruptions throughout a
    program, violence, adult themes, and content simply not suitable for
    children.
        Public Broadcasting Service provides more than just a wide range of
    programs for children's learning. PBS also provides online learning
    games and activities for children, as well as resources--including
    workshops and free books--for parents, caregivers, and educators to
    further enhance the academic and pro-social skills-learning experience
    for the children. These high quality tools, many of which are developed
    jointly with the U.S. Department of Education, have been proven to help
    build our children's literacy and school-readiness skills.
        I am also a supporter of public broadcasting because of the value
    it adds to smaller towns and rural counties throughout Illinois and
    elsewhere. Sixty-five million Americans live in rural areas, yet many
    of these households do not have cable and broadband access. Free, over-
    the-air, public educational television continues to be a critical asset
    to rural Americans.
        Thus, there is no question in my mind when it comes to fully
    funding the Corporation for Public Broadcasting and the other requests
    made by the public broadcasting community. It is a bargain to think
    that we can have such an abundance of quality programs for the entire
    year at the cost of a little more than $1 of public funding per person
    in America.
        Public funding is especially important for smaller or rural
    stations that depend on the federal funding as seed money to plan out
    their operations for the upcoming years. For these stations, the
    federal funds we provide each year make up a larger portion of their
    annual budget than stations in other parts of the country. But, unlike
    their counterparts in big cities, rural public stations simply do not
    have the fundraising bases--such as large pool of individual,
    corporate, and foundation donors--that could potentially replace any
    shortfall in federal funding.
        I look forward to working with the Chairman and the members of this
    subcommittee to ensure that every item asked for by our local stations
    can be met in our appropriations process this week and beyond.
        I also look forward to clearing the air today of several
    controversies surrounding recent activities at the Corporation for
    Public Broadcasting. I am very concerned to read in the press that
    there may be partisan political activities taking place at CPB, and I
    hope we will receive some straight answers to these lingering questions
    from representatives of CPB.
        Mr. Kenneth Tomlinson, who appears before us today as CPB's
    chairman of the board of directors, has been associated with many of
    these allegations. There are reports that he has made personnel
    decisions based on partisan or political factors and that he has
    influenced the content of programs that are aired on public
    broadcasting. These allegations rise to such a serious level that CPB's
    own inspector general has initiated an internal investigation.
        One episode is particularly troubling. According to press reports,
    Mr. Tomlinson paid an outside consultant over $14,000 of taxpayer funds
    to have him monitor certain public broadcast programs to determine the
    political ideology of guests who appear on these shows. The
    consultant's report is now in the public domain, and its conclusions
    are suspicious, at best. For example, according to Mr. Tomlinson's
    consultant, my Republican colleague, Senator Chuck Hagel, is a
    ``liberal'' because he happened to disagree with some of President
    Bush's positions on a show that aired on public broadcast. The report
    is full of such ridiculous assertions.
        I have also read that Mr. Tomlinson personally advocated for the
    addition of a program to the PBS lineup hosted by editors of the Wall
    Street Journal's editorial page, in his self-described attempt to
    balance the perceived liberal bias of ``NOW'' with Bill Moyers. This
    comes at the same time when CPB is insisting on tying new funding for
    PBS to an agreement that PBS would commit to strict new standard of
    ``objectivity and balance'' in its programs.
        Apparently, Mr. Tomlinson believes public broadcasting is too
    liberal, even though a series of focus groups and two national surveys
    conducted at CPB's own request concluded that the public perception is
    otherwise. Specifically, the survey of over 1,000 adults found that
    only 21 percent thought the Public Broadcasting Service had a liberal
    bias and 22 percent thought the National Public Radio had a liberal
    bias. The survey found that 12 percent thought PBS had a conservative
    bias and 9 percent thought the same of NPR. This means that two-thirds
    of those surveyed believed there was no apparent bias on PBS or NPR.
        Additionally, the survey conducted on CPB's behalf found that 80
    percent of respondents had a ``favorable'' opinion of public
    broadcasting, while only 10 percent had an ``unfavorable'' opinion.
    More than half of the respondents (55 percent) also said that PBS
    programming was ``fair and balanced,'' while NPR received an even
    higher approval rating of 79 percent.
        The internal survey results and the overwhelming support expressed
    by the public as evidenced by the recent vote in the House of
    Representatives to restore funding for public broadcast seem to
    indicate that perhaps Mr. Tomlinson should rethink what he believes is
    in the best interests of the consumers of public broadcasting.

        Senator Specter. Mr. Boaz, let us start with the question
    that you raised, that public broadcasting can survive without
    Federal funding. Ms. Mitchell, can public broadcasting survive
    without Federal funding, as Mr. Boaz suggests?
        Ms. Mitchell. Mr. Chairman, I would respectfully disagree
    with the principle of Mr. Boaz's arguments. It is a principle
    of this democracy that, while we have very successful private
    bookstores, we still invest in private--in public libraries.
    And we have private schools, but we invest in public schools.
        This Congress saw the benefit of setting aside public
    spectrum for public service broadcasting and that is, it seems
    to me, a great use of public funds, using the power of media to
    inform and engage citizens so that the great work of this
    democracy might go forward.
        Senator Specter. Ms. Mitchell, I am not quite sure of your
    answer. Can public broadcasting survive without Federal
    funding?
        Ms. Mitchell. The taxpayer dollars, Mr. Chairman, are
    leveraged with private money. So that 15 percent is a hugely
    important critical foundation for not only the station
    services, because most of the money, as Ms. Harrison
    represented, goes directly to the stations, and there they
    leverage from the 15 or 20 percent of their budget that is
    provided by appropriations, they leverage all of this private
    investment from foundations, corporations, and, yes, viewers
    like you, who still voluntarily support at a level that is the
    largest single percentage.
        Senator Specter. Mr. Lawson, the point is made by Mr. Boaz
    that there ought not to be a national newspaper and analogizes
    that to public broadcasting. Let me ask you a two-part
    question. Would you agree that there ought not to be a national
    newspaper, part one? And part two, does public broadcasting--
    and I am going to give Mr. Boaz a chance to respond to this,
    too--come anywhere in the range of constituting what would be a
    national media organ?
        Mr. Lawson. No, sir, I do not think there should be a
    national newspaper and I do not think public broadcasting in
    any way constitutes a national media organ. As I said in my
    statement, we are the last of the locally controlled media.
    That is a characteristic of American public broadcasting that
    is different from any other country. We are not the BBC, we are
    not NHK, we are not centrally managed. It is about local
    control.
        I can tell you, if the 15 percent went away, first you
    would see stations serving rural America go dark. Secondly,
    even for the big market stations there would be so much
    pressure on them to replace that money. The Federal money is
    the foundation, it is the seed money. All the other money we
    raise is based on that, and you would see enormous pressure on
    even the largest stations to become more commercial.
        So localism is the key to public broadcasting in the United
    States.
        Senator Specter. Mr. Boaz, you raise a very fundamental
    point here on the kinds of programming and have identified a
    series of subjects which you note that the ``Front Line''
    documentary has never addressed, such as burden of taxes or the
    regulatory system or pursuit of private companies. Has ``Front
    Line'' or other similar programs on public broadcasting
    addressed any of the issues which you think would provide
    balance on the kind of hard questions which ought to be asked?
        Mr. Boaz. I am sure that no program has been completely
    unbalanced. But I am not aware of ``Front Line''--I did
    actually check with ``Front Line'' on these specific claims and
    they acknowledge that, no, they have never done a documentary
    on those. Certainly some of the questions that ``Front Line''
    deals with I think are important and sometimes ``Front Line's''
    programming is I think balanced.
        But I do not think you can watch it or listen to National
    Public Radio, which I do at least twice a day, and not get the
    impression that there is a particular perspective guiding it.
    As I say in my written testimony, I agree with some of that
    perspective. I am sympathetic to NPR's skepticism about the
    religious right, its support for social tolerance and freedom
    of expression. But I do think that is a perspective.
        I have a political opinion and so do the editors and
    producers at NPR. So I do think it is impossible to avoid some
    sort of perspective or theme running through your programming
    and I think that ``Front Line,'' the other documentary series,
    NPR, have not avoided that bias.

                            HOUSE APPROPRIATION BILL

        Senator Specter. Ms. Harrison, the Appropriations Committee
    is going to have to consider the issue of digital transition.
    The House did not provide a direct appropriation for digital
    transition, but instead gave CPB authority to carve out funds
    from station grants.
        To what extent would the absence of a direct grant for
    digital transition and a requirement that the money come out of
    station grants be problemsome for you?
        Ms. Harrison. Mr. Chairman, if I could answer that question
    by folding in some of the things that we have been discussing
    here today. Public broadcasting is our strongest connected
    community at a time when we need an informed citizenry. Even
    though we have multiple channels, it seems amazing; the more
    channels we have, the more dumbing down occurs through
    programs, whether it is aimed at children or it is aimed at
    people who are older.
        If we have to give up the money for this very, very
    important digital technology, it will come directly out of the
    sole purpose for which public broadcasting exists, and that is
    to be a network of knowledge. We will have to meet with the
    stations, the general managers, and the cuts will be very bad.
        I feel so strongly about the purpose of public broadcasting
    as an educator, and now as we have increasingly more young
    people in this country who do not understand our history or
    civics, we have new Americans--and you know, sometimes those
    moms and their kids are sitting in front of these children's
    programs and they are learning English, they are learning about
    our country. If we did not have public broadcasting today, we
    would have to re-invent it.
        I come to this job from a former position where in the
    early 90s exchanges were cut. We thought technology was going
    to enable us to increase mutual understanding between the
    people of the United States and other countries. What we found
    out is the people to people connection is important. This
    community connection is vital to our country's strength and I
    think to the strength of our democracy.
        Senator Specter. We have since been joined by Senator
    Stevens, formerly the chairman of the full committee. Before
    going to Senator Inouye for his opening round of questions,
    Senator Stevens, would you care to make an opening statement?

                        STATEMENT OF SENATOR TED STEVENS

        Senator Stevens. Thank you very much, Mr. Chairman. I am
    sorry to be late. To confess, my mind is still in Alaska on the
    fishing stream, and there is 4 hours time difference, too. But
    I do appreciate the opportunity to come here and I hope I can
    stay through a round of questioning.
        I believe that the full amount of the request should be
    supported by the subcommittee and moneys deleted by the House
    be restored. But I also believe that what Mr. Boaz has just
    said is true, that there are signs in portions of the
    Corporation for Public Broadcasting and the Broadcasting
    Service which indicate that there are unfortunate trends in
    some places to take on political issues in a way that
    demonstrates a bias.
        It is my judgment that there should be no bias, no leaning
    to the right or to the left by management or by those who
    operate the stations. The answer that I think you should have
    given, Ms. Mitchell, to the chairman's question are the Federal
    dollars necessary, can these organizations survive without
    Federal money, the answer has got to be no. In my State there
    are many places where you do not have sufficient base for
    public support. Our State helps by paying in some areas the
    telephone services for these various stations. But there are
    other areas in the country which do not have public support
    capability, financial support capability.
        I do believe that the Federal money is not only seed money
    for the system, but it is absolutely necessary to assure that
    the system will be extended to wherever there is a need, rather
    than wherever there is the public support base for financial
    contributions.
        But I thank you for holding the hearing. I do think that
    members of the Congress ought to calm down. This system needs
    our support. I remember so well when we started some of the
    concepts of matching funds. We took away the actual matching
    fund requirement that existed for a little while. But I do
    believe that this is an essential service.
        My mind goes back to ``The Adams Papers'' or to the
    rebroadcasting of some of the BBC programming that we would not
    have had otherwise. I know this system is needed by the
    country, but I deplore the fact that there are some people
    within it that want to exercise their political bias in
    delivering it. That is your problem. I think the board's
    problem is to get rid of that and restore the balance that
    existed in the past in the system and really not look to the
    left or the right, but just look wherever there is bias going
    either direction and set the record straight so we will not
    face this challenge that the House has delivered.
        I think they were right in delivering it, because I think
    you are all here today to really react to the cause of that
    deletion. I think our job is to put the money back and convince
    them that there has been a wakeup call, that the bells have
    rung and that people have heard the message, and we are all
    going to make this system work.
        Thank you, Mr. Chairman.
        Senator Specter. Thank you very much, Senator Stevens.
        Senator Inouye.

                     STATEMENT OF SENATOR DANIEL K. INOUYE

        Senator Inouye. Thank you very much.

                             AUDIENCE DEMOGRAPHICS

        I would like to assure the panel here that I fully support
    full funding of what you are requesting. I would like to ask
    Ms. Harrison or Ms. Mitchell, do you believe that in the case
    of your operation monies--funded by the taxpayers--are they
    being spent to cater only to the rich and the educated? That is
    what was said here.
        Ms. Mitchell. Our viewers and our supporters, Senator
    Inouye, reflect and mirror very closely the demographic makeup
    of our communities, and that is in terms of income and
    education and ethnicity and cultural background. I would like
    to take Mr. Boaz on some of my visits to our stations, where he
    would meet these people and see their faces, the faces of
    caregivers in rural Mississippi who have no books in the home,
    who are unprepared themselves, and often, as Pat said, even
    without the literacy skills they need, much less the skills to
    pass it on to the children in their care.
        In those places and the rural places in this country, all
    over this country, we are there providing caregivers with
    materials they would not have otherwise: free books, training
    for these caregivers, literacy skills that prepare those
    children, usually the most disadvantaged.
        I would also point out that among all the other children's
    programs that are on television, ours are the only ones that
    begin with educators, that begin with clear learning
    objectives, and that are based in every way, through
    characters, scenarios, to appeal to every child in this
    country, so that no parent or caregiver is left behind.
        Mr. Chairman, may I take this moment also to say that in a
    time when, as Senator Stevens referenced, the trust in media
    has never been lower in this country--and I think there is good
    reason for that. And since our trust level is so high, we felt
    it very important for us to review the editorial standards that
    guide our program decisionmaking. More than a year ago we put
    together a blue ribbon panel of journalists and we asked them
    to look at our programming from every perspective: Was it
    reflecting the needs of our communities that we knew from the
    public opinion polls, and then the editorial standards, were
    they ensuring that we complied, not only with the statutory
    obligations for objectivity and balance, but that we went
    beyond that and clarified what we mean by accuracy,
    reliability, transparency.
        Those new guidelines are in place and we believe that they
    will further ensure that on all subjects--and those subjects
    that Mr. Boaz referenced I am going to pass along to ``Front
    Line'' this afternoon; they sound like subjects we should be
    looking at--that on all subjects we represent the diversity of
    perspectives that is in this country.
        Ms. Harrison. Senator Inouye, I welcome this opportunity to
    address your question and also in an oblique way Mr. Boaz. CPB
    is the only organization within public broadcasting that really
    is cast to look at the concerns you expressed: Are we taking
    care of minorities? Are we looking at rural communities? Are we
    doing the outreach which only public broadcasting can do, prior
    to a program and after, involving communities?
        My father when he died had Alzheimer's. I only wish that my
    mother had been able to access a recent program that public
    broadcasting did on Alzheimer's that was not just a program; it
    had a shelf life long after the program was over. It involved
    caretakers and organizations. After you watched this series,
    you felt there was some light at the end of the tunnel.
        Commercial television cannot do this. This is the focus
    that CPB has and the mandate that we have, that it is not an
    elite programming entity, that we look at the big picture.
    Children more and more--I keep harping on that--if we do not
    focus on children, we are not going to have a very positive big
    picture for anyone across the line of all issues.
        Thank you.

                         IMPORTANCE OF FEDERAL FUNDING

        Senator Inouye. Do you believe that our funding, Federal
    funding, is in our national interest?
        Ms. Harrison. I certainly do. You know, I do not want to
    appear as an instant expert. I have only been on this job for
    4\1/2\ working days. But what surprised me was that in 1975 in
    an amendment to the Public Broadcasting Act President Ford at
    the time not only wanted Federal funding, he suggested it be 5
    years out. Also, there is the authority to fund up to 40
    percent, and the percentage has been going down. So we are at
    15 percent now. I think the highest was 19 percent. 15 percent
    is modest, and I think all credit to the stations who have
    raised 85 percent of what they need to do, which keeps it
    local.

                               PREPARED STATEMENT

        Senator Inouye. I notice my time is up, sir.
        [The statement follows:]

                 Prepared Statement of Senator Daniel K. Inouye

        Since its creation as part of the 1967 Public Broadcasting Act,
    public broadcasting has pursued an ambitious mandate to provide
    educational, cultural and informational programming that takes creative
    risks while serving traditionally unserved and underserved populations.
        Public broadcasting is a unique voice in the local community that
    we have come to trust and depend on. A recent survey conducted by The
    Roper Center for Public Opinion Research determined that public
    broadcasting is one of America's most trusted institutions.
        Public television has set the standard with award-winning
    documentaries, outstanding children's programming, and in-depth news
    and public affairs programming that cannot be found on commercial
    television channels. The current audience for National Public Radio
    programming is 26 million listeners each week, up 97 percent over the
    past decade, as more and more Americans seek thoughtful analysis of the
    important issues facing our nation and our communities.
        I am proud to be a long-time proponent of public broadcasting and
    believe that public broadcasting has been a tremendous success.
        The funding cuts proposed by the House are ill-advised and poorly
    timed. As this Committee is well-aware, massive consolidation in the
    media industry along with a general coarsening of public discourse on
    the commercial airwaves is making it more and more difficult for
    families to find quality programming that is suitable for children. It
    makes no sense to undermine the primary place on the channel line-up
    that parents and families trust the most.
        I am concerned not only about the funding cuts but also about the
    recent controversies reported in the press over possible misuse of
    taxpayer funds and the lack of transparency in decisions made by the
    Chairman of the CPB Board.
        As a result of the current budget deficit, many important programs
    face funding cuts. These are not easy choices to make. While I am
    pleased that some of the funding for public broadcasting was restored
    by the House, funding for several important programs has been
    eliminated.
        Funding for ``Ready to Learn,'' which supports high quality
    children's programming, and grants supporting the transition from
    analog to digital broadcasting and the interconnection services that
    link public broadcasting stations together were all canceled out by our
    House colleagues. Traditionally, the Senate has restored this funding
    and I hope that Senators Specter and Harkin will continue to champion
    these important programs.
        In particular, I question the wisdom of eliminating the funding to
    help local stations make the transition from analog to digital
    television, while at the same time, the Commerce Committees in both the
    House and Senate are considering legislation to complete the digital
    transition.
        Public broadcasters are leading the way in the digital transition.
    More than 87 percent of public television stations are operating in
    digital. Public television licensees have embraced new services enabled
    by digital technology. Many stations already utilize multicasting
    capabilities to provide ``PBS Kids'' programming as a dedicated
    children's channel and to provide educational services through ``PBS
    You'' as a dedicated channel.
        Even without a government mandate, public radio stations are moving
    quickly to implement digital technology with 79 public radio stations
    broadcasting in digital and over 300 with licensed digital technology.
        The use of taxpayer funds by the Chairman of CPB to hire lobbyists
    and consultants raises serious concerns. Not only do such actions
    potentially violate the prohibitions against advocacy in current law,
    but the fact that these steps were apparently taken without
    consultation with either the full Board or the President and CEO of CPB
    is extremely troubling.
        The Inspector General is currently investigating whether these
    decisions violate the law and the CPB's bylaws, and I will look forward
    to his full report on those concerns. Without accountability and
    transparency in the use of taxpayer funds, the legitimacy of these
    actions is rightly questioned.
        Concerns have also been raised that the CPB is straying from its
    statutory obligation to act as a heat shield between Congress and
    programming decisions. The Public Broadcasting Act requires the CPB
    ``to carry out its purposes and functions and engage in its activities
    in ways that will most effectively assure the maximum freedom of the
    public telecommunications entities . . . from interference with, or
    control of, program content or other activities.''
        Thank you Mr. Chairman and I look forward to the testimony of the
    witnesses today on these important issues.

        Senator Specter. Thank you very much, Senator Inouye.
        Senator Stevens.
        Senator Stevens. Senator Durbin.
        Senator Specter. Well, the early bird rule would go to
    Senator Durbin, but the practice of the committee has been to
    alternate between the sides.
        Senator Stevens. I am not prepared yet.
        Senator Specter. Senator Durbin, you have the floor.

                    POLITICAL BALANCE IN PUBLIC BROADCASTING

        Senator Durbin. Thank you, Mr. Chairman, and I thank the
    panel. I especially thank you, Mr. Chairman, for calling this
    hearing because if your experience is like mine, this is an
    issue on the minds of a lot of people, what is happening to
    public broadcasting. Are we going through some effort now to
    politicize this, to change the nature and philosophy of
    something that we value very much in this country?
        I am a fan, have been for a long time. Obviously, I am not
    alone. When you read the surveys of people asking them what
    they think about public broadcasting, it is pretty good. Over a
    thousand adults polled, PBS and NPR had an 80 percent favorable
    rating. Not a single one of us on this side of the panel would
    look askance at that number. 80 percent favorable is pretty
    good.
        When you ask if it is fair and balanced, not to steal a
    line from some other company, 55 percent said PBS programming
    is, 79 percent said NPR is fair and balanced.
        That is why it strikes me as odd, Mr. Tomlinson, that we
    are on this crusade of a sort here, this mission, to change
    what is going on. I do not quite get it, understand what your
    agenda is here and what you are trying to achieve.
        I read and I watched over the break Mr. Moyers' speech in
    St. Louis, ordered a copy online, read it twice. It is
    troubling to me. I think Bill Moyers' program now is a balanced
    program and I think most people would agree with it. Now, Mr.
    Mann that you hired or someone hired to monitor this program
    came up with some rather strange conclusions about who is a
    liberal and who is a conservative and who is a friend of the
    President and who is not.
        Even I think in your opening statement you have tried to
    clarify that you do not stand by his conclusions, for example
    on Senator Hagel, the characterization of Senator Hagel as
    liberal and such. Maybe you do think he is a liberal. I do not
    know what that conclusion might be.
        But the point I would like to get to is this. Let us go to
    a specific question. Under section 19 of Public Broadcasting
    Act you are required to mandate political balance on all shows.
    It has been reported that you have championed the addition of
    ``Wall Street Journal Editorial Report'' to the PBS lineup and
    that you have raised money for that purpose. I would like you
    to clarify. If you did that, how much money was raised? What
    was your purpose in bringing in the Wall Street Journal, which,
    as has been noted, is a publication owned by a company that has
    been very profitable and would not appear to need a subsidy to
    put on a show?
        Mr. Tomlinson. I think Senator Stevens hit the nail on the
    head: no bias. No bias on the left, no bias on the right. If we
    have programs, like the Moyers program, that tilt clearly to
    the left, then I think according to the law we need to have a
    program that goes along with it that tilts to the right and let
    the people decide.
        Senator Durbin. Let me ask you about this ``clearly to the
    left'' bias on the Moyers show. How did you reach that
    conclusion? Did you watch a lot of those shows?
        Mr. Tomlinson. I watched a lot of those shows, and I think
    Mr. Mann's research demonstrates that the program was clearly
    liberal advocacy journalism. It was good broadcasting. Bill
    Moyers is a very capable broadcaster. But it seems to me we
    should be able to agree that we do not want bias, and if we do
    in the interest of provoking debate, if we have some bias on
    public television, let us balance it out in the course of the
    evening.
        Senator Durbin. So what was Mr. Mann's expertise? Why did
    you happen to hire him? According to Senator Dorgan, who has
    seen the raw data, he was paid thousands of dollars. His data,
    riddled with spelling errors, was faxed to you from a Hallmark
    store in downtown Indianapolis. What is this man's background
    for judging a program like Moyers' program and whether it is
    liberal or not?
        Mr. Tomlinson. He worked for 20 years for the National
    Journalism Center, which is a 401(c)(3) organization.
        Senator Durbin. National Journalism Center?
        Mr. Tomlinson. National Journalism Center.
        Senator Durbin. What is that?
        Mr. Tomlinson. But the point of watching----
        Senator Durbin. Excuse me. What is the National Journalism
    Center?
        Mr. Tomlinson. It is a center here in Washington that funds
    internships for----
        Senator Durbin. And they are straight down the middle of
    the road, moderate, centrist group, right and left?
        Mr. Tomlinson. I think it qualified for 401(c)(3) support.
    I do not think it was regarded as right of center.
        But the point is, it is like Bob Dylan said, you do not
    need a weather vane to see which way the wind is blowing. It
    was very clear that the Moyers program was liberal advocacy
    journalism. I wanted a statistical basis because I did not
    think people were responding appropriately. We got the
    statistical basis, and as soon as----
        Senator Durbin. From Mr. Mann?
        Mr. Tomlinson. From Mr. Mann's research. And as soon as we
    got the statistical basis, it turned out other people had
    determined that that program should be balanced. It was
    balanced. All this took place something like a year and a half
    ago.
        Senator Durbin. Well, let me--I have got to get to the
    basic question here. I will not go through the list of some of
    Mr. Moyers' more liberal guests--Frank Gaffney, Grover
    Norquist, Richard Viguerie, Paul Gigot--on his liberal program.
        Mr. Tomlinson. It was our experience----
        Senator Durbin. But let me ask you this if I can.
        Mr. Tomlinson. Yes, sir.
        Senator Durbin. Did you feel that it was your
    responsibility or authority to go out and put together the Wall
    Street editorial page show and to find subsidy for that? Did
    you feel that that was your responsibility to do?
        Mr. Tomlinson. I felt that the law required us to reflect
    balance in our current affairs programming. I was not the only
    one involved in encouraging a program that represented a
    diverse point of view from the Moyers show.
        Senator Durbin. So following Mr. Moyers' comments in St.
    Louis, can we expect you to do the same for ``The Nation
    Magazine?'' Are you going to raise $5 million to make sure they
    have a show?
        Mr. Tomlinson. I do not see, I do not see today we have a
    balance problem. We have a 30-minute show ``Now'' and we have a
    30-minute show, ``Wall Street Journal.'' That is balanced. Let
    the people decide. Balance is common sense.
        Senator Durbin. But Mr. Tomlinson, the people I said at the
    outset already decided. They thought that the Corporation for
    Public Broadcasting was presenting balance and they thought
    that--they gave a high approval rating. You have perceived a
    problem here which the American people obviously do not
    perceive.
        Mr. Tomlinson. Well, certainly in terms of ``Jim Lehrer
    News Hour'' there is no balance problem. That is great
    journalism. Public broadcasting has a great reputation in these
    areas.
        We had a period of time a few years ago where I think we
    were all asleep at the switch in terms of the Moyers program. I
    never wanted to take the Moyers program off the air.
        Senator Durbin. What do you mean by ``asleep at the
    switch'' with the Moyers program? I would like you to tell me a
    little bit more.
        Mr. Tomlinson. Because we should have been aware that on
    Friday evening if you presented liberal advocacy journalism for
    an hour you really should present conservative advocacy
    journalism for an hour, just for a matter of balance. The law
    requires balances.
        Senator Durbin. This was your conclusion based on Mr.
    Mann's investigation?
        Mr. Tomlinson. This was my conclusion when I found that
    there was a dispute over my view of this program and the
    general view of this program. I quite frankly have run into
    next to no serious people who regarded the Moyers program as
    anything other than good liberal advocacy programming.
        Senator Durbin. Will you accept his invitation to take an
    hour, go on the air on public television, and to debate that
    issue?
        Mr. Tomlinson. Absolutely. But you know----
        Senator Durbin. Oh, you will accept it?
        Mr. Tomlinson. Oh, absolutely. But you know, Senator
    Durbin, Bill Moyers and I both have concluded that this debate
    is not good for public television.
        Senator Durbin. No, it is not.
        Mr. Tomlinson. There were things that Moyers said in that
    speech about me that were most inaccurate and unfair. It
    saddened me to see that. I could have come back in kind. I
    chose not to. We are for public broadcasting, we are for no
    bias in public broadcasting. We do not want bias on the right
    and we do not want bias on the left.
        Senator Durbin. I have gone over my time. I thank the
    chairman for giving me a couple extra minutes and I will wait
    for the next round.
        Mr. Tomlinson. Thank you, sir.
        Senator Specter. I thought we had a little more leeway
    here, Senator Durbin, than we do on the Judiciary Committee. So
    the red light was flexible.
        Senator Stevens, would you care to question?

                    PUBLIC TELEVISION INTERCONNECTION SYSTEM

        Senator Stevens. Well, I would clear up the Senator from
    Illinois' confusion. I think Bill Moyers is biased and I
    respect him for it. I think he is a very talented spokesman for
    his point of view in the political spectrum. I applaud you for
    recognizing that and counterbalancing it. I think your support
    will demonstrate that in the long run.
        But the main thing is I want to get back to the financing
    of this, because that is the question before us, really. I just
    was waiting for the information, Mr. Chairman. My State
    contributed $5.3 million as a State to public broadcasting
    stations in Alaska because we recognize the need for the system
    and to maintain it. I do believe that all States that have
    similar dependent communities should recognize it and should
    come forward and support it.
        I would like to know whether you can tell me about the
    concepts that have been left out of this bill this year. The
    satellite upgrade of $40 million, the request from the
    President was deleted. The digital programming of $45 million
    was deleted. Each of those had had money in the fiscal year
    2005. And the Ready to Learn program of $32 million was
    deleted.
        Now, those are the items that we are really concerned with.
    CPB's request was $430 million. The House brought it down to
    $400 million. There are lots of small adjustments that have to
    be made in these bills this year. I am not as disturbed about
    that as I am disturbed about the deletion of satellite
    upgrading, digital programming, and the Ready to Learn program,
    which I think has been eminently successful in places like the
    rural stations that I mentioned in my State.
        Who among you would be willing to talk about the satellite
    upgrade and its necessity? Mr. Lawson, is that you?
        Mr. Lawson. Yes, sir, I will take that one. It has been a
    Federal responsibility since day 1 to provide for this
    interconnection between the stations for the distribution of
    programming. Congress last, with your support, last funded that
    in the early 1990s. That system is becoming obsolete. The
    satellite leases are expiring. If that system is not renewed,
    then we are FedExing tapes around.
        This is a system, this is the glue that holds our whole
    system together in terms of technical infrastructure. The
    exciting thing about the next generation, right now we are
    feeding a lot of programming to tape machines. It is expensive,
    it is very labor-intensive. This system will allow more peer to
    peer, station to station interaction. They will literally be
    emailing programs around as attachments to emails.
        So you are going to see Alaska and stations all over this
    country with this new system not only receiving the PBS
    programming over the satellite, but they themselves will be
    able to move programming around and share it with other
    stations, without even having to go through a national
    organization like PBS.
        So the infrastructure for the satellite interconnection is
    absolutely crucial. Without it we are not connected.
        Senator Stevens. Let me tell you a little history. When I
    moved to Alaska our programming, such as sports and weekly
    programming, they were sent up by tapes to Alaska. So if you
    had a baseball game on Friday on the 1st in Washington, D.C.,
    you would see it on the 8th in Alaska. You know, I soon got out
    of the habit of watching baseball.
        My point is right now what this means is real-time delivery
    to the country as a whole. Satellite interconnections are
    available in the South 48. In many places you can use fiber or
    you can use other connections. But in the rural part of the
    country that satellite connection is absolutely important.
        So I want to assure you that is one thing, and I think in
    my colleague's State in Hawaii those small stations around the
    islands--actually, if you put a ring around Hawaii it would be
    bigger than Alaska; did you know that? We do not let them count
    the water. Ours is frozen in between, but his is open water.
        But the point is is we need that.
        Now, digital programming, who is going to tell us about the
    digital programming and the reason for even the President
    increased it by $6 million? Who wants to comment on that? Is
    that yours too, Mr. Lawson? Ms. Harrison?

                               DIGITAL CONVERSION

        Ms. Harrison. Well, again jumping in probably where I
    should not, but I, as somebody new to this position, I come
    with a fresh eye, I do believe. And I am just so impressed.
    Just to give you an example, there is something called the
    Think Bright Digital Content Initiative, and that is going to
    be programming targeted to address five community needs: family
    literacy, success in school, family health, learning
    disabilities, civic engagement. It is going to also include
    research and development.
        What is really happening as we move into this new
    technology--and again, that is part of the 1967 mandate--as we
    keep up with changing technology, so we can be that connector
    to the community, we are now facing almost a different viewer
    and listener, not the passive viewer or listener, but the
    viewer and listener who wants to really have input, who wants
    to participate.
        Now, right now we are saying this is the younger
    generation. They are learning. In many cases they are way ahead
    of us. The technology is ahead of us. For public broadcasting
    to be vital and, as we said, this important connector to
    community, the technology must be there. We cannot have the
    programming without the advanced technology. It is going to
    enable us to do things we had not thought possible before.
        I think it is one of the most exciting developments. As we
    look at the successor generation and how they are involved with
    computers and downloading on their MP3's, we are going to have
    a growing group of listeners and viewers who are really going
    to be there on some of these issues that I mentioned earlier.
        Senator Stevens. My time is up, but if I could I would like
    to ask one question about Ready to Learn. Ready to Learn money
    also went up by $8.7 million, I believe--no, $7.7 million. Who
    can explain Ready to Learn to us now?
        Ms. Mitchell. The Ready to Learn grant, Senator, as you
    know has been a very successful partnership with the Department
    of Education. Over the last 10 years PBS, our children's
    programming producers, and our stations have leveraged this
    grant again to provide new series that are based on educational
    learning objectives, teaching the most disadvantaged, as well
    as all of our Nation's preschoolers, the skills that they need
    for literacy.
        In addition, we work with the Department of Education to
    provide these educational programs and then stations take the
    largest percentage of these Ready to Learn funds and use them
    to provide, through experienced educational teams at every
    station, the kind of workshop, training, and programs that are
    making the difference in the lives.
        We looked at the number. It was 100 million families have
    been affected by the Ready to Learn programs. Going forward,
    CPB, PBS, and other teams of producers worked together on our
    new proposal, looking at how we might engage these new digital
    technologies to enhance what we are already doing.
        If I might augment what Pat said about our leadership in
    the digital arena, we know how to use these technologies and we
    know how to use them for public interest and public education.
        Senator Stevens. I am sorry, my time is up. I am informed I
    made a mistake. I was looking at your request rather than the
    President's request.
        But let me tell you this. Alaska has the highest rate of
    computer literacy in the Nation on a per capita basis, despite
    our isolation. The reason is our young people get the computers
    from the second grade up. But they also, through the local
    stations that they are watching, have these programs. That
    makes them relevant to their lives even though they in most
    instances do not have modem capability, they do not have the
    ability to go up. Now, the schools, libraries, and health
    facilities do, but individual citizens do not have that same
    access.
        So it is very important to us that this kind of concept of
    Ready to Learn be supported also.
        Thank you very much, Mr. Chairman.
        Senator Specter. Thank you, Senator Stevens.

                                  BILL MOYERS

        Senator Harkin, who is the ranking Democrat on the
    subcommittee, could not be here this morning. But he asked me
    to ask this question on his behalf and on his time, although it
    retraces some of what Senator Durbin has had to say. This
    question is for you, Mr. Tomlinson.
        Mr. Bill Moyers' comment was made in a speech in St. Louis
    about 2 weeks ago and Senator Harkin would like to know whether
    you would be willing to take up Mr. Moyers' expression of an
    interest in a public debate between you and him on the
    questions you have raised about him and his objectivity. The
    question that Senator Harkin has is is that a conversation or
    debate which you would be prepared to engage in with Mr. Moyers
    publicly?
        Mr. Tomlinson. Absolutely, Mr. Chairman. Let me say,
    though, that in that speech in St. Louis Mr. Moyers said some
    most inaccurate things about me. He charged or he implied that
    in the early 1980s when I was chairman, when I was director of
    Voice of America, that I was somehow involved in some blacklist
    scandal. I have never been associated with anything like that.
        He implied I was forced out of office because of that. I
    left my years of service at VOA with general acceptance that I
    had been a success, as it were.
        Now, this thing between Mr. Moyers and me could be a lot of
    fun. We would have a lot of fun debating on television for an
    hour about that. It would not be good for public television and
    I think Mr. Moyers and I both agree that in recent weeks we
    stopped--we now have balance on that Friday evening offering
    and we did not think it was in the interest of public
    broadcasting for us to continue.
        Senator Specter. Do you think it would be a lot of fun?
        Mr. Tomlinson. It would be a lot of fun.
        Senator Specter. Would you think it ought to be broadcast
    on ``Saturday Night Live?''
        Mr. Tomlinson. That is probably where it belongs.
        Senator Specter. How about on public broadcasting, where
    you have a little more control? I do not think you can control
    ``Saturday Night Live,'' but would you be willing to have it on
    public broadcasting?
        Mr. Tomlinson. Yes. As I say----
        Ms. Mitchell. Mr. Chairman, if I might, Mr. Tomlinson would
    have to----
        Senator Specter. Do you want to join in the debate, Ms.
    Mitchell?
        Ms. Mitchell. No, I just thought it was important to
    clarify that that is not Mr. Tomlinson's decision, what would
    go on PBS. That decision is made by PBS management.
        Senator Specter. We may come to PBS management here. But
    Mr. Tomlinson has standing to express a view as to whether he
    would like to have it there or not.
        Ms. Mitchell. We would consider it.
        Senator Specter. Now that you have considered it, what is
    your decision?
        Ms. Mitchell. I think your suggestion of ``Saturday Night
    Live'' might be a better place.
        But in all seriousness, Senator, it just seems important
    to, as Mr. Tomlinson has said and I think you are hearing from
    all of us, to focus on the fact that, as Senators on this
    committee have already indicated, the American public looks at
    all of our programming and they trust it and they value it, and
    they do not judge it only in terms of political balance. There
    are a lot of other balances that we are concerned about.
        We are concerned in media about the balance between what is
    important, what matters in this country, as well as what just
    amuses us. What entertains us is not as important as what is
    educating us. Our role as public service media is to use this
    enormous power to educate, to strengthen family values, and to
    contribute to the strength of this democracy, and that judges
    and that guides our decisions about programming.
        Senator Specter. Well, Senator Harkin is almost out of
    time. I would perhaps--well, your acceptance of the debate
    challenge is fine, Mr. Tomlinson. We will now have to find a
    venue, and perhaps if you cannot find any other venue we can
    have a hearing before the subcommittee. But I do not know that
    C-SPAN would be willing to do any more on this subject, but we
    could see.
        Senator Harkin wants to yield back 53 seconds.

                          CPB INTERCONNECTION REQUEST

        Coming back to my own 5 minutes of time, I have asked the
    question about the digital transmission and the lack of funding
    in the House bill. Senator Stevens has covered this to an
    extent, but I want to be sure about your response. The
    interconnection 10-year lease expires on October 1 next year
    for the satellite that transmits public radio and television
    programs. It is going to cost $120 million. We have already put
    up almost $50 million and CPB is requesting an additional $40
    million. The President and the House have both proposed
    diverting $52 million from 2006 grants.
        Ms. Mitchell, Mr. Lawson, I take it your answer would be
    the same as on the issue of digital transition, if you did not
    get funding that it would be very, very problemsome?
        Mr. Lawson. Yes, sir, it would. That would come--that money
    would come directly out of the station operational money and
    programming money. I would like to point out that the
    conversion to digital is a Federal mandate and our stations
    have raised and spent $1.1 billion to do that. Half of that
    came from State legislatures. Congress has been generous in the
    last few years with Federal support and we are sort of over the
    hump in terms of getting this thing built out. But that final
    money for the next couple of years is needed, especially for
    stations serving rural America that do not have the kind of
    matching money that some of the other stations have.
        Senator Specter. Thank you very much, Mr. Lawson. We do not
    have much time. I want to move on to some other questions.
        Mr. Boaz, in your written statement you say: ``As a
    libertarian, I have an outsider's perspective on both liberal
    and conservative bias and I am sympathetic to some of the
    public broadcasting's biases, such as its tilt toward gay
    rights, freedom of expression, and social tolerance and its
    deep skepticism of the religious right.''
        Picking up on your statement about being sympathetic toward
    gay rights, let me ask you about the request from Education
    Secretary Margaret Spellings in January of this year to PBS
    asking that it not distribute an episode of the children's
    program ``Postcards from Buster'' that featured a family with
    two lesbian moms. PBS agreed not to distribute the program.
    What is your view of that?
        Mr. Boaz. Well, I am not personally offended by Buster's
    trip to Vermont. I think it is good to teach social tolerance.
    But I understand that there are a lot of Americans who do not
    appreciate that, who did not like the program or would not have
    if they had seen it. So I understand why Secretary Spellings
    thought it was her responsibility to interfere.
        What I would say in relation to public television is this
    is why it is a bad idea to have a government-run television
    station, because Secretary Spellings can write a letter to Fox
    or CNN saying, hey, I wish you would not run this program, but
    she has no authority over them. Here, because of the
    government's funding, the taxpayers fund these networks,
    therefore the taxpayers are occasionally going to exercise
    their authority to look at what the stations are running.
        I think that is not good. I think it is not good to have
    political overseers. I am sure that Senators would exercise
    more oversight if they saw these things more often. I am sure
    Senators, for instance, are usually in transit or visiting
    community affairs on Friday nights, so they have not actually
    seen the Bill Moyers program, because if they did I think it
    would be difficult to sustain the argument that it was not
    advocacy journalism, though good advocacy journalism.
        But I think the basic point that ``Buster'' illustrates is
    the danger of having political oversight of a news and public
    affairs program.
        Senator Specter. Ms. Mitchell, who made the decision with
    respect to ``Postcards from Buster'' and Secretary Spellings'
    request?
        Ms. Mitchell. The decision not to distribute the program on
    the national program service that goes from PBS to our stations
    was made by PBS management and was made before the letter from
    Secretary Spellings.
        But might I speak just a moment more about this unique
    partnership and why it has worked so well? The Ready to Learn
    teams, who include PBS children's producers, a PBS team,
    station teams, as well as the team at the Department of
    Education, sit down and very carefully review the objectives of
    these programs, and they review the subjects that are going to
    be treated. But when this subject came in we felt that it was
    of such controversial nature for some of our communities that
    it was best to go back to what you have heard us all say all
    morning: public broadcasting is a local institution.
        Senator Specter. Do you share Mr. Boaz's--my red light just
    went on, but I want to finish this subject up with a very brief
    question and then you can expand on your answer. Do you share
    Mr. Boaz's comment about his concern about the regulatory
    approach or the decision being made by a public agency on this
    kind of an issue?
        Ms. Mitchell. No, indeed I do not. The money that has come
    to PBS and our producers from the Ready to Learn partnership
    with the Department of Education has made it possible to
    prepare millions of children in this country for school.
        Senator Specter. Senator Inouye.

                             CPB USE OF CONSULTANTS

        Senator Inouye. Thank you.
        I would like to ask Mr. Tomlinson a few questions. Do you
    believe it is legal or appropriate for the chairman of the
    board, CPB board, to hire a consultant at Federal funds in
    excess of $14,000 without the consultation or approval of the
    board?
        Mr. Tomlinson. Senator Inouye, I observed every procedure
    that I had seen used over my 5 years on the board in the hiring
    of this consultant. These decisions were made in the CPB front
    office. I went to the president of CPB, I went to the general
    counsel. I asked that this contract be handled like any
    consultant's contract through the business office. It was
    handled by the general counsel.
        In my 5 years on the board, the board had never been asked
    about contracts. I certainly was not trying to hide this from
    the board and I would have taken it to the board in a minute if
    anyone had pointed to me that this should have been done.
        Senator Inouye. In the case of Mr. Mann, did you get the
    approval of Ms. Mitchell?
        Mr. Tomlinson. I am CPB. She is PBS. I got the approval of
    the president of CPB, the general counsel, and the business
    office. The consultant's contract was handled no different----
        Senator Inouye. The law does not require you to consult
    with the board?
        Mr. Tomlinson. No, sir. I was certainly not trying to hide
    it from the board and if I had known of any tradition that the
    board should be involved I certainly would have involved the
    board.

                                  CPB POLLING

        Senator Inouye. There are also press reports that allege
    that you refused to make public CPB's own research that had
    been conducted by two polling firms, Terrence Group and the
    Lake Snell and Perry Associates.
        Mr. Tomlinson. That is simply not true. On the day that
    charge was made, you could go to the CPB website and find all
    the results of these polls.
        Senator Inouye. Well, I am giving you the opportunity.
        Mr. Tomlinson. Yes, sir. I appreciate it.
        We also share the friendship of Mary Bitterman, who did an
    outstanding job at Voice of America and has done an outstanding
    job for public broadcasting.

                             CPB USE OF CONSULTANTS

        Senator Inouye. Did you use $15,000 of taxpayers' funds to
    hire two Republican lobbyists without the knowledge of the
    board to defeat amendments to the reauthorization bill?
        Mr. Tomlinson. The board was stunned to discover that there
    was a serious proposal in the authorization process to require
    that four of our nine members come from the community of public
    broadcasters. The board unanimously opposed this. We have a
    very small staff relative to other agencies at CPB. Our
    legislative person was on vacation when we made this discovery.
    Our leadership, the leadership, again our president, general
    counsel, were involved in hiring at least three consultants to
    help us communicate, determine what the situation was on
    Capitol Hill in that time frame.
        I was an indirect part of the process. The decision again
    was made by the chain of command.

                            JOURNAL EDITORIAL REPORT

        Senator Inouye. Is it appropriate for the chairman of the
    board to secure private funding from the corporate world for
    the ``Journal Editorial Report'' hosted by Mr. Paul Gigot?
        Mr. Tomlinson. The decision to add Paul Gigot and the
    ``Wall Street Journal Editorial Report'' was one that involved
    a lot of people at both PBS and CPB. It was a decision that I
    saw no opposition to, and I was not directly involved in
    negotiating any contracts involving it.
        Senator Inouye. You had no role to play in that?
        Mr. Tomlinson. I certainly thought it was a good idea and I
    thought it was an important idea because of the importance of
    having balance in current affairs broadcasting. I would never
    have put the Wall Street Journal show on alone. Again, as
    Senator Stevens said, no biases; make it neutral, make it
    common sense. If you have a liberal show, have a conservative
    show, one in the middle. If you have a conservative show, have
    a liberal show.
        This is to me common sense and it is good for public
    broadcasting.
        Senator Inouye. So your position is that these press
    reports are false?
        Mr. Tomlinson. The press reports, yes, sir.
        Senator Inouye. Thank you.
        Senator Specter. Thank you, Senator Inouye.
        Senator Durbin.

                            ``NOW WITH BILL MOYERS''

        Senator Durbin. Mr. Tomlinson, I am going to follow up on
    that. So let me understand what you are saying. You had to get
    ``Now'' off the air because of liberal advocacy----
        Mr. Tomlinson. No, no. I never wanted to take ``Now'' off
    the air.
        Senator Durbin. No pressure on Mr. Moyers?
        Mr. Tomlinson. No, no, sir. No, sir. In fact, if I had put
    pressure on Mr. Moyers you know exactly the way Mr. Moyers
    would have responded.
        Senator Durbin. So let me ask you this question. Mr. Moyers
    has said that when rumors began to circulate regarding hiring a
    consultant to monitor his show he tried three times to meet
    with the CPB board to hear their concerns and answer their
    questions three times, and every time he was refused. So let me
    ask you to clarify then. If you had no axe to grind with Mr.
    Moyers, no problem with Mr. Moyers, why is it he could not get
    to meet with you?
        Mr. Tomlinson. Well, I did have a problem with his show. In
    terms of at the time--and I would have to go back and
    reconstruct about his requests to meet with us. At the time I
    remember discussing it with the president of CPB and he did not
    think it was appropriate to have such a meeting because our
    purpose--you are not going to change Bill Moyers. He has got a
    wonderful record of public service, but you are not going to
    change the politics of Bill Moyers, nor were you going to
    change the politics of that show. Frankly, I did not want to
    change the politics of----
        Senator Durbin. Well, I wish you would check, because he
    said he tried to reach out to you three times and could not get
    a meeting.
        The point I want to get to is this. Assume for a second
    this was, as you called it, liberal advocacy on the ``Now''
    show. Now we have something from the Wall Street Journal. Would
    you call that conservative advocacy?
        Mr. Tomlinson. Yes.
        Senator Durbin. Would you?
        Mr. Tomlinson. Yes.
        Senator Durbin. Okay.
        Mr. Tomlinson. So now we have a 30-minute show, a successor
    to Moyers' called ``Now,'' and a 30-minute Wall Street Journal
    show. That is balanced.
        Senator Durbin. You do not expect within the content of
    each show that there be a balanced presentation, or do you?
        Mr. Tomlinson. No, I do not think that is realistic. I am
    old school. I think you should have the kind of programming
    that gives you back and forth. I think that you should have
    liberals and conservatives on these shows and let the viewer
    decide.
        Senator Durbin. I guess what troubles me then is why you
    had to put this pressure on Mr. Moyers. I do not understand
    that. If you just wanted to put a conservative show on next to
    him, you could have done that all along.
        Mr. Tomlinson. I do not quite understand how I put pressure
    on Mr. Moyers.
        Senator Durbin. You do not think you put any pressure on
    Mr. Moyers?
        Mr. Tomlinson. No, no. In fact, I think if I had he would
    have responded in kind. He does not respond well to pressure.

                                VOICE OF AMERICA

        Senator Durbin. Let me say that you made some references to
    your service at the Voice of America quite a few years ago and
    also the fact that it was referred to in Mr. Moyers' speech. I
    would like to make sure the record reflects that Mr. Moyers
    said this about your service at Voice of America and the
    controversy involving Mr. Frick, and I quote Mr. Moyers'
    speech:
        ``Let me be clear about this. There is no record apparently
    of what Ken Tomlinson did. We don't know whether he supported
    or protested the blacklisting of many American liberals or what
    he thinks of it now.''
        That is a direct quote from his speech. So I do not know if
    that is all of the things that he said there, but that was
    included in his remarks.
        If I might ask you, too----
        Mr. Tomlinson. There was an earlier reference that linked
    me to----

                            ``NOW WITH BILL MOYERS''

        Senator Durbin. That you were working there at the time Mr.
    Frick was involved in some of these activities, that is true.
        Let me ask you this. The board leadership, you say in your
    testimony: ``The board leadership of PBS recognized that Friday
    evening programming should reflect different points of view.
    When it was clear that PBS was following through on its
    commitment, I ended the Mann study and did not make it public
    because to do so would have called attention to the fact that
    for nearly 2 years public broadcasting ignored our legal
    responsibility for presenting diverse viewpoints on
    controversial views.''
        I am trying to follow what you are saying here. Without
    your study--in other words, without your study alleging liberal
    bias in PBS programming, people would not have noticed it? Is
    that what you are saying?
        Mr. Tomlinson. I did not need a study to document that the
    Moyers program was biased.
        Senator Durbin. Then why did you pay Frederick Mann 14,000
    taxpayers' dollars?
        Mr. Tomlinson. Because I was facing people, not unlike you,
    who were saying at the time: Gee, there is nothing wrong with
    the Moyers program; this program is balanced. Statistically--
    you know, Warner Wolf used to say: ``Let's go to the
    videotape.'' We took 6 months of Moyers programs and
    demonstrated that it was left wing advocacy journalism.
        As I said, it is outstanding stuff. He is a great
    broadcaster. But the show was biased from the left.
        Senator Durbin. I do not understand how this gentleman is
    competent to make that conclusion, and some of the things that
    he characterizes on here are clearly off the wall. But at the
    risk of----
        Mr. Tomlinson. He had, for example, Bob Barr, a Republican
    former Congressman, was on the Moyers show to attack the
    Patriot Act. He was not on the Moyers show to take any of his
    traditional positions.
        Senator Durbin. Sounds pretty balanced to me.
        Mr. Tomlinson. He was on the show to balance the Patriot
    Act. That is how he got on the show. Conservatives and
    Republicans got on the Moyers show by and large when they took
    positions which agreed with Mr. Moyers.
        Senator Durbin. Are you familiar with the fact that the
    bill to reform the Patriot Act is co-sponsored by me and
    Senator Larry Craig.
        Mr. Tomlinson. Well, I certainly welcome reform of
    anything, Senator. I am just talking about journalism here.
        Senator Durbin. That is what I am talking about, too.
        Mr. Tomlinson. I am talking about how he came to be on that
    show.
        Senator Durbin. Ms. Harrison, are you familiar with Bill
    Moyers' program? Did you watch it?
        Ms. Harrison. I have to admit I have not. I have been
    working 24-7 in my previous job. But I guess I should let you
    ask the question before I answer a question you have not asked
    yet.

                          PATRICIA HARRISON BACKGROUND

        Senator Durbin. I just want to try to understand your
    familiarity with Corporation for Public Broadcasting, NPR, PBS.
        Ms. Harrison. I understand the mission and that we have two
    tracks here. One is to ensure that public broadcasting is not
    pressured or interfered with by the Federal Government in any
    way or the board. The other mission is to ensure that there are
    a diversity of views.
        I do believe in just looking at a lot of material in the
    last several days that one of the answers to this--and I too
    would like to get back to the mission of public broadcasting--
    is the Office of the Ombudsman, an independent office. They
    really have no authority to pre-censor, to censor, but they
    just do what many ombudsmen do for newspapers, and to take it
    out of this whole controversial range and have it as something
    that is just ongoing; I know PBS has their own ombudsman, and
    to start focusing on the real issue here, which is the
    importance of public broadcasting.
        Senator Durbin. Mr. Chairman, if I could ask one last
    question of Ms. Harrison.
        Ms. Harrison. Yes.
        Senator Durbin. If we matched up our resumes, very few
    things would come out the same, but----
        Ms. Harrison. I have a feeling where you are going.
        Senator Durbin. But it would demonstrate that we are both
    political animals. We both from our partisan perspectives have
    been pretty actively involved in our partisan beliefs. Clearly
    the concern over what is happening with Mr. Tomlinson is that
    we are politicizing public broadcasting, and the fear is now
    that if it reaches the point where the average viewer, who now
    thinks so highly of public broadcasting by radio or television,
    begins to believe that it has now been taken over by people
    with a political agenda, who want to spare this administration
    or any administration of criticism, who want to make certain
    that those who are the most effective advocates for one point
    of view are silenced or diminished, it is going to really tear
    at the heart of what is good about public broadcasting.
        Now, you come in with a strong Republican resume. I in the
    same spot would have a strong Democratic resume. The obvious
    question is, can you put this aside? Do you feel like you have
    got water to carry here for the White House and the
    administration in this new position?
        Ms. Harrison. That is a three-part question and it is
    actually a very important question. First, let me say before I
    am a member of any party I am an American. For the last 4
    years, as I alluded to, I ran a bureau. During that period of
    time the OIG did its first review in 50 years of the Bureau of
    Educational and Cultural Affairs. I am very proud of the fact
    that what they found was that my leadership style, my
    management style, was inclusive, I am a team-builder.
        I have a track record in the private sector. Running a
    company, I could not tell you who is Republican and Democrat.
    When I take on, let me just call this a mission, I am looking
    at best achievable outcome and I think about the last day that
    I am going to be on the job. I have a strong enough ego to want
    to say because I took this job the entity, the organization,
    was stronger than before I came here.
        I am committed to this. Without going into braggadocio too
    much, I did have other opportunities, but I believe in the
    mission of public broadcasting. And I believe that the people
    who are concerned need to not only listen to what I say, but to
    watch what I do. I am going to fight for this. I am here
    fighting for this budget. I am now the CEO of the Corporation
    for Public Broadcasting and I know what my clear mission is.
        I fought for similar things. One of the reasons I wanted to
    do this, Senator, is I find a similar mission that I had at the
    Bureau of Educational and Cultural Affairs, where people look
    at exchanges and say, why do we need those people coming here.
    Basically, these things are the things that are really going to
    connect our country.
        I do not know what else to say. I was president of Capital
    Press Women. I have been an advocate for women. I founded an
    organization, National Women's Economic Alliance. I have
    written two books really focused on helping women. I feel
    confident that I am a fair person, that I have a great deal of
    integrity, and that nobody owns me ever. Plus I come from
    Brooklyn, New York, and I am an Italian-American.
        Senator Durbin. I have a daughter living in Brooklyn now.
    Maybe she is picking up some of the same attributes.
        Thank you to the panel. Mr. Chairman, thank you for your
    patience.

                             CPB USE OF CONSULTANTS

        Senator Specter. Senator Durbin, I thought you would not
    have any question after that last response.
        Mr. Tomlinson, the New York Times has reported a couple of
    payments, one for a lobbyist, $10,000 into the insights of a
    specific Senator. Is that true?
        Mr. Tomlinson. I described that situation a moment ago and
    with your indulgence I would like to go over how we got to that
    point.
        Senator Specter. Go ahead.
        Mr. Tomlinson. Our board discovered that there were
    interests in public broadcasting which wanted to put into the
    authorization bill language which would have required four of
    our members come from the public broadcasting community. The
    board was very concerned about this. We were unanimously
    opposed to this. When our board members, including our
    Democrats, called counterparts on Capitol Hill, they discovered
    quite a lot of work had gone into this on the part of the
    public broadcasting community.
        We have a small staff at CPB. Our legislative person the
    week we discovered this was on vacation. Our front office
    turned and hired to my knowledge, or at least had three--
    brought in three different consultants to work that bill, to
    try to get to Capitol Hill----
        Senator Specter. Mr. Tomlinson, that is all very
    interesting, but why pay $10,000 to find insights into a
    Senator? Why not your picking up the phone and talking to him
    or going to pay him a visit, and save $10,000 on a very tight
    budget?
        Mr. Tomlinson. If our legislative person had been in town
    that week, that might have been the direction we would have
    gone.
        Senator Specter. Well, you had some protracted period of
    time to make the contact, did you not?
        Mr. Tomlinson. Yes.
        Senator Durbin. Do you not think the Senator would be a lot
    more impressed by having you in your position come talk to him,
    giving him your reasons, than the amorphous approach of
    somebody seeking insights into his background?
        Mr. Tomlinson. Absolutely. But the reason CPB has
    traditionally hired these consultants is because we have a
    small core staff and we tend to turn to the outside for help in
    these areas.
        Senator Durbin. And $5,000 being paid to provide advice on
    the legislative process for a month, without having talking to
    any of the lawmakers; is that also accurate?
        Mr. Tomlinson. Yes, although we--because this thing was
    sprung on us overnight. Our board, both Democrats and
    Republicans, we were absolutely unaware that for apparently
    weeks leaders in public broadcasting had been working to
    require that four of our nine members be drawn from the public
    broadcasting community. We did not think that was right.
        Senator Specter. Well, Mr. Tomlinson, when we see reports
    in the press about that and then have them confirmed by you, it
    raises a question at least in my mind as to the propriety of
    the expenditures. We Senators see a lot of people and I would
    repeat that if a man in your position came to see a Senator I
    think it would bear a lot more weight, or even a telephone
    call.
        So as a little guidance to the future, when you are short
    on budget to bear that in mind.
        Mr. Boaz, do you think that public broadcasting ought to
    take any further steps to seek the avoidance of what you
    consider to be political bias?
        Mr. Boaz. I think it is valuable to seek to avoid the bias,
    and I do think if you look at the examples--there is this
    report nobody has mentioned, that appeared in the newspaper
    ``Current,'' the newspaper of public TV and radio, not by a
    conservative, that goes through looking at Bill Moyers show and
    points out several examples of heavy bias on the issues that
    mattered a lot to Mr. Moyers.
        One way you balance that is by having different programs
    there. I do not think the addition of the ``Wall Street Journal
    Editorial Report'' is going to balance the overall thrust of
    prime time programming on PBS.
        But as I say, I do believe that it is impossible to choose
    the topics and choose the speakers and choose the angles
    without having some perspective involved, and that is why,
    rather than seek political balance, put a Republican onto the
    CPB board, put a Republican somewhere into NPR or PBS, the
    better thing is to depoliticize the system, take it out of
    politics entirely.
        My guess is that public radio and television might be more
    adventurous if they did not have a Republican administration
    and a Republican Congress looking over their shoulders. Some
    people would remember a few years ago when PBS broadcast
    ``Tales of the City'' and there was a lot of controversy
    because this was a fictional program that had some gay
    characters and some drugs involved in it. They decided not to
    do more ``Tales of the City.'' The commercial network Showtime
    picked it up and nobody complained, because it was not
    taxpayers' money, it was not an official government imprimatur,
    and we understand that in a free society Showtime can pretty
    much show what it wants to.
        So I think if you depoliticize you will avoid this problem
    of getting two ombudsmen or a new chairman, a new president.
    You take it completely out of the realm of politics.
        Senator Specter. Ms. Mitchell, do you think there is any
    substance at all to Mr. Boaz's contention of political bias on
    the public broadcasting?
        Ms. Mitchell. The public opinion polls certainly
    substantiate our firm conviction that we are producing a
    schedule that meets our editorial standards and that meets the
    obligations of fairness and balance.
        Might I also respond to something else I think you asked?
        Senator Specter. Before you go on to another subject, I do
    not think that is quite responsive to my question. My question
    was do you think there is any basis for Mr. Boaz's contention
    that there is political bias on public broadcasting?
        Ms. Mitchell. We take every allegation of that very
    seriously. Last year, out of 3,000 hours there were less than
    30 hours that rose to what we would consider any kind of
    question or controversy. But 2 years ago we looked at our
    editorial standards and said they need to be updated, we need
    to be very clear with our producers what we expect from them in
    terms of fairness and objectivity, accuracy, and transparency.
    So we clarified it.
        Senator Specter. Is your answer no?
        Ms. Mitchell. The answer is we work very hard to ensure
    that there is not, and when there is an opinion or a point of
    view, Senator, we are very clear that that is what the viewer
    is hearing; it is someone's point of view, someone's
    commentary.
        Senator Specter. Okay, I interpret that to mean possibly.
    To the extent that there is any possible bias, what you are
    saying is that you take every step you can to eliminate it?
        Ms. Mitchell. In dealing with controversial issues, we
    require of our producers that they do the most thorough,
    accurate, transparent process to examine--and we take on the
    complex issues, Mr. Chairman, as you know, many of which are
    not taken on by mainstream media. We do not attempt, except in
    our news programs, to balance everything within a segment or
    within a program, because that is what the law requires, and we
    believe that there is a better understanding and comprehension
    if you do it over a series of programs.
        But we take very seriously any charge that our programs are
    not representing the diversity of perspectives in this country.
    We think of ourselves as a big tent where a Bill Moyers and a
    Paul Gigot and a Travis Smiley and a Gwen Eifel all are
    welcome.
        Senator Specter. Ms. Harrison, do you have anything you
    would like to add? We are about to conclude the hearing.
        Ms. Harrison. Just very briefly. There are some mechanisms
    in place, because public broadcasting, the word most important
    is the ``public.'' So there is a toll-free number where viewers
    and listeners can call in. We direct them also to connected
    links. We have a very vigorous e-mail program.
        So we are hearing from viewers and listeners all the time,
    and these are remarks and observations that are not just
    dismissed. I am very busy answering my own enormous mail right
    now and I have to tell you the interesting thing is I am
    getting about the same degree from people saying it is too left
    and the same degree it is too right, concerns on both sides. I
    think we have a very passionate listener and viewer audience,
    and I think the Office of the Ombudsman is a good step.
        Senator Specter. Mr. Lawson, anything you care to add?
        Mr. Lawson. Yes, sir. My association was the author of the
    amendment in question that prompted Mr. Tomlinson to hire the
    two lobbyists. That just speaks to the need for----
        Mr. Tomlinson. I did not hire the lobbyists, John. They
    were hired by the front office.
        Mr. Lawson. Mr. Chairman, it just speaks to the need for
    greater transparency in the way that CPB operates. We would
    like to pick up the conversation we had with the Senate
    Commerce Committee last year and the rest of Congress to work
    out some reforms to the way CPB operates.
        Senator Specter. Mr. Tomlinson, awaiting the Moyers-
    Tomlinson debate, do you have anything else to add now?
        Mr. Tomlinson. No, Mr. Chairman. Thank you so much for your
    support of public broadcasting.
        Senator Specter. Mr. Boaz, we will give you the last word
    if you want it.
        Mr. Boaz. I feel like Daniel in the lion's den. But I am
    glad to have the last word. I believe that the controversies
    that----
        Senator Specter. Daniel did not do too badly and neither
    have you.
        Mr. Boaz. I believe the controversies that we are
    discussing are an illustration of the problem I raised, that it
    is inevitable that you are going to have politicization if you
    have government funding. That is why I think public radio and
    television would be better off without government funding.

                         ADDITIONAL SUBMITTED STATEMENT

        Senator Specter. We have received an additional submitted
    statement that will be included in the record at this point.
        [The statement follows:]

                  Prepared Statement of Americans for the Arts

        On behalf of Americans for the Arts, I am pleased to provide you
    this statement in support of funding for the Corporation for Public
    Broadcasting (CPB). As you know, recently the fiscal year 2006 funding
    for CPB was threatened during House subcommittee consideration. The
    House bill was substantially improved during full committee debate and
    floor action, but it is still inadequate. I write to you today to ask
    for your support in keeping CPB fully funded.
        Americans for the Arts is the service organization for the nation's
    4,000 local arts agencies, which provide $1 billion of annual funding
    and support for the arts and humanities at the local level. It is
    important to note at the outset that many local arts agencies are
    important partners, and funders, of local public television and radio
    stations. We are asking the federal government to continue to honor its
    commitment to public broadcasting, just as local arts agencies continue
    to honor theirs.
        CPB supports public television and radio through its partners, the
    Public Broadcasting Service (PBS) and National Public Radio (NPR).
    These organizations provide important access to the arts for millions
    of Americans. With both community-based arts programming, and
    nationally televised shows such as ``On Stage at the Kennedy Center''
    and ``Austin City Limits,'' public broadcasting is often a primary
    source of arts programming in many rural parts of the country. Public
    broadcasting also serves as an important source of information about
    live arts performances and exhibitions. Any reduction to its budget
    would drastically reduce the access that many Americans have to the
    arts.
        Public broadcasting's national programs are probably well known to
    members of the Committee. While you are probably familiar also with
    local programming in your own state, I would like to provide a few
    examples of local arts programming from around the country.
      --In Pittsburgh, WQED, the nation's first community-owned television
            station, airs ``Performance in Pittsburgh'' featuring recorded-
            in Pittsburgh concert highlights as well as interviews with
            Pittsburgh musicians and presenters. The WQED-FM, the radio
            station produces ``Pittsburgh Symphony Radio'' presenting the
            Pittsburgh Symphony Orchestra's recent concerts at Heinz Hall,
            archival tapes and tour performances.
      --Iowa Public Television (IPT) has a show named, ``A Century of Iowa
            Architecture,'' which uses high definition cameras to capture
            the details and drama behind the construction and design of
            Iowa's most significant buildings. Also, as part of its School-
            to-Careers programming IPT has programming specifically on
            becoming an artist. The National Employer Leadership Council
            (NELC) highlighted Iowa Public Television in its publication
            Best Practices in School-to-Careers: Rural Issues.
      --The Mississippi Arts Council and Mississippi Public Broadcasting
            produced a seven-part radio show titled, ``Sounds From Around
            the Corner'' which included gospel and old-time fiddling, as
            well as more recent immigrant traditions such as Latino music
            and classical Indian singing--all performed by Mississippi
            artists.
      --In Alaska, CPB has provided funding for the weekly ``AK'' cultural
            magazine show produced by the Alaska Public Radio Network. In
            2003, Public Radio News Directors International voted AK second
            place nationally for ``Best Public Affairs Program''.
        Budget cuts would heavily impact public radio broadcasting, as CPB
    funding represents 15 percent of the budget for many individual member
    stations of NPR. If they lose that support, many of them will have to
    make severe cuts to their programming and local services. This will
    especially impact rural areas and stations serving minority
    populations, as they heavily rely on federal funding for their
    operating budgets. While local and state arts agencies also support
    these stations, they could not make up for a loss of federal funding on
    this scale.
        While the House partially restored CPB funding, its legislation, as
    passed, eliminated $39 million to help local stations switch to digital
    transmission, $40 million to upgrade aging satellite technology, and
    made a $23 million cut to the ``Ready to Learn'' program, which
    provides money for the creation of shows such as ``Sesame Street'' and
    ``Reading Rainbow.'' These are all important items for CPB operations.
    We hope you will fully fund these programs in your subcommittee
    consideration, and that you will fight for them in conference with the
    House.
        With your leadership, we can insure that CPB funding is adequately
    funded, and that public television and radio can continue to provide
    high quality arts and cultural programming to our nation.

                             CONCLUSION OF HEARINGS

        Senator Specter. Thank you all very much for coming in. Let
    me tell you, drawing four Senators on a Monday morning in
    Washington is high praise for this panel and this subject. That
    concludes our hearings.
        [Whereupon, at 12:39 p.m., Monday, July 11, the hearings
    were concluded, and the subcommittee was recessed, to reconvene
    subject to the call of the Chair.]

      DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
              RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2006

                                  ----------

                                           U.S. Senate,
               Subcommittee of the Committee on Appropriations,
                                                        Washington, DC.

        MATERIAL SUBMITTED BY AGENCIES NOT APPEARING FOR FORMAL HEARINGS

        [Clerk's note.--The Social Security Administration and the
    Railroad Retirement Board were unable to testify and the
    following information was received in support of their fiscal
    year 2006 budget requests.]
        [The information follows:]

                         SOCIAL SECURITY ADMINISTRATION

                  Questions Submitted by Senator Arlen Specter

                             HUMAN CAPITAL PLANNING

        Question. In January 2001, the General Accounting Office identified
    strategic human capital management as a government wide high-risk area.
    What steps are you taking to acquire, develop, and retain an
    appropriate mix of agency staffing/talent, particularly in light of the
    Agency's impending retirement wave? What is the Agency's plan for
    creating an organizational culture that promotes high performance and
    accountability and empowers and includes employees in setting and
    accomplishing programmatic goals? How does the fiscal year 2006 budget
    support these activities?
        Answer. SSA has a long history of successful human capital
    planning. We first analyzed the impact of our impending retirement wave
    in 1998. This prompted development of a Future Workforce Transition
    Plan (FWTP) which laid out the strategies to ensure that a highly
    skilled staff was in place.
        We update our analysis of projected retirements annually and make
    appropriate adjustments to our recruitment, retention and succession
    strategies. We expanded upon the FWTP to publish a comprehensive and
    strategic Human Capital Plan in January 2004. The plan lays out how SSA
    will use human capital to meet the Agency's mission and goals and
    ensure that we have employees in place with the skills necessary to
    continue SSA's tradition of excellent citizen service. Employees across
    the Agency work together to accomplish these initiatives and, as a
    result, SSA received a President's Management Agenda score of ``green''
    for the Strategic Management of Human Capital in June 2004.
        To date, we have maintained our green status by successfully
    completing planned activities, continuing with initiatives underway and
    adding new ones that will further improve our management of human
    capital.
        Since 2001, we have implemented a new national recruitment strategy
    with the following key elements: (1) an integrated marketing campaign
    with a new SSA brand entitled ``Make a difference in people's lives and
    your own;'' (2) emphasis on the Inter/Intranet; (3) coordinated on-
    campus college recruitment; (4) automated staffing/recruiting; (5)
    practical methods for diversity recruitment; (6) streamlined hiring;
    and (7) maximum use of hiring flexibilities. We have expanded on these
    key elements through other key recruitment successes, including the
    release of a National Recruitment Guide to ensure consistency and
    excellence in our recruitment activities and the establishment of
    partnerships with other Federal agencies to assist veterans with
    transitioning to civilian employment.
        We are maximizing the use of technology to improve recruitment and
    hiring. SSA is in the process of transitioning to a new web-based
    staffing automated system. We are also working to improve methods of
    submitting, collecting, and processing electronic job applications.
    Improving the application process in those areas is expected to improve
    the hiring process by encouraging a larger number and more qualified
    applicants to apply for Federal positions and by facilitating more
    timely selections.
        Our recruitment efforts have proven successful in attracting
    quality hires. We hired over 15,000 employees in fiscal years 2001-
    2004. For fiscal year 2005, we have hired 2,616 through March 2005.
    This includes employees who were recently hired in support of the
    recent Medicare legislation which will provide drug benefit subsidies
    to the elderly.
        We develop employees from entry-level through the Executive level.
    Our orientation programs for new employees emphasize our organizational
    culture and public service values.
        SSA has received many accolades for its national leadership
    development programs that have often been referred to as the ``best in
    government.'' This reputation is based upon our use of competency-based
    programs that include a rigorous selection process and a variety of
    program features that produce well-rounded graduates. The programs
    include the Senior Executive Service Candidate Development Program for
    executives, the Advanced Leadership Program for middle- and senior-
    level employees, the Leadership Development Program for employees at
    the journeyman level, and the Presidential Management Fellows Program
    for entry-level professionals.
        SSA has redesigned entry level training, developing job-specific
    training competencies and delivering related training for about 24,000
    positions in the claims representative, service representative, and
    teleservice representative occupations. In fiscal year 2006, SSA will
    develop competency-based training that will be used for another 4,000
    positions in the benefit authorizer, claims authorizer and technical
    support technician occupations.
        SSA is also delivering training to prepare employees for the new
    Medicare legislation. The intent of this training is to ensure all
    employees understand and can process the workloads associated with the
    new legislation.
        We are also maximizing the use of technology in the training arena
    by implementing a project development plan to migrate to a common,
    government-wide electronic-learning service.
        Our 2-year retention rate for new hires has been gradually
    increasing from 84 percent for 1998 hires to 89.9 percent for 2002
    hires; a rate which is considered outstanding in the private and public
    sectors. We have enhanced our orientation process and are improving our
    exit interview processes to further support our high retention rate.
        We are promoting high performance and accountability by improving
    our performance management systems. We implemented new multi-tiered
    appraisal systems for Senior Executive System employees in October 2002
    and for GS-15s in October 2003. We are further improving our
    performance management systems by implementing a new multi-tier
    performance appraisal model for union-represented employees that, when
    implemented, will differentiate between levels of performance and
    enhance managers' ability to hold employees accountable for results.
        Full funding of the fiscal year 2006 President's budget will allow
    us to continue to carry out our Strategic Human Capital Plan
    activities.

                            DIRECT SERVICE POSITIONS

        Question. What is your plan to increase the number of direct
    service positions, while maintaining appropriate levels of technical,
    policy, and administrative support staff? The Subcommittee is aware
    that SSA met its long-term goal of reallocating 5 percent of
    headquarters positions to direct service in fiscal year 2004.
    Specifically, how was this accomplished? What does the budget assume
    for such redirections in fiscal year 2005 and fiscal year 2006?
        Answer. We met our goal through a combination of redeployments and
    overall attrition in staff components. For example, 71 employees
    transferred from staff components to direct service positions in the
    Office of Central Operations in November 2002. The fiscal year 2006
    budget request assumes no additional redirections for fiscal year 2005
    or fiscal year 2006. The fiscal year 2006 budget request does assume an
    increase in full-time equivalents from fiscal year 2005, attributable
    mainly to the 2,200 direct service employees hired in fiscal year 2005
    to handle workloads related to the new Medicare prescription drug
    program. Although hired initially to deal with this new Medicare
    workload, these employees will be trained on all of SSA's programs so
    they can ultimately help backfill for the 3,000-4,000 employees we lose
    each year due to retirements and resignations.

                     ENRICHMENT OPPORTUNITIES AND LEARNING

        Question. One long-term outcome identified in SSA's Agency
    Strategic Plan is ensuring ongoing enrichment opportunities and
    training. Specifically, how does the fiscal year 2006 budget support
    this long term outcome?
        Answer. SSA is dedicated to improving its training and development
    programs in order to build the skills our employees at all levels need
    to deliver quality customer service in the 21st century's technological
    environment. To fill emerging skills gaps, SSA is focusing on improving
    the training it provides all its employees--from the lowest levels to
    the top. We are using the lessons we learned from ``getting to green''
    to stay focused on our commitment to improve learning at SSA so all of
    our employees are prepared to support SSA's mission.
        Currently, SSA's Office of Training is moving forward to:
      --Develop and implement a competency-based training approach to
            ensure that our employees on the front-line doing mission
            critical work have the skills and knowledge they need to
            effectively address the concerns of the American public.
      --Ensure that the Agency has the number of well-rounded, competent
            leaders it needs by implementing a new leadership development
            strategy that will enhance SSA's nationally acclaimed career
            development programs.
      --Open up more learning opportunities for SSA's employees by moving
            from SSA's Online University to the government-wide GoLearn
            online learning system. SSA employees nationwide will be able
            to select from over 2,000 courses that are designed to make the
            most of their potential.
        Of the many influences that are shaping SSA's future, none may be
    more fundamental or influential than the training we provide our
    employees. Our shared learning helps us to forge a sense of common
    purpose nationwide and provides us with the knowledge and skills we
    need to do our jobs. SSA's future success at meeting the public's
    increasingly varied needs depends on our ability to open up learning
    opportunities that make the most of our employees. Because of this, SSA
    is continuing to reassess the needs of its workforce and investing in
    workforce learning and performance for each of our employees and the
    Agency as a whole.
      --SSA provided an average of 48 hours of training per employee over
            SSA's Interactive Video Teletraining (IVT) network and Online
            University. SSA employees were particularly interested in new
            IVT broadcasts that covered the new Medicare policy, security
            in SSA's offices, and the growing use of the Internet.
      --The Office of Training is continuing to work with Operations to
            redesign the training for new or recently promoted employees in
            our mission critical positions. In redesigning our training,
            SSA has been using results from private sector source surveys
            and studies to develop a competency-based training program.
            This approach provides our students with the knowledge, skills,
            and abilities they need to do their jobs in an environment that
            is becoming increasingly automated.
        By the end of last year, the entry-level training for Title II and
    Title XVI Claims Representatives (CRs), Service Representatives (SRs),
    and Teleservice Representatives were redesigned to reflect this
    competency-based approach.
        Redesigned training lessons improve the way our new employees learn
    their jobs by integrating information regarding SSA's programs and
    policies with structured off-air activities and on-the-job-training.
    This plays a key role in helping new employees master the technology
    and automated processes that are a critical element of today's SSA work
    environment. Mentors help guide and support students as they develop
    new skills by practicing on SSA computer systems, taking part in role-
    playing, and having on-the-job experiences that will serve them well
    when they take on their new roles full time.
        The Office of Training has also been developing training for
    specific groups of employees. Working with Operations' offices across
    the country, they have completed the development of competency-based
    training for Benefit Authorizers, Claims Authorizers, and Technical
    Support Technicians in the Program Service Centers by 2006. They have
    also improved fundamentals training for employees who do not provide
    direct services to the public. This training gives general information
    about the Title II and Title XVI programs and strengthens our
    commitment to work purposefully together in shaping and managing these
    programs.
        Because of the continuing changes in the disability programs, SSA
    is working to update and expand the disability training materials for
    new or recently promoted disability adjudicators. SSA also provides a
    significant amount of training for OHA employees who process disability
    claims at the appeals levels. Topics that SSA provides on its IVT
    network focus on OHA's Case Processing Management System, Speech
    Recognition Software, Digital Recording, Dismissals, Remands, and
    Docket Management.
        The Office of Training is evaluating the training needs of SSA's
    Executive Officers and expects to develop a core curriculum for that
    position by the end of the fiscal year.
        Technology has also played an important role in SSA training.
      --During fiscal year 2004 and into fiscal year 2005, Social Security
            continued to move forward towards realizing its vision of
            providing IVT nationwide. By the end of 2004, employees in more
            than 100 additional offices were linked to the IVT network.
            Today, over 98 percent of Agency and Disability Determination
            Service (DDS) employees have access to IVT.
      --The IVT network continues to play an important role in ensuring
            that our employees learn what they need to know, when they need
            it. The first part of the Medicare Part D subsidy training on
            policy was developed and successfully delivered over the IVT
            network. The second part of this training, which will cover
            systems and subsidy changing events, is being readied for
            delivery this May.
      --SSA is working behind the scenes to improve the delivery of its IVT
            broadcasts. With the conversion of the headquarters' practice
            studio, SSA now has a fully functional digital broadcast
            facility in Baltimore that helps us improve our ability to get
            up-to-date programs to our employees. SSA is also upgrading its
            other six broadcast facilities and enhancing our automated
            scheduling and evaluation procedures as well in an effort to
            better ensure that our IVT programs reach the employees who
            need them.
      --SSA is expanding the benefits and values of online learning through
            the SSA GoLearn training site. SSA GoLearn replaces SSA's
            current Online University (OLU). All employees and their
            managers will have unprecedented opportunities to take over
            2,000 courses at their workstations or at home, at no cost to
            them or their offices. Each employee will learn at his or her
            own pace and be able to select courses that will help them
            learn and perform better or become eligible for other, more
            rewarding work. Successful learners will automatically get
            credit for completed courses on their personnel records,
            without filling out any paperwork.
      --IVT provides disability policy training to SSA and the DDS
            employees. IVT broadcasts provide these employees with help in
            handling a host of difficult technical issues, including
            electronic disability, evidence in childhood cases, disability
            fraud detection, and disability onset. SSA also broadcasts
            vocational and adjudicative tips in case development and
            processing for employees who handle SSA's disability workloads.
        Since 2004, SSA has ensured that it has the talent it needs to lead
    the Agency by supporting the expansion of the national leadership
    development programs.
      --60 employees have been selected to take part in the Leadership
            Development Program (LDP) that will begin mid-year. The GS-9
            through GS-11 employees who will participate in the program
            will have the opportunity to move forward in the Agency by
            making the most of the training and rotational assignments
            available to them in the 18-month program.
      --The Senior Executive Service Candidate Development Program (SES
            CDP) is expected to be announced later this year. The SES
            candidates are expected to begin their program in 2006. In
            order to develop the qualifications they need to become the
            government's top executives, SSA's SES candidates will take a
            variety of Agency rotational assignments and some will spend
            time at other Federal agencies to prepare them to successfully
            lead change within the Federal Government.
      --Approximately 26 top graduate students are expected to be selected
            at the end of this calendar year for the Presidential
            Management Fellows (PMF) 2-year development program.
        SSA is continuing to seek new ways to ensure that the Agency has
    the leadership it needs to succeed in the 21st century. Earlier this
    year, a national workgroup of manager and trainers in headquarters and
    from the field worked together to establish a new strategy for
    developing leaders at SSA. The Office of Training is getting nationwide
    comments on the strategy which is designed to foster competencies that
    leaders and managers need to effectively manage people, achieve
    results, and promote performance management. SSA anticipates
    implementing this new, improved approach to leadership by the end of
    this year.
        Full funding of the fiscal year 2006 President's budget request for
    SSA will permit us to continue to carry out these training and
    development programs.

                           INITIAL DISABILITY CLAIMS

        Question. Over the period fiscal year 2000-fiscal year 2004,
    initial disability claims pending have increased by more than 16
    percent and now total more than 620,000, despite an increase in agency
    resources from $6.6 billion to $8.3 billion, or almost 26 percent.
    Please provide a breakout of DDS (Disability Determination Service)
    resources (dollars and staffing) over this period. What explains this
    growth in backlogs, despite increasing Agency resources? What specific
    actions are underway or planned in fiscal year 2005 and fiscal year
    2006 to ensure more timely adjudication of disability cases and more
    cost-effective expenditure of agency resources?
        Answer. The growth in initial disability claims pending is the
    result of a dramatic growth in initial claims receipts. Over the fiscal
    year 2000-2004 period, DDS initial claims receipts increased almost 24
    percent.
        SSA responded within available resources to this increase in
    receipts by: (1) increasing DDS resources; (2) initiating fewer
    continuing disability reviews in fiscal year 2003 and fiscal year 2004
    and redirecting those resources to process initial claims; and (3)
    improving productivity in the DDSs. In spite of these efforts, we were
    unable to keep up with the growth in receipts.
        In fiscal year 2005, we implemented a plan to lower initial pending
    levels to 592,000 by the end of the fiscal year. Thus far this year, we
    have succeeded in lowering pendings to 608,000. To help achieve the
    pending goal, increased funding was provided to the DDSs, and DDSs were
    authorized additional hiring and increased overtime. In addition, where
    requested and needed, Federal assistance in case processing is being
    provided to some DDSs. In fiscal year 2006, the President's budget
    request reflects productivity and processing time improvement for the
    DDSs, mainly through an electronic disability claims process (eDib).
        Despite not receiving the full President's budget request for the
    last two fiscal years, my Service Delivery Budget goal is still to
    reduce disability claims pending to 400,000 by 2008. To achieve this,
    we need the Committee's support, including full funding for the
    President's budget request of $9.403 billion for SSA's administrative
    expenses.
        A breakout of DDS resources (dollars and staffing) for fiscal year
    2000-fiscal year 2004 is provided in the chart below.

                              [Dollars in millions]
    ------------------------------------------------------------------------
                         Year                        Worrkyears     Amount
    ------------------------------------------------------------------------
    2000..........................................       14,231       $1,461
    2001..........................................       14,397        1,513
    2002..........................................       14,947        1,588
    2003..........................................       14,700        1,593
    2004..........................................       14,772        1,672
    ------------------------------------------------------------------------

                            EDIB AND IMPLEMENTATION

        Question. The Government Accountability Office (GAO) added Social
    Security's disability programs to its list of High-Risk programs. SSA's
    fiscal year 2006 budget request supports complete implementation of an
    electronic disability process--eDIB--as a means to improving the
    timeliness of and efficiency associated with disability decision. How
    much funding is included in the fiscal year 2006 request to support the
    eDIB? In several recent reports, GAO has raised concerns about the
    cost-benefit analysis, risk assessment and mitigation, and
    implementation plan for this initiative. Given the difficulties
    experienced in previous attempts to improve this process, what
    contingencies are in place to deal with challenges in implementing
    eDIB? Specifically, what resources are available and supports in places
    to deal with any potential implementation challenges?
        Answer. SSA has requested approximately $50 million in fiscal year
    2006 for information technology (IT) hardware/software services, as
    well as internal IT staff to support eDib.
        The most important thing to note is that eDib functionality was
    implemented by January 2004 and has been working effectively since that
    time. This includes the Internet Disability Report, the Electronic
    Disability . . . Collect System (EDCS), new hardware and software for
    the State legacy systems, the Document Management Architecture (DMA),
    and the Office of Hearings and Appeals (OHA) Case Process Management
    System (CPMS). We are well on our way to the completion of the eDib
    rollout to all of the Social Security and State offices.
        SSA has put many controls and resources into the process to assure
    our success as we implement these features, as we build upon them, and
    as we continue to roll-out full electronic folder capability across the
    nation to all components involved in processing the disability
    workload. This includes regular high level monitoring of the project
    status. There is frequent contact among all of the SSA components
    involved in eDib including staff from systems, policy and operations.
    SSA also deploys policy, systems, workflow, and usability experts to
    field offices, Disability Determination Service (DDS) offices, OHA
    offices, and Office of Quality Assurance (OQA) sites to learn first-
    hand about the issues faced by staff working with the eDib applications
    and works to resolve any problems quickly.
        In addition, SSA is conducting an Independence Day Assessment (IDA)
    before moving a DDS, OHA, or OQA office to a fully electronic process
    (i.e., new cases can be processed in the electronic folder with no new
    paper folder created). This assessment ensures that everything is
    working properly before going fully electronic by validating the
    business process, the systems functionality, and other processes and
    procedures. The assessment also makes sure the electronic folder meets
    all documentation standards set forth by SSA and the National Archives
    and Records Administration (NARA).
        SSA has assigned an ``integrator'' for each State. The integrator
    is responsible for tracking the progress of testing and implementation
    in each State and is the single point of contact for the DDS should
    they encounter issues. The integrator is responsible for identifying
    the component/person that can address and resolve each issue. This has
    proven to be a very successful model for eDib implementation. In
    addition, each DDS receives onsite support by their legacy system
    vendor and SSA Systems staff during testing and training, as well as
    during the first week of production.
        We have placed a strong focus on risk management. We hired a
    contractor to work with our Project managers to develop Risk Management
    Plans for each of the major eDib projects. We have assigned each of the
    risks to the appropriate Project Managers for their use in addressing
    the risks. Our contractor updates these plans with the Project Managers
    to assure continued monitoring and mitigation of risks.

                          DISABILITY REDESIGN PROCESS

        Question. According to SSA's service delivery assessment of the
    disability process completed in 2002, persons pursuing their disability
    claims through all levels of Agency appeal wait an average of 1,153
    days for that final decision. Due to backlogs, cases that go through
    all levels of appeal spend nearly 50 percent of the time (535 days)
    waiting for SSA action. Commissioner, you have proposed an ambitious
    redesign concept for the disability determination process, and also
    have established a date of January 2006 as the earliest major changes
    in the disability determination process may become effective.
    Improvements to this process are needed, as the current process takes
    too long. What process will you follow for making final decisions about
    the redesign plan and what is the timeline for making those decisions?
    How much funding is proposed in the FY'06 budget associated with
    redesign implementation (OB) and what redesign activities do they
    support?
        Answer. Improving the disability process is one of my highest
    priorities as Commissioner. I am close to making the final decisions
    that will convert my new approach for improving disability
    determinations into a proposed regulation which will provide the right
    decision as early in the process as possible and create work
    opportunities for people with disabilities.
        When I announced my new approach, I stressed that the changes
    envisioned were predicated on successful implementation of our
    electronic disability system (which we call eDib) and that it was
    critically important to listen to the ideas of all interested parties
    as we developed the disability determination improvements.
        I am pleased to report that our State-by-State roll out of eDib is
    on track. All of our field offices across the nation are now using the
    Electronic Disability Collect System (EDCS) that initially creates the
    electronic folder. This system was implemented at the first State
    Agency Disability Determination Services (DDS) in January 2004, and
    additional DDSs have continued to implement eDib ever since. Currently,
    eDib has been rolled out in all States except North Dakota, Alaska,
    Nebraska, New York and Washington, DC. With the exception of New York,
    all remaining States will be rolled out by the end of June 2005. At the
    same time, our Office of Hearings and Appeals (OHA) has begun using the
    new Case Processing and Management System (CPMS), which is a new
    software for processing cases and managing OHA office workloads. CPMS
    will enable OHA to work with the electronic file.
        In view of the complexity and importance of the disability
    programs, my second strategy, having an open process, has been
    invaluable in my decision making. Last year, I launched a massive
    outreach effort to obtain and give thoughtful consideration to all
    comments on the current system and our proposed improvements. I created
    the Disability Service Improvement Staff within my immediate office to
    coordinate this effort and I have been taking a personal role in
    listening to those involved and interested in the disability process. I
    have personally participated in more than 60 meetings with more than 40
    organizations--both within SSA and outside of the Agency. As I have
    been making decisions, I have carefully considered hundreds of views
    and suggestions received from the Congress, the general public, and
    many public and private sector groups and individuals.
        With respect to fiscal year 2006 funding, I anticipate that our
    plan to roll out the new process region by region will enable us to
    implement these improvements without seeking additional resources
    beyond those the President requested for SSA from the Congress for
    fiscal year 2006.

                            SPECIAL DISABILITY CASES

        Question. The Subcommittee is aware that SSA's latest plan is to
    complete the entire review of the special disability cases by 2010.
    What specifically is the Agency's plan for accomplishing this goal and
    how much funding will be required to review all of these cases?
        Answer. As of fiscal year 2004, we have processed 96,600 cases of
    the estimated 300,000 individuals eligible for Supplemental Security
    Income (SSI) who are also entitled to (but not receiving) Social
    Security Disability Insurance benefits. In fiscal year 2005, we plan to
    process 30,500 cases at a cost of $78 million. The fiscal year 2006
    budget includes $79 million for the processing of 30,600 special
    disability cases.
        Through fiscal year 2004, SSA spent approximately $175 million on
    the processing of Special Disability cases. Assuming full funding of
    the President's fiscal year 2006 budget request, as well as sufficient
    funding in future years to support continued processing of this
    workload, we expect to complete case processing by September 2010 at an
    administrative cost of about $630 million.

                                      CDRS

        Question. The Subcommittee notes that one of the Agency's Long-Term
    Outcomes under its Stewardship goal is to remain current with
    Disability Insurance CDRs and to regain currency with SSI CDRs. What
    are the performance outcomes the Agency needs to achieve during the
    years fiscal year 2005 through fiscal year 2009 to meet this long-term
    outcome measure? What is SSA's plan for meeting this goal? What best
    practices did SSA develop during the period when Congress provided
    special funding that are being applied to the process currently that
    will ensure the most cost-effective expenditure of LAE resources? How
    will the Agency determine an appropriate balance between Continuing
    Disability Reviews processed through mailers and those cases requiring
    a full medical review?
        Answer. To remain current in Title II CDRs and achieve currency in
    Title XVI CDRs by the end of fiscal year 2009, SSA would need to
    process over 7.5 million CDRs, including those that will come due
    during the period fiscal year 2006-fiscal year 2009 and CDRs that we
    have been unable to initiate through fiscal year 2005 because of
    funding limitations. While we are updating our CDR plan to reflect more
    current information, including the latest projections of initial
    disability claims receipts, we do not believe that we will be able to
    achieve Title XVI currency until after fiscal year 2009.
        The President's fiscal year 2006 budget includes budget enforcement
    legislation that would place caps on net discretionary budget authority
    and outlays. The legislation would permit adjustments to these caps for
    spending above a base level for several government-wide program
    integrity activities, including SSA's CDRs. The amount of the
    adjustment for CDRs is $189 million, which means if the President's
    proposal is enacted, $189 million of SSA's budget request would not be
    counted towards the overall cap on discretionary budget authority.
        Congress provided SSA with special funding for CDRs, outside the
    discretionary budget caps, from fiscal year 1996 through fiscal year
    2002. During this period and continuing, SSA has worked continuously to
    improve the efficiency and effectiveness of the CDR program. The
    results are borne out by the following passage from SSA's most recent
    Annual Report to Congress on CDRs covering fiscal year 2003:

        ``SSA's CDR process has consistently yielded a favorable ratio of
    savings to costs in the Disability Insurance (DI) program. Prior to the
    implementation of the current process for case selection, it was
    estimated that we were achieving $3 in DI program savings for each $1
    in administrative costs invested in full medical CDRs. The addition of
    the mailer process beginning in 1993 was estimated to result in a
    doubling of this ratio to approximately $6 to $1.
        ``Actual results to-date for the period during which supplemental
    administrative funding has been available have been even better than
    anticipated. During this period, the number of cases processed has
    expanded significantly, especially in the review of SSI cases. This
    expanded process has yielded savings-to-cost ratios for the seven
    fiscal years 1996-2002 averaging roughly $10.3 to $1.''----From SSA's
    Annual Report of Continuing Disability Reviews, fiscal year 2003;
    published October 27, 2004.

        The breakthrough innovation was the implementation of a statistical
    profiling/mailer process in 1993 which permitted SSA to reliably
    identify large cohorts of beneficiaries with a low probability of
    cessation due to medical improvement for whom the expensive full
    medical review process is not required. The CDR statistical scoring
    models are a series of mathematical formulas designed to predict the
    likelihood of medical improvement for each Retirement Survivors
    Disability Insurance (RSDI) beneficiary and SSI adult recipient. Based
    on the scores generated by these models and a statistical threshold
    which determines whether a mailer or full medical examination would be
    the most cost effective type of review to perform, cases scoring below
    the threshold are targeted for CDR mailers, and those scoring at or
    above the threshold are targeted for full medical reviews.
        During the early years of the special funding we focused primarily
    on improving internal systems and operational processes needed to
    reliably control and track more than a million reviews annually. SSA
    engaged a statistical contractor in fiscal year 2000 to improve the
    performance of the statistical modeling. Since then, the contractor has
    updated and expanded the data and mathematical formulas upon which the
    statistical scoring is based.
        SSA has been able to implement several processing improvements
    based on research findings by our statistical contractor. Since fiscal
    year 2002, SSA has been able to use the profiling/mailer process to
    identify RSDI disabled workers with a statistical model score
    signifying ``medium'' probability of medical improvement who do not
    require a full medical review. The process was extended to SSI disabled
    adult beneficiaries in fiscal year 2005. In fiscal year 2003, we were
    able to apply Medicare usage data to identify additional RSDI disabled
    workers with a low or medium probability of medical improvement.
    Altogether since fiscal year 2002, these innovations have avoided well
    over 500,000 full medical reviews, more than $300 million in
    administrative costs, and significantly reduced unnecessary burden on
    our most severely disabled beneficiaries.
        We continuously monitor the performance of the statistical models
    and can readily make enhancements that are suggested. In addition, the
    models have been scrutinized by several teams of auditors and found to
    be accurate and reliable. And, together with our statistical
    contractor, we continue to look for additional processing efficiencies
    that can be implemented in the future.
        With respect to determining the appropriate balance between CDRs
    processed through mailers and those performed as full medical reviews,
    this decision is determined through the CDR statistical scoring models.
    For cases with medical re-examinations due to be scheduled in the
    particular fiscal year, we begin releasing CDR mailers and full medical
    reviews at the start of the fiscal year, and continue the release
    process throughout the year, with the goal of releasing all cases due
    for a CDR in that year.

                                 TICKET TO WORK

        Question. According to the ``Justification of Estimates for
    Appropriations Committees'' for the fiscal year 2006 budget request,
    the Ticket to Work Program will be expanded to all States and U.S.
    Territories by September 2004. Specifically, how much funding is
    available within the fiscal year 2006 request for the Limitation for
    Administrative Expenses account to support implementation of the Ticket
    to Work program and what activities are supported? How much funding
    from other sources within the fiscal year 2006 budget request support
    the program?
        Answer. The administrative budget for fiscal year 2006 includes
    $39.4 million for Return to Work activities. This funding is for
    Benefits Planning and Assistance Cooperative Agreements ($23 million),
    Protection and Advocacy grants ($7 million), and the Program Manager
    Contract ($9.4 million).
        The following chart summarizes other objects administrative costs
    of the Ticket to Work program by major category:

                                 RETURN TO WORK
                            [In millions of dollars]
    ------------------------------------------------------------------------
                                                           Fiscal year
                                                   -------------------------
                                                        2005     2006 budget
                                                      estimate    submission
    ------------------------------------------------------------------------
    Benefits Planning & Assistance Cooperative             23.0         23.0
     Agreements (including training and technical
     assistance)..................................
    Protection & Advocacy Grants..................          7.0          7.0
    Program Manager Contract......................      \1\ 6.9          9.4
                                                   -------------------------
          Total...................................         36.9        39.4
    ------------------------------------------------------------------------
    \1\ The fiscal year 2005 contract is only for nine months. The contract
      is being re-competed for fiscal year 2006. The President's budget
      estimates $9.4 million for fiscal year 2006, the same as the full year
      cost for fiscal year 2004.

        Benefits Planning and Assistance and Cooperative (BPAO) Agreements
    are intended to ensure that community based benefits planning and
    assistance outreach services are available across the United States and
    its territories. The law authorized $23 million to be appropriated each
    year and the Social Security Protection Act of 2004 (Public Law 108-
    203) extended this authorization through 2009.
        The Protection and Advocacy (P&A) grants are used to provide advice
    to beneficiaries and to provide an avenue for resolving disputes. The
    Social Security Protection Act of 2004 also extended authorization to
    provide funding for P&A grants through fiscal year 2009. The budget
    continues funding of $7 million for P&A grants in fiscal year 2005 and
    fiscal year 2006.
        The Program Manager Contract provides funds to an outside
    contractor to help SSA manage the Ticket to Work program. The contract
    will be re-competed and the required funding has been estimated to be
    $9.4 million for fiscal year 2006.
        The budget also includes program funding to cover outcome and
    milestone payments made to Employment Networks (ENs) under the Ticket
    to Work program. State Vocational Rehabilitation (VR) agencies have the
    option, on a case-by-case basis, to elect to be paid under the
    reimbursement payment system or as an EN. The Beneficiary Services
    Budget for fiscal year 2006 includes $262 million to cover
    reimbursement payments to VR agencies and Ticket payments to ENs (see
    chart).
        The chart below summarizes the estimated Beneficiary Services
    payments:

                                              BENEFICIARY SERVICES PAYMENTS
                                                [In millions of dollars]
    ----------------------------------------------------------------------------------------------------------------
                                                                            OASDI                      SSI
                                                                 ---------------------------------------------------
                                                                         Fiscal year               Fiscal year
                                                                 ---------------------------------------------------
                                                                      2005         2006         2005         2006
    ----------------------------------------------------------------------------------------------------------------
    Reimbursement Payments (VR).................................           80          104           52           67
    Ticket Payments (EN)........................................           25           54           25           37
                                                                 ---------------------------------------------------
          Total Payments........................................          105          158           77          104
    ----------------------------------------------------------------------------------------------------------------

                          DISABILITY PROGRAM NAVIGATOR

        Question. How has SSA collaborated with other federal agencies and
    partners to increase the work opportunities of individuals receiving
    Social Security and SSI disability payments and what resources are
    included within the fiscal year 2006 budget request to carry out such
    activities? Specifically, what has been the experience in increasing
    work opportunities through the Disability Program Navigator housed in
    One Stop Centers and the Area Work Incentive Coordinators? Why is
    funding for the Disability Program Navigator position being
    discontinued in 2005?
        Answer. On September 30, 2002, SSA and DOL entered into an
    interagency agreement to jointly fund a two-year pilot and evaluation
    of a new position within the One-Stop Career Center system, the
    Disability Program Navigator (DPN). This funding, in the form of
    cooperative agreements, was distributed to 14 States in fiscal year
    2003. A primary objective of the Navigator is to increase employment
    and self-sufficiency for individuals with disabilities by linking them
    to employers and by facilitating access to programs and services that
    will enable their entry or reentry into the workforce.
        SSA and DOL funded the DPN's for a second year which will support
    the project through June 2005. During the second year of this joint
    initiative, Navigators experienced increased activity in the area of
    relationship building within the One-Stop Center as well as with
    employers, Vocational Rehabilitation agencies, Benefit Planning,
    Assistance and Outreach (BPAO) providers, and SSA Area Work Incentive
    Coordinators (AWIC). Evaluation survey data is currently being
    collected and, based on the results, SSA will make a decision regarding
    funding for an additional year.
        The SSA AWICs are the Agency focal point for public information
    outreach and education efforts for the Ticket to Work program. The
    fifty-five nationwide AWICs work closely with the external Ticket to
    Work partners, such as Protection and Advocacy representatives, BPAO
    representatives, Employment Networks (ENs), Disability Program
    Navigators, Vocational Rehabilitation and other disability advocates.
    In some regions AWICs are included in regional training events with the
    BPAOs and have partnered with Maximus to provide training to the ENs.
    AWICs, Plan for Achieving Self-Support (PASS) specialists and SSA
    regional office staff participate in the training and refresher
    training sessions.
        In addition, SSA has entered into a number of interagency
    agreements and cooperative agreements which are focused on increasing
    work opportunities for individuals receiving disability benefits.
        SSA has entered into a $100,000 interagency agreement with HHS'
    Office of the Assistant Secretary for Planning and Evaluation (ASPE) to
    subcontract the evaluation of the Florida Freedom Initiative (FFI). The
    FFI is an expansion of a Real Choice Systems Change grant from the
    Centers for Medicare and Medicaid Services (CMS), which is targeted to
    a subpopulation of participants in the section 1115 waiver
    demonstration called Consumer-Directed Care Plus. This subpopulation
    consists of adults with mental retardation/developmental disabilities.
    In addition to the financial commitment to the evaluation of the FFI,
    SSA will be waiving certain SSI and SSDI program rules for FFI
    participants to test whether the combination of Social Security and CMS
    waivers fosters greater self-sufficiency among demonstration
    participants.
        SSA's Youth Transition Demonstration (YTD) consists of seven
    cooperative agreements in six States (California, Colorado, Iowa,
    Maryland, Mississippi, and New York). The goal of these cooperative
    agreements is to find more effective ways to enable youth who receive
    SSI and SSDI as well as those who are at risk of receiving these
    benefits, to transition successfully to work or post-secondary
    education and ultimately to maximize their economic self-sufficiency.
    These seven cooperative agreements were awarded September 30, 2003 for
    up to five years. The latest budget estimate for fiscal year 2006
    includes $11.8 million for funding the demonstration projects,
    evaluation and technical assistance. These partners are collaborating
    at the State level with the Vocational Rehabilitation Services,
    Department of Education, Department of Labor One Stop Centers as well
    as other State and local agencies.
        Since 2001, SSA has been working under an Interagency Agreement
    with DOL's Office of Disability Employment Policy (ODEP) to promote
    SSA's Ticket to Work Program within DOL's ``Employer Assistance
    Referral Network'' (EARN). DOL has incorporated Ticket to Work into a
    specialized unit of EARN called ``Ticket to Hire'' (TTH). EARN's
    primary purpose is to provide employers with a one-stop service to help
    them locate and recruit skilled candidates with disabilities for jobs.
    TTH matches employers' job openings with qualified, job-ready
    candidates from the Ticket to Work Program. Presently, there is
    $600,000 budgeted for the continuation of this Interagency Agreement
    for fiscal year 2006.

                                  OHA HEARINGS

        Question. Over the period fiscal year 2000-fiscal year 2004, the
    number of social security hearings pending have increased by 90 percent
    to more than 590,000, despite an increase in agency resources from $6.6
    billion to $8.3 billion, or almost 26 percent. Pending hearings grew by
    nearly 80,000 during the last fiscal year and the average processing
    time increased by almost 14 percent, despite the provision of
    additional staff support to OHA and the hiring of 103 administrative
    law judges. Please provide a breakout of Office of Hearings and Appeal
    resources (dollars and staffing) over this period. What accounted for
    this growth in backlogs, despite increasing agency resources? What
    actions are underway or planned in fiscal year 2005 and fiscal year
    2006 to ensure more timely dispositions and more cost-effective
    expenditure of agency resources?
        Answer. The inability to hire ALJs between fiscal year 2001 and
    fiscal year 2004 resulted in increased cases pending, even though we
    were able to hire 103 ALJs in fiscal year 2004. This ALJ shortage,
    along with a 14 percent increase in case receipts during the same time
    period, has also increased processing time. OHA has hired an additional
    100 ALJs during fiscal year 2005, and anticipates hiring additional
    ALJs during fiscal year 2006 which will, when these ALJs are fully
    trained, facilitate case processing. Other actions being implemented to
    decrease processing time include the:
      --development of File Assembly Units for assembling files for
            hearings;
      --establishment of a Centralized Screening Unit which reviews and
            prepares cases for potential On-The-Record Decisions;
      --implementation of various initiatives at the hearing level to
            expedite the issuance of decisions. These include the
            following: screening cases for on-the-record allowances;
            issuance of fully favorable decision by the ALJ at the hearing
            (bench decisions); providing an easily prepared decision format
            for ALJ's to prepare decision findings; and
      --electronic developments such as eDib, the Digital Recording
            Acquisition Program and the Case Processing Management System
            (CPMS), are expected to expedite case processing and tracking.
        Despite not receiving the full President's budget request for the
    last two fiscal years, my Service Delivery Budget goal is to eliminate
    the hearings pending backlog by 2010. To achieve this, we need the
    Committee's support, including full funding for the President's budget
    request of $9.403 billion for SSA's administrative expenses.
        The breakout of OHA's resources (dollars and staffing) over the
    period covering fiscal year 2001 through fiscal year 2004 is as
    follows:

                              [Dollars in millions]
    ------------------------------------------------------------------------
                         Year                        Workyears      Amount
    ------------------------------------------------------------------------
    2001..........................................        7,945       $692.8
    2002..........................................        8,049        751.1
    2003..........................................        7,903        815.7
    2004..........................................        8,204        867.0
    ------------------------------------------------------------------------

                                  hiring aljs
        Question. What is SSA's plan for hiring Administrative Law Judges
    in fiscal year 2005 and fiscal year 2006? How does the fiscal year 2006
    budget request support continued improvement in Administrative Law
    Judge productivity, one way to help reduce the growing average
    processing time for hearings, which is up 31 percent from fiscal year
    2000 to fiscal year 2004? The Committee is aware of the more than 100
    day decrease in average processing time for hearings associated with
    the use of the video teleconferencing capability. What are the savings
    associated with the expansion of these facilities proposed in the
    fiscal year 2006 budget request?
        Answer. OHA hired 100 ALJs for fiscal year 2005 and plans to hire
    additional ALJs in fiscal year 2006 depending on the level of funding
    available. After the nine-month learning curve, we expect that the
    increase in ALJ resources will help reduce the hearings backlog, and as
    a result, reduce the average processing time.
        Including the 80 additional sites installed this fiscal year, there
    now are a total of 240 video teleconferencing sites in operation. We
    have conducted nearly 12,000 video hearings this fiscal year through
    April compared to 4,000 through April of fiscal year 2004. Video
    hearing usage contributes to ALJ productivity improvements because
    fewer hearings are postponed, ALJ travel is decreased, and expert
    resources are more accessible.

                    OHA'S CASE PROCESSING MANAGEMENT SYSTEM

        Question. The new Office of Hearings and Appeals Case Processing
    Management System was scheduled to be completed by September 2004. What
    training resources are being expended to support its successful
    implementation? What does the fiscal year 2006 budget assume about
    savings related to this new system in fiscal year 2005 and fiscal year
    2006?
        Answer. The Case Processing Management System (CPMS) conversion
    began in May 2004 and was completed in August 2004. The following
    training resources supported successful implementation of the Case
    Processing Management System (CPMS):
      --CPMS training began in April 2004 and ended in July 2004;
      --CPMS training took place ``onsite'' at each hearing office (HO);
      --CPMS training was performed over a 40-hour week;
      --Training was broken into several categories, general training for
            all staff then job specific training for each job type;
      --The on-site trainers were in the HO to help with the conversion of
            all Hearing Office Tracking Systems data to CPMS;
      --The trainers remained onsite the week after training to address any
            CPMS issues that arose; and
      --Further support has been provided after the training was completed:
        --A CPMS help desk in Falls Church is now maintained full-time;
        --CPMS training manuals have been made available on the OHA's
                website;
        --CPMS training material is on the OHA Website;
        --Continual updates are made to the training materials on the
                website;
        --Net meetings are conducted with HO's on the use of CPMS; and
        --A series of three Interactive Video Teletraining sessions on the
                use of CPMS were completed in March 2004.
        No specific savings were associated with implementation of CPMS.
    However, the system is an essential element for implementation of the
    electronic folder process at the hearings level and will assist us in
    our plan to achieve an annual productivity improvement of 2 percent.

                          ELECTRONIC SERVICE DELIVERY

        Question. Given the focus SSA has placed on electronic service
    delivery as a means of providing appropriate service to growing
    workloads, how is the agency monitoring electronic service delivery use
    and experience to alter and build its electronic service delivery
    infrastructure in a secure and user-friendly way?
        Answer. E-Government services within SSA are maturing as a service
    delivery alternative to face-to-face contact, mail, and telephone.
    Substantial investments in infrastructure have been made with the
    expectation that electronic services will continue to grow and become a
    viable, efficient channel for the delivery of SSA's services. In fiscal
    year 2004, over 611,000 electronic entitlement and supporting actions,
    i.e., applications, Medicare replacement cards, change of address,
    etc., were processed. This represents an increase of 179 percent over
    the fiscal year 2002 baseline.
        Electronic services are monitored using management information
    data. This data is analyzed to identify usage trends and to determine
    the level of resources required for these workloads. Customer feedback
    using email, surveys and telephone calls are additional ways to monitor
    usage.

    Customer Feedback
      --We have general feedback mechanisms on most web-pages that allow
            customers to send us their comments or complaints via email.
      --Some on-line applications on the SSA web site also allow general
            customer feedback through the use of surveys. In addition, SSA
            has incorporated several American Customer Satisfaction Index
            (ACSI) surveys on its web site. Sponsored by the Department of
            the Treasury's Federal Consulting Group, ACSI surveys use a
            standardized set of questions to measure user satisfaction.
      --SSA's Office of Quality Assurance uses telephone surveys to measure
            customer satisfaction with the Agency's programs, including
            services available from the web site.
      --SSA subscribes to demographic data services that allow us to
            identify who is visiting the SSA site, from where, how long
            they stay, how many pages they visit, etc. This data helps us
            identify both popular and problem pages/services on the web
            site, and to focus marketing of the web site and its services.
        Question. What new electronic services will be supported by the
    fiscal year 2006 budget and how will current services be improved to
    enhance user experience and Agency efficiency?
        Answer. The following services will be supported:
      --SSA's Internet Change of Address application has been enhanced to
            allow access through Knowledge Based Authentication in addition
            to the pin/password access.
      --Speech technology provides citizens with the option to use
            automated telephone applications on the National 800 Number
            Network to access claims, benefits and related programmatic
            information.
      --Last year, we completed speech-enabled automation of the
            transcription process over the National 800 Number Network.
            Prior to this conversion, callers left a message which was
            manually transcribed by SSA employees. Now callers hear a
            message confirming that their request was received and is being
            processed. If the request was not successful, the caller is
            directed to an agent for assistance.
      --SSA's Electronic Wage Reporting initiative encourages employers to
            report their employees' wages electronically rather than via
            paper, magnetic tape or diskettes/CD ROMs. SSA offers online
            assistance and staffs an Employer 800 Number to provide
            information and technical support to employers. At least 70
            percent of all W-2s will be filed electronically in fiscal year
            2006, resulting in WY savings for the Agency and in more
            accurate, timely postings to the Master Earnings File.
      --The Electronic Special Redetermination Mailer is an approved
            project in the Agency IT Systems Plan fiscal year 2005-2006.
            Under this project, High Error Profile (HEP) redeterminations
            will be processed using a new, expanded redetermination mailer
            that will be scanned in the Office of Earnings Operations
            (OEO). Mailer responses will be extracted electronically and
            compared to the Supplemental Security Record, and decision
            logic will be applied which clears cases or refers them for
            manual review/exception resolution in OEO or the Field Offices.
            Testing of the electronic special mailer is planned for April
            2006 with implementation by October 2006.
      --Social Security Number Verification Service (SSNVS) was recently
            approved by OMB. SSA plans to begin implementation in June
            2005, with full nationwide implementation in October 2005.
            Employers who previously called the Employer 800 Number to
            verify employee SSNs will be able to obtain that confirmation
            via the Internet, instead. SSA plans extensive marketing of
            electronic SSNVS, which is expected to reduce SSN verification
            calls to the Employer 800 Number, verifications requested by
            tape/diskette, and the processing of paper listings.
      --Electronic Freedom of Information Act (EFOIA) is expected to expand
            the use of the Internet to provide faster and better access to
            Government services and Information. The EFOIA system will
            employ technology that will automate SSA's internal FOIA
            processes to substantially reduce the FOIA processing time and
            allow us to respond to citizens within the legally required 20-
            day timeframe. The new system will accept electronic credit
            card payments and respond to requests via aggressive use of the
            Internet. EFOIA is expected to reduce the OEO unit time for
            FOIA actions by 20 percent effective with fiscal year 2006.
      --The Microfilm/Microfiche Replacement Project was approved by the
            Information Technology Advisory Board in fiscal year 2004 after
            evaluation of Proof of Concept (POC) results. The processes SSA
            has used to produce, store, and access microfilm/fiche data
            have been among its most labor-intensive and costly.
            Microfilming technology is outdated and increasingly difficult
            to maintain. Online access by Operations employees from their
            workstations will enable SSA to process related workloads on a
            timely basis and ensure both the availability and integrity of
            SSA's databases. Based on POC results, the unit time required
            for employees in the PSCs, ODIO and OEO to access data will
            decrease from an average of 12 minutes to an average of 2
            minutes.
      --W-2C Online will continue to decrease the volume of W-2 corrections
            received in OEO for manual processing (examination, data entry/
            balancing, microfilming, etc.).
      --As part of the e-Authentication initiative of the Presidential E-
            Government Initiatives, SSA has signed a Memorandum of
            Understanding with GSA to implement the federated
            authentication architecture with several SSA applications
            through fiscal year 2006. The federated authentication
            architecture will allow SSA to use the authentication of an
            online customer by a trusted partner (e.g., a financial
            institution whose authentication process has been certified by
            GSA) to conduct business online. The federated authentication
            architecture offers the potential for millions of online
            customers of banks and other financial institutions to use
            their existing pin/passwords to gain secure access to SSA
            electronic applications, improving and simplifying user access
            to our electronic applications without SSA (or any other
            government agency) having to establish or maintain pin/
            passwords.
      --Development of the electronic folder to replace the paper
            disability folder will continue with processes to speed the
            request and retrieval of electronic evidence from medical,
            educational, and other third parties.
      --SSA is studying ways to enhance the claims process to incorporate
            secure messaging with claimants as an alternative communication
            approach to the more-expensive telephone and in-person
            channels.
        Question. What specific activities are supported in the fiscal year
    2006 budget to promote the use of electronic services to employers,
    covered workers and current recipients/beneficiaries?
        Answer. Through our network of field office managers and Public
    Affairs Specialists, we conduct ongoing outreach to raise awareness of
    online services and to encourage their use. Each year, working in their
    local communities, these professionals deliver speeches, submit
    newspaper articles, conduct workshops, lead seminars, and conduct radio
    and television interviews on all aspects of Social Security's programs,
    including the benefits of doing business with us online. We include
    information about our online services in all our Social Security
    publications, including the Social Security Statement, which we send to
    all workers age 25 and older.
        We also use a variety of other tools tailored to specific target
    audiences, as follows:

    General Public
      --An Online Services Marketing Kit, which includes:
        --A Fact Sheet (also available in Spanish);
        --Links to Special Places, a one-page handout that lists webpages
                such as the Glossary, the Immigration page, Most Popular
                Baby Names--items that draw people of all ages and
                ethnicities to the site;
        --A tri-fold leaflet, Apply Online for Social Security Benefits,
                that answers questions about our online retirement
                application;
        --A one-page ``URL Handout'' that provides addresses for the online
                retirement application, the Social Security Statement page,
                the Benefit Planners and Social Security card information;
                and
        --An Internet bookmark
      --800 Number on-hold messages promoting online services
      --Partnerships with local libraries to distribute Social Security
            Online bookmarks and conduct educational seminars

    Third Parties With Clients Applying for Disability Benefits
      --PowerPoint overview of the i3368PRO (Internet Adult Disability and
            Work History Report)
      --Instructional CD containing examples of the i3368PRO online
            application screens
      --``eColleague letters'' (email messages that formerly were paper-
            based ``Dear Colleague'' letters) to national organizations
            (advocates, attorneys, social service agencies, etc.)
      --Webpage www.socialsecurity.gov/i3368prohelp that provides
            background information, helpful tips, etc.

    Covered workers
      --Cost-of-Living Adjustment (COLA) notices sent to all beneficiaries
            in January each year inviting them to visit
            www.socialsecurity.gov
      --Panel on homepage promoting online retirement application
      --Door signs that show office hours and encourage visitors to do
            business online
      --Posters, tent cards, leaflets
      --PowerPoint presentations
      --PowerPoint overview of the i3368 (Internet Adult Disability and
            Work History Report)
      --Instructional CD containing examples of the online application
            screens
      --Draft redesign of Baby Names page to promote online retirement
            planners and calculators
      --800 Number on-hold messages promoting online services

    Current recipients/beneficiaries
      --Change of Address:
        --Articles for local news outlets, organizations' house organs,
                etc.
        --Correspondence with people who wrote to the Commissioner, the
                Congress, or the White House
        --Fact Sheet
        --Partnership with USPS to place a link to SSA from their homepage
      --Direct Deposit:
        --Partner with Fidelity to allow their online customers to set up
                direct deposit of their Social Security benefits into an
                eligible account
      --800 Number on-hold messages promoting all online services

    Employers
      --Articles in SSA/IRS Reporter
      --Electronic Wage Reporting CD
      --Posters, pamphlets, fact sheets
      --Inserts for inclusion in IRS correspondence with employers
      --Seminars at national conferences, such as the IRS Tax Forums the
            American Payroll Association and the National Restaurant
            Association to promote online wage reporting and filing for
            retirement online
      --Partnerships with Chambers of Commerce across the country to
            encourage small business owners to file their wage reports
            online
      --Partnerships with Human Resource Managers including the Society of
            Human Resource Managers to encourage their employees to file
            for retirement online
      --CD for Human Resource Managers promoting online retirement and
            providing useful tips
      --Screen calendars (calendar strips that people affix to their
            computer monitors)
      --Survey of non-electronic filers to identify (and help us overcome)
            barriers to online wage reporting
      --Website covering all aspects of online wage reporting
      --Toll-free call center specifically for employers with wage
            reporting issues
      --W2News e-mail specifically for employers discussing wage reporting
            issues
        Question. How much savings does SSA expect through its electronic
    service delivery initiative in fiscal year 2005 and over the period
    fiscal year 2004-fiscal year 2007?
        Answer. Although savings have not been specifically identified for
    most of these initiatives, we expect that the efficiencies gained
    through implementation and expansion of these efforts will be an
    essential element in our ability to reach a goal of a 2 percent annual
    improvement in productivity.

                     BI-PARTISAN SOLVENCY EDUCATION PROGRAM

        Question. Please provide the Subcommittee with additional
    information related to the proposed bi-partisan solvency education
    program. What resources are requested within the fiscal year 2006
    budget for these activities? How does this planned level of expenditure
    compare with fiscal years 1999-2004?
        Answer. Among the many services provided by the Social Security
    Administration is educating the American public about the programs and
    finances of Social Security. One of the stated objectives in our Agency
    Strategic Plan is: ``Through education and research efforts, support
    reforms to ensure sustainable solvency and more responsive retirement
    and disability programs.'' No specific amount was included in SSA's
    fiscal year 2006 budget request for solvency education. As in prior
    years, this effort is part of the ongoing educational program conducted
    by SSA to educate the public about the Social Security program,
    including the financing challenges facing them, through our ongoing
    communication efforts. As the national discussion continues on how best
    to strengthen Social Security for the future, we will work to continue
    to ensure that policymakers and the public have the information needed
    to assess the implications of all proposals under consideration.
        Messages about the current status of the Trust Funds, as described
    in the Annual Report of the Board of Trustees of the Federal Old-Age
    and Survivors Insurance and Disability Insurance Trust Funds are
    included in a number of our public information resources, including:
      --On our website--www.socialsecurity.gov;
      --In our publications--``The Future of Social Security'' and
            ``Understanding The Benefits'' pamphlets;
      --In the annual Social Security Statement mailed to all workers age
            25 and older not currently receiving benefits; and
      --When appropriate, as part of the presentation by our Agency
            communicators when speaking to groups and organizations.

                            SOCIAL SECURITY EARNINGS

        Question. Each year approximately nine million wage records cannot
    be reconciled due to a mismatch associated with the name or Social
    Security Number of a person. According to the Inspector General of the
    Social Security Administration, as of July 2002, the Earnings Suspense
    File contained 236 million wage items totaling roughly $374 billion. Of
    these amounts, roughly 80 million items worth $13 billion are more than
    30 years old. What activities are proposed in the fiscal year 2006
    budget to update the records of wage earners whose current or future
    social security benefits would be lower than provided under current law
    due to processing mismatches? What steps are being taken to ensure that
    earnings are posted to the correct social security number upon initial
    submission and how does the fiscal year 2006 budget support these
    actions?
        Answer. In fiscal year 2003, SSA began developing new matching
    software to associate earnings items in the Earnings Suspense File
    (ESF) with the correct individual master earnings file. The new
    routines use data housed on the ESF, enumeration records, benefit
    records and earnings records to confirm that the correct earnings
    records were identified. In fiscal year 2003 and 2004, SSA removed
    about 10 million items from the ESF and posted them to the correct
    earnings records for tax years 1937 through 2000. In fiscal year 2005,
    we are continuing to expand our new software and are focusing on tax
    year 2001. The improvements will also be used to remove additional ESF
    items for years prior to 2001.
        To prevent future earnings from going into the ESF, SSA works with
    employers to provide tools to allow them to determine if they have a
    name/Social Security number (SSN) mismatch on their payroll records
    prior to sending W-2s to SSA for processing. SSA provides a free
    Employee Verification Service where an employer can verify if a name
    and SSN match. SSA has piloted an Internet-based version of this
    service, the Social Security Number Verification Service (SSNVS). SSA
    anticipates offering this free Internet-based service to all employers.
        SSNVS allows an employer to verify up to ten names/SSNs at a time
    with SSA over the Internet while receiving a response within seconds.
    In addition, an employer may submit a file over the Internet of up to
    250,000 names/SSNs and receive a response on the next business day.

                  LEGISLATIVE PROPOSAL--SSI DISABILITY CLAIMS

        Question. The fiscal year 2006 budget request includes a
    legislative proposal that would require SSA to review at least 50
    percent of favorable decisions for adult SSI disability claims before
    starting payments. What are the administrative costs of this proposal
    in fiscal year 2006, and are these costs requested within the LAE
    account? What are the anticipated programmatic savings from this
    proposal?
        Answer. Under current law, SSA reviews at least 50 percent of all
    Title II initial disability allowances made by State agencies on behalf
    of SSA. The budget proposal would apply the same requirement for adult
    disability allowances in the SSI program. When fully phased in, 50
    percent of initial SSI disability allowances would be reviewed.
        The administrative costs in fiscal year 2006 are estimated to be
    about 45 workyears and $6 million which would be absorbed under the LAE
    account if the legislation is enacted.
        The estimated program savings to general revenues of the
    preeffectuation proposal in the budget are about $493 million over 10
    years in the SSI program alone. Additional Medicaid savings from the
    proposal over 10 years are estimated to be about $639 million.

                         SOCIAL SECURITY PROTECTION ACT

        Question. According to the ``Justification of Estimates for
    Appropriations Committees'' for the fiscal year 2006 budget request,
    the LAE account includes resources needed to implement the Social
    Security Protection Act. How much funding is required to implement each
    activity required by the Act?
        Answer. There are fifty-one sections of the SSPA enacted March 2,
    2004. The fiscal year 2006 administrative budget includes $14.7
    million, and 211 workyears (WYs), to fund the following provisions:
      --Expanding numbers of onsite representative payee reviews the Agency
            will need to conduct under Section 102(b).
      --Processing suspensions of Title II benefits to persons fleeing
            prosecution, custody, or confinement, and/or those violating
            probation or parole as provided in Section 203. This section
            extends fugitive felon provisions currently applied to Title
            XVI beneficiaries to Title II beneficiaries.
      --Issuing receipts to acknowledge submission of reports of changes in
            work or earnings status of disabled beneficiaries as provided
            in Section 202.
        The SSPA also authorizes attorney fees to be paid directly out of
    individuals' retroactive SSI benefits to the same extent and under the
    same processes as currently are in place for deducting attorney fees
    from retroactive OASDI benefits (Section 302). Additionally, it
    requires SSA to test the impact of establishing a fee payment process
    for non-attorney representatives that is similar to the current one for
    attorneys (Section 303).

                           RAILROAD RETIREMENT BOARD

              Prepared Statement of Michael S. Schwartz, Chairman

        Mr. Chairman and Members of the Committee: We are pleased to
    present the following information to support the Railroad Retirement
    Board's (RRB) fiscal year 2006 budget request.
        The RRB administers comprehensive retirement/survivor and
    unemployment/sickness insurance benefit programs for railroad workers
    and their families under the Railroad Retirement and Railroad
    Unemployment Insurance Acts. The RRB also has administrative
    responsibilities under the Social Security Act for certain benefit
    payments and Medicare coverage for railroad workers. During fiscal year
    2004, the RRB paid $9 billion in retirement/survivor benefits to about
    649,000 beneficiaries, and $83 million in unemployment/sickness
    insurance benefits to about 34,000 claimants.
        We are respectfully requesting a total agency budget of
    $103,398,240 in fiscal year 2006. This total includes $102,543,040 for
    ongoing agency operations, which is the same as the amount included in
    the President's proposed budget for the year. In addition, we are
    requesting $855,200 for critical elements of the RRB's Enterprise
    Architecture Capital Asset Plan.

                         ADMINISTRATIVE FUNDING ISSUES

        The President's proposed budget would provide the same level of
    funding for the RRB's administrative expenses in fiscal year 2006 as
    the amount appropriated for fiscal year 2005. To operate at this level,
    RRB staffing has been significantly reduced. Early this fiscal year, 77
    employees were separated from the agency through a program of voluntary
    separation incentives, and since that time, new hiring has been
    severely restricted. The agency's funded staffing level for fiscal year
    2005 is currently 76 full-time equivalent staff years (about 7.3
    percent) lower than fiscal year 2004.
        Continuation of the same funding level from fiscal year 2005 to
    2006 would effectively require the RRB to absorb all fiscal year 2006
    cost increases for the goods and services required to administer the
    railroad retirement/survivor and unemployment/sickness insurance
    benefit programs. These rising costs include the January 2006 pay
    increase for the agency's employees, which would total approximately
    $1.61 million at the currently estimated rate of 2.6 percent.
        Under current law, the cost increases would require further cuts in
    agency staffing, because nearly 80 percent of the RRB's budget is used
    for employees' salaries and benefits. We estimate that the President's
    proposed budget would provide sufficient funding for a staffing level
    of 931 FTE's, which is 41 FTE's less than we expect to use in fiscal
    year 2005. In order to reach this level, we would need to conduct a
    reduction-in-force of about 18 employees at an estimated cost of
    $233,000.

                       NONGOVERNMENTAL DISBURSEMENT AGENT

        The President's proposed budget assumes that the RRB will contract
    with a nongovernmental agent for disbursement services, as provided
    under Section 107(e) of the Railroad Retirement and Survivors'
    Improvement Act of 2001 (Public Law 107-90). However, initial market
    research has indicated that the cost of doing so would be about three
    times the cost of having similar services provided by the Department of
    the Treasury. In addition, our Inspector General has questioned whether
    certain services provided by the Department of the Treasury, such as
    reclamations, would be provided as effectively by a nongovernmental
    disbursement agent.
        We have concluded that outsourcing this function would be
    inconsistent with the President's policy of outsourcing only where the
    government would save costs. For fiscal year 2005, the Congress added
    language to our appropriations bill prohibiting this transfer: Section
    516 of the Departments of Labor, Health and Human Services, and
    Education, and Related Agencies Appropriations Act, 2005 provides that
    none of the funds appropriated under the Act are to be used to contract
    with a nongovernmental disbursement agent. The RRB also submitted
    separate legislation to address this issue during the previous
    Congress, and we plan to again submit legislation on the subject during
    this Congress.
        Current estimates indicate that the cost of contracting with a
    nongovernmental disbursement agent would be in excess of $3 million for
    the first year and $2.3 million in subsequent years. By comparison, the
    annual cost of having these services provided by the Department of the
    Treasury is about $800,000. Enactment of legislation to remove this
    requirement would provide sufficient savings in fiscal year 2006 to
    enable the RRB to cover essential operating costs at the proposed
    budget level.

                   ENTERPRISE ARCHITECTURE CAPITAL ASSET PLAN

        Our budget request includes funding for a key element of the RRB's
    Enterprise Architecture Capital Asset Plan, which addresses the major
    initiatives needed to implement the agency's target enterprise
    architecture. This request is highlighted separately because of its
    significance to the long-term, continued viability of agency programs,
    and the realization that movement toward the desired target
    architecture will be a multi-year effort involving special funding
    needs. We are requesting an additional $855,200 in fiscal year 2006 to
    continue with an initiative to convert our processing systems to a
    relational database management system.
        Gartner Consulting recommended that we investigate alternatives for
    our Computer Associates' Integrated Database Management System (IDMS)
    and prepare to actively retire the platform beyond 2006. The RRB's day-
    to-day operations are heavily dependent on application systems that are
    based on IDMS technology. Delaying the database management system
    conversion would create a high risk of loss for these systems, which
    would compromise the agency's ability to pay benefits and fulfill its
    mission in the future. For this reason, we have already begun project
    development for this initiative. We are currently developing
    specifications for contractual assistance, and we expect to release a
    request for proposals later in fiscal year 2005. Preliminary estimates
    indicate that a full conversion might be accomplished within 12 to 18
    months, although our schedule will depend on the availability of
    resources.
        In addition to the requests for administrative expenses, the
    Administration's budget includes $97 million to fund the continuing
    phase-out of vested dual benefits, and $150,000 for interest related to
    uncashed railroad retirement checks.

                      FINANCIAL STATUS OF THE TRUST FUNDS

        Railroad Retirement Accounts.--The RRB continues to coordinate its
    activities with the National Railroad Retirement Investment Trust
    (NRRIT), which was established by the Railroad Retirement and
    Survivors' Improvement Act of 2001 to manage and invest railroad
    retirement assets. The RRB transferred $586 million to the NRRIT in
    fiscal year 2004. This amount is in addition to the $19.188 billion and
    $1.502 billion transferred in fiscal years 2003 and 2002, respectively.
    In fiscal year 2004, the NRRIT transferred $1.564 billion to the RRB
    for the payment of tier 2 benefits.
        In June 2004, we released the annual report on the railroad
    retirement system required by Section 22 of the Railroad Retirement Act
    of 1974, and Section 502 of the Railroad Retirement Solvency Act of
    1983. The report, which reflects changes in benefit and financing
    provisions under the Railroad Retirement and Survivors' Improvement Act
    of 2001, addresses the 25-year period 2004-2028 and contains generally
    favorable information concerning railroad retirement financing. The
    report included projections of the status of the retirement trust funds
    under three employment assumptions. These indicated cash flow problems
    only under a pessimistic employment assumption, and then not until
    calendar year 2026. This is 4 years later than in the previous year's
    report.
        Railroad Unemployment Insurance Accounts.--The equity balance of
    the railroad unemployment insurance accounts at the end of fiscal year
    2004 was $87.5 million, an increase of $36 million from the previous
    year. The RRB's latest annual report on the financial status of the
    railroad unemployment insurance system, issued in June 2004, was
    generally favorable. The report indicated that even as maximum daily
    benefit rates rise 35 percent (from $55 to $74) from 2003 to 2014,
    experience-based contribution rates are expected to keep the
    unemployment insurance system solvent. No loans are anticipated even
    under our most pessimistic assumption. The average employer
    contribution rate remains well below the maximum throughout the
    projection period, but a 1.5 percent surcharge is now in effect and is
    expected for calendar year 2006 and probably 2007. We did not recommend
    any financing changes based on this report.
        In conclusion, we want to stress the RRB's continuing commitment to
    improving our operations and providing quality service to our
    beneficiaries. We recognize that fiscal year 2006 will be a tight
    budget year throughout the Federal government, and our budget request
    reflects our continued commitment to contain the RRB's administrative
    costs accordingly. Thank you for your consideration of our budget
    request. We will be happy to provide further information in response to
    any questions you may have.
                                     ______

           Prepared Statement of Martin J. Dickman, Inspector General

        Mr. Chairman and Members of the Subcommittee: My name is Martin J.
    Dickman, Inspector General of the Railroad Retirement Board (RRB). I
    would like to thank you, Mr. Chairman, and the members of the committee
    for your continued support for the Office of Inspector General. I wish
    to describe our fiscal year 2006 appropriations request and our planned
    activities.
        The Office of Inspector General requests funding of $7,195,968 to
    ensure the continuation of its independent oversight of the RRB. The
    agency is responsible for managing benefit programs which paid $9
    billion in retirement and survivor benefits to approximately 649,000
    beneficiaries in fiscal year 2004 and an additional $83 million in net
    railroad unemployment and sickness insurance benefits to 32,000
    claimants. The RRB also administers Medicare Part B, the physician
    services aspect of the Medicare program, for qualified railroad
    retirement beneficiaries. Through this program, approximately $923
    million in annual Medicare benefits are paid to approximately 551,000
    beneficiaries.
        In fiscal year 2005, the Office of Inspector General will continue
    to concentrate its efforts on the performance of reviews of significant
    policy issues and program operational areas. We will coordinate our
    efforts with agency management to identify and eliminate operational
    weaknesses. We will also continue our investigation of allegations of
    fraud, waste and abuse, and refer cases for prosecution and monetary
    recovery action.
        We also request the removal of the prohibition on the use of
    appropriated funds for any audit, investigation or review of the
    Railroad Medicare program. The RRB manages a nationwide contract for
    processing Medicare Part B claims for railroad beneficiaries. The
    agency is responsible for the enrollment of beneficiaries, premium
    collection, answering beneficiary inquiries and conducting the annual
    Carrier Performance Evaluation for the Medicare carrier.
        The prohibition does not permit the OIG to fulfill its statutory
    oversight responsibilities for a major agency program. The prohibition
    is contrary to Federal government priorities to reduce fraud in one of
    the largest Federal programs.
        We also request oversight authority to conduct audits and
    investigations of the National Railroad Retirement Investment Trust
    (NRRIT), the body responsible for the investment of approximately $27
    billion in trust funds used to support Railroad Retirement Act benefit
    programs. This office would ensure sufficient reporting mechanisms are
    in place and assess if the NRRIT members are fulfilling their fiduciary
    responsibilities. We have repeatedly expressed concerns about RRB
    management's passive relationship with the NRRIT, and identified the
    issue as a serious challenge for the RRB.
        The OIG currently is required to reimburse the agency for office
    space, equipment, communications, office supplies, maintenance and
    administrative services. We are the only Federal OIG that cannot
    negotiate a service level agreement with its parent agency. We,
    therefore, request that the language in appropriation law be removed.

                                OFFICE OF AUDIT

        Auditors will perform the audit of the RRB's 2005 financial
    statements and preliminary work for the 2006 financial statements to
    ensure the issuance of reliable financial information. The OIG will
    obtain the services of a consulting actuary to audit the statement of
    social insurance.
        Audit staff will work with agency management to ensure detailed and
    verifiable financial information is available from the National
    Railroad Retirement Investment Trust (NRRIT). As discussed above, we
    believe RRB management should take a more active interest in NRRIT
    activities.
        They will conduct the annual evaluation of the RRB's information
    systems security to meet the requirements of the Federal Information
    Security Management Act of 2002. We will also monitor the agency's
    information systems operations to determine if the agency is meeting
    the goals established in its Strategic Information Resources Management
    Plan and to ensure the agency is in compliance with the provisions of
    the Information Technology Management Reform Act.
        Auditors will continue to monitor agency actions to address
    security deficiencies and complete corrective actions. They will ensure
    that network and system security safeguards are in place to protect the
    confidentiality of sensitive financial and personal information.
    Auditors will also perform assessments of the agency's e-government
    initiatives to identify and eliminate system vulnerabilities, and to
    ensure compliance with the E-Government Act of 2002. We will continue
    our monitoring efforts of the RRB's document imaging activities and the
    expansion of paperless processing to ensure the integrity of records.
        Auditors will continue to review RRB benefit processes and
    procedures to identify ways to reduce administrative and adjudicative
    errors. They will offer recommendations to strengthen the agency's debt
    collection program to reduce the outstanding receivables.

                            OFFICE OF INVESTIGATIONS

        The Office of Investigations (OI) identifies, investigates and
    presents cases for prosecution, throughout the United States,
    concerning fraud in RRB benefit programs. In fiscal year 2006, OI will
    continue to focus its resources on the investigation of cases with the
    highest fraud losses. OI currently has approximately 500 active
    investigations involving fraudulent benefit payments and fraudulent
    reporting with fraud losses of approximately $11 million. These cases
    involve all RRB programs that provide sickness and unemployment
    insurance benefits to injured or unemployed workers, retirement
    benefits, and disability benefits for workers who are disabled.
        We will continue our efforts with program managers to address
    weaknesses in agency programs that allow fraudulent activity to occur,
    and will recommend changes to ensure program integrity.
        We will concentrate our resources on cases with the highest fraud
    losses, those related to the RRB's retirement and disability programs
    as well as fraudulent reporting by railroad employers. OI will dedicate
    considerable resources to the investigation of nationwide schemes to
    defraud the RRB disability program. Disability cases currently
    constitute about 40 percent of our investigative caseload. These cases
    involve more complicated schemes and result in the recovery of
    substantial funds for the agency's trust funds.
        In fiscal year 2006, we will continue to use the Department of
    Justice Affirmative Civil Enforcement (ACE) program for those cases
    which do not meet the criminal guidelines of U.S. Attorneys. Through
    this program, we are able to obtain civil judgements and recover trust
    fund monies for the RRB.

                                    SUMMARY

        In fiscal year 2006, the Office of Inspector General will continue
    to focus its resources on the review and improvement of RRB program
    operations and ensuring the integrity of agency trust funds. We will
    also continue to aggressively pursue individuals who engage in
    activities to fraudulently obtain RRB funds.

                           NONDEPARTMENTAL WITNESSES

        [Clerk's note.--The subcommittee was unable to hold
    hearings on nondepartmental witnesses. The statements and
    letters of those submitting written testimony are as follows:]

                              DEPARTMENT OF LABOR

         Prepared Statement of Motivation, Education and Training, Inc.
        Honorable Chairman, Senator Arlen Specter, and Honorable Committee
    Members: It is with sincere appreciation that I convey our gratitude
    for your efforts on behalf of all hard working Americans, and for
    granting us the opportunity to share information about the nation's
    migrant and seasonal agricultural workers and the importance of the
    National Farmworker Jobs Program.
        I am the executive director of Motivation Education & Training,
    Inc. (MET), the authorized National Farmworker Jobs Program (NFJP)
    operator in Louisiana, Minnesota, North Dakota, and Texas, which are
    all funded through Section 167 of the Workforce Investment Act (WIA).
    MET is a community-based organization headquartered near Houston,
    Texas, and has been actively engaged serving low-income populations and
    communities for almost four decades.
        Since the 1960s, the affirmative efforts of both Congress and
    various Presidential Administrations have created and preserved a
    modest, though vital, system to aid farmworkers and their family
    members who seek improved economic prospects through career training
    and stabilization services. As you may know, a typical American
    agricultural worker faces some of the harshest working conditions in
    the United States, and yet their compensation is neither commensurate
    with the risks taken, nor sufficient for the work performed. During the
    most recently completed Program Year, MET served more than 3,000
    migrant and seasonal farmworkers with reported average annual earnings
    of $5,855 per client. Despite this shockingly low income, very few
    farmworkers, only 6.3 percent, seek and receive public assistance,
    preferring instead the path of self-reliance and an extremely meager
    existence.
        Uncertainty, which is inherent in the agricultural economy, ensures
    the perpetuation of a cruel paradox wherein extended periods of
    joblessness due to lack of available work, are interspersed with
    fleeting spikes in labor demand as crops mature or weather conditions
    permit activity in the fields. The long distances that many farmworkers
    and their families travel represents the desperate tradeoff between the
    mere hope of income and the likelihood that any semblance of stability
    can be achieved and maintained. But members of this community face
    severe challenges when seeking to exercise other career options, and
    for many families, reliance on agriculture is passed along from one
    generation to the next, thus ensuring the inheritance of work,
    subsistence, and poverty for decades to come.
        Historically, migrant and seasonal farmworkers have had relatively
    limited access to the public workforce investment system. A number of
    factors have worked in concert to discourage their participation, and
    even in the recently expanded One-Stop network, farmworkers can expect
    little assistance outside of the local systems where NFJP programs
    consistently offer high caliber career development and stabilization
    services. Yet despite both the need for the program and the phenomenal
    performance of the NFJP with respect to all other workforce investment
    programs, the current leadership at the US Department of Labor fails to
    see any value in preserving this most basic form of individual, family,
    and community economic development. Though duly authorized in WIA we
    now face the regular threat of elimination, but MET and our partners
    across the country continue to strive for better employment options for
    farmworkers and increased earnings that can move families out of
    poverty and into progressively higher tiers of economic stability and
    security.
        Within the last year, a series of DOL-sponsored community forums in
    three regions of the country reinforced the necessity of preservation
    of the NFJP. The dialogues brought together local workforce boards,
    local and regional One-Stop partners, state agencies, federal
    stakeholders, and NFJP representatives in a setting that encouraged
    analysis and discussion related to improved One-Stop access for migrant
    and seasonal farmworkers. The forum in Texas that I attended primarily
    served as the central U.S. regional dialogue, and ultimately delivered
    two resounding messages: (1) preservation of the NFJP is crucial if
    farmworker clients can expect any type of appropriate workforce
    investment service; (2) expanded farmworker access to the One-Stop
    system is an improbable, if not impossible, prospect in the absence of
    the NFJP or a substantially similar nationally-administered initiative.
        Workforce board representatives affirmed the necessity of our
    experienced and capable administration of workforce investment services
    for migrant and seasonal farmworkers. Citing the complexity of the
    challenge that farmworker clients represent to the general system's
    core, intensive, and training delivery operations, as well as our
    singular expertise in working with these constituents, boards and other
    key stakeholders candidly expressed their concerns about some of the
    limitations within the evolving One-Stop system. I did not hear one
    dialogue participant state, suggest, or even imply that passing
    responsibility to the states and local boards would do anything except
    dramatically reduce farmworker access to public workforce services.
        A reasonable evaluation of NFJP performance clearly places this
    critical workforce component in the highest echelon of WIA authorized
    partners, achieving better results than programs that receive
    substantially more funds per client, as well as those serving
    populations that are better equipped than farmworkers upon program
    entry to secure sustainable employment. We work hard to place our
    clients in permanent positions that will afford an opportunity for
    consistent long-term upward mobility, and that provide compensation
    packages consistent with the needs of today's families. Few jobs are
    permanent in the strictest sense, and given the nature of the evolving
    global economy, an individual's ability to acquire and retain
    employment is only as promising as that person's capacity to satisfy
    emerging skill demands and their facility in utilizing available
    resources to promote their employment. Without the individual attention
    and highly intensive case management intervention that is available to
    farmworkers only through the NFJP, most of this population would be
    unable to matriculate or complete a workforce development training
    program of the type necessary to secure and retain higher wage and
    higher skill employment.
        Belt-tightening and budget reductions are inevitable considerations
    in light of the current federal revenue shortfall; however, we would do
    immeasurable injustice to a worthy few and an extreme disservice to our
    national character if, in our attempt to reduce expenditures, we place
    a heavier load on the backs of our already overburdened and less
    fortunate citizens. I would respectfully request your favorable
    consideration of full restoration for the NFJP in fiscal year 2006, and
    if that proves altogether too ambitious, at least the maintenance of
    current federal support for this crucial component in the struggle for
    economic self-sufficiency among the poorest of America's workers.
                                     ______

        Prepared Statement of the National Association of Home Builders

        On behalf of the more than 220,000 members of the National
    Association of Home Builders (NAHB), as well as our workforce
    development arm, the Home Builders Institute (HBI), we thank you for
    the opportunity to submit this statement for the record on the
    Responsible Reintegration of Youth Offenders program, and the Prisoner
    Re-entry Program.
        NAHB members are involved in home building, remodeling, multifamily
    construction, property management, subcontracting, design, housing
    finance, building product manufacturing and other aspects of
    residential and light commercial construction. Known as ``the voice of
    the housing industry,'' NAHB is affiliated with more than 800 state and
    local home builder associations around the country. NAHB's builder
    members will construct about 80 percent of the more than 1.6 million
    new housing units projected for 2005, making the housing industry one
    of the largest engines of economic growth in the country, and vital to
    the nation's overall economic growth and prosperity.
        Throughout the past two decades, one of the most pressing problems
    confronting our industry has been a shortage of skilled workers. Record
    numbers in the construction of new homes, retirements and lackluster
    interest in the construction trades by younger generations, compounded
    by insufficient training opportunities for those interested in
    construction, are among the many factors contributing to the shortages.
    According to the Bureau of Labor Statistics, some 240,000 workers are
    needed each year to meet the nation's demand for housing, and they
    anticipate that over 1 million new jobs in the residential construction
    industry will be created in the next decade as builders attempt to keep
    up with demand for affordable housing.

                HOME BUILDERS INSTITUTE (HBI) PROGRAM BACKGROUND

        Each year, the Home Builders Institute (HBI) works through various
    programs to train and place several hundred youth in residential
    construction jobs. Through real-life, hands-on training, some of our
    nation's most at-risk young people, learn a skill, and earn a second
    chance at a productive and successful life and career. Since 1994, HBI
    has focused a significant portion of its effort and resources on one
    particular targeted population, adjudicated youth, through its Project
    CRAFT (Community Restitution Apprenticeship-Focused Training) program.
    Piloted in 1994 through a Department of Labor demonstration grant,
    Project CRAFT is targeted solely to adjudicated youth and youthful
    offenders. This program has successfully combined employers, the
    juvenile justice system, workforce development and other systems, in
    one overall approach, and has since been implemented at 15 sites in ten
    states (Colorado, Ohio, Florida, Maryland, Mississippi, New Jersey,
    North Dakota, South Carolina, Tennessee, and Texas). Funding for HBI's
    implementation of this program in the state of Tennessee has come
    largely through funds provided under the Responsible Reintegration of
    Youth Offenders budget line.
        Project CRAFT incorporates the apprenticeship concept of hands-on
    training and academic instruction, utilizing its Pre-Apprenticeship
    Certificate Training (PACT), numeracy, literacy and employability
    skills curricula. Under the supervision of journey-level trade
    instructors, students learn residential construction skills while
    completing community service construction projects. Nearly 85 percent
    of Project CRAFT graduates achieve success through industry jobs each
    year.
        Since 1994, Project CRAFT has helped more than 2,000 high-risk
    youth, and in addition to offering adjudicated youth trade skills and
    job placement, community service projects by students saved taxpayers
    nearly $400,000 in labor costs in 2003-2004 alone. During 2003-2004,
    Project CRAFT graduates were placed in jobs with an average wage of
    $8.58/hour and graduates performed over 49,000 hours of community
    service as part of their programs. Recidivism rates for Project CRAFT
    have averaged between 10-15 percent, an impressive rate when compared
    to the national average of over 50 percent. Additionally, students in
    the program tend to evidence one grade level of improvement in math and
    language skills attributable largely to the formal education component
    that includes contextual learning. Math and communication skills are
    continually reinforced as students are challenged to apply these skills
    to everyday situations in the field and in the classroom.
        Project CRAFT efforts were recognized by the Department of Labor
    and the National Youth Employment Coalition when in September 2002, the
    program received a PEPNet (Promising and Effective Practices Network)
    Award. We are also grateful to the Senate Subcommittee on Labor, Health
    and Human Services and Education for its acknowledgement of Project
    CRAFT in fiscal year 2005 Report Language, as well as Congress' years
    of dedicated support for the Responsible Reintegration of Youth
    Offenders program.

              RESPONSIBLE REINTEGRATION OF YOUTH OFFENDERS PROGRAM

        NAHB and HBI's encouraging experience with Project CRAFT is an
    example of the enormous success of the Responsible Reintegration of
    Youth Offenders pilot program, and the reason why we very strongly
    support the continuation of funding for a youth-focused program
    targeting adjudicated youth with training that provides this at-risk
    population with important job- and life-skills. The Responsible
    Reintegration of Youth Offenders Program has helped to bring together
    industry and government in a partnership with tangible positive
    outcomes. Since 1994 the program has earned a reputation as a
    worthwhile investment of taxpayer dollars, a significant and important
    resource to the nation's building industry, and a major contributor to
    the future success of thousands of young people. It is a demonstration
    model that works, and as such deserves to be touted and replicated. We
    hope that its proven success and recognition as an effective
    intervention will help enable it to receive continued funding, whether
    through a stand-alone program, or as part of a youth-focused component
    of the Prisoner Re-entry Program.

                           PRISONER RE-ENTRY PROGRAM

        In its fiscal year 2006 budget proposal, the administration
    proposes to fund the Prisoner Re-entry Program through appropriations
    to three federal departments (Department of Labor, $35 million;
    Department of Justice $15 million, Department of Housing and Urban
    Development, $25 million.) We hope this joint funding level will
    provide more opportunities to train the nation's at-risk youth. The
    Prisoner Re-entry Program continues to focus on ``helping individuals
    exiting prison make a successful transition to community life and long-
    term employment'' through programs to help ex-offenders find and keep
    employment, obtain housing, and take advantage of mentoring programs.
        NAHB and HBI support the goals of the Prisoner Re-entry program,
    and agree that there is enormous potential for successful programming
    targeting ex-offenders. NAHB and HBI continue to believe that an
    important targeted community within the Prisoner Re-entry program must
    be adjudicated juveniles and we support extending Prisoner Re-entry
    program eligibility to adjudicated juveniles and youthful offenders
    ages 16-24, in addition to other age groups served by the program. We
    have found that these young people in particular are energetic,
    interested and engaged in learning the skills taught through our
    Project CRAFT program. We believe that any funding targeted to training
    those who are re-entering society must include a component targeted to
    the youth offender population.
        As we have stated, the Prisoner Re-entry program has significant
    potential for helping the adult offender community receive important
    training and job skills. And we believe that HBI is well-positioned to
    participate in an adult-focused program through its Project TRADE
    (Training, Restitution, Apprenticeship, Development and Education)
    program--which is the sister program to the youth-focused Project
    CRAFT. Designed to train and place adult offenders in employment in the
    home building industry, TRADE is currently being implemented in
    Colorado Springs and Sheridan, Ill. Project TRADE has trained over 500
    adult offenders in the residential construction trade since 1995
    through programs in Maryland, North Carolina, North Dakota, Oregon,
    Pennsylvania, Washington, Tennessee, Colorado and Illinois. We believe
    that Project TRADE's emphasis on adults complements the work done by
    Project CRAFT with younger offenders.

                                   CONCLUSION

        NAHB and HBI continue to strongly support the goals of the
    Responsible Reintegration of Youth Offenders program. We also support
    the Department of Labor's interest in targeting a program to ex-
    offenders and adjudicated individuals through the Prisoner Re-entry
    program, and we very strongly support the inclusion of youth offenders
    and adjudicated juveniles in this initiative.
        We believe that the Responsible Reintegration of Youth Offenders
    demonstration program has been highly successful, as evidenced by our
    own accomplishments with Project CRAFT. We fervently hope that any
    proposal supported by congressional appropriators will take into
    account the needs of both the youth and adult ex-offender populations,
    and will clearly lay out congressional intent to continue serving the
    youth ex-offender population.
        Again, we thank the subcommittee for this opportunity to share our
    views on the Responsible Reintegration of Youth Offenders program, and
    Prisoner Re-entry Initiative. We look forward to working with you to
    promote training programs that help America's at-risk youth acquire the
    skills they need for successful and productive careers in the home
    building industry.
                                     ______

       Prepared Statement of the National Coalition for Homeless Veterans

                                  INTRODUCTION

        The National Coalition for Homeless Veterans appreciates the
    opportunity to submit recommendations on fiscal year 2006
    appropriations for and program management issues related to the U.S.
    Department of Labor (DOL).
        The National Coalition for Homeless Veterans (NCHV), established in
    1990, is a nonprofit organization with the mission of ending
    homelessness among veterans by shaping public policy, promoting
    collaboration, and building the capacity of service providers. NCHV's
    nearly 250 member organizations in 46 states and the District of
    Columbia provide housing and supportive services to homeless veterans
    and their families, such as street outreach, drop-in centers, emergency
    shelter, transitional housing, permanent housing, recuperative care,
    hospice care, food and clothing, primary health care, addiction and
    mental health services, employment supports, educational assistance,
    legal aid and benefit advocacy.
        More than 250,000 veterans are homeless on any given night; more
    than 500,000 experience homelessness over the course of a year.
    Conservatively, one of every three homeless adult males sleeping in a
    doorway, alley, box, car, barn or other location not fit for human
    habitation in our urban, suburban, and rural communities has served our
    nation in the Armed Forces. Homeless veterans are mostly males (2
    percent are females). 54 percent are people of color. The vast majority
    are single, although service providers are reporting an increased
    number of veterans with children seeking their assistance. 45 percent
    have a mental illness. 50 percent have an addiction.
        America's homeless veterans have served in World War II, Korea, the
    Cold War, Vietnam, Grenada, Panama, Lebanon, anti-drug cultivation
    efforts in South America, Afghanistan, and Iraq. 47 percent of homeless
    veterans served during the Vietnam Era. More than 67 percent served our
    nation for at least three years and 33 percent were stationed in a war
    zone.
        Male veterans are twice as likely to become homeless as their non-
    veteran counterparts, and female veterans are about four times as
    likely to become homeless as their non-veteran counterparts. Like their
    non-veteran counterparts, veterans are at high risk of homelessness due
    to extremely low or no income, dismal living conditions in cheap hotels
    or in overcrowded or substandard housing, and lack of access to health
    care. In addition to these shared factors, a large number of at-risk
    veterans live with post traumatic stress disorders and addictions
    acquired during or exacerbated by their military service. In addition,
    their family and social networks are fractured due to lengthy periods
    away from their communities of origin. These problems are directly
    traceable to their experience in military service or to their return to
    civilian society without appropriate transitional supports.
        Contrary to the perceptions that our nation's veterans are well-
    supported, in fact many go without the services they require and are
    eligible to receive. One and a half million veterans have incomes that
    fall below the federal poverty level. Neither the VA, state or county
    departments of veteran affairs, nor community-based and faith-based
    service providers are adequately resourced to respond to these
    veterans' health, housing, and supportive services needs. The VA plays
    only a limited role in providing employment services to veterans,
    administering just one small supported employment program for veterans
    with serious disabilities.
        The U.S. Department of Labor and state and local workforce agencies
    bear primary responsibility for ensuring that veterans are provided
    opportunities to prepare for and obtain productive employment.
    Accordingly, we urge Congress to provide full funding for the programs
    of the Department of Labor Veterans Employment and Training Service
    (VETS) in order to ensure that our nation's workforce services system
    is equipped to fulfill their obligations to our nation's veterans.

        FISCAL YEAR 2006 APPROPRIATION RECOMMENDATION--HOMELESS VETERAN
                             REINTEGRATION PROGRAM

        The Homeless Veterans Reintegration Program (HVRP), within the
    Department of Labor's Veterans Employment and Training Service (VETS),
    provides competitive grants to community-based, faith-based, and public
    organizations to offer outreach, job placement and supportive services
    to homeless veterans. HVRP is the primary employment services program
    accessible by homeless veterans and the only targeted employment
    program for any homeless subpopulation. Homeless veterans have many
    additional barriers to employment than non-homeless veterans due to
    their lack of housing. HVRP grantees remove those barriers through
    specialized supports unavailable through other employment services
    programs. Grantees are able to place HVRP participants into employment
    for $2,100 per placement, a tiny investment for moving a veteran out of
    homelessness, and off of dependency on public programs.
        DOL estimates that 14,750 homeless veterans will be served through
    HVRP at the fiscal year 2005 appropriation level of $21 million. This
    figure represents just three percent of the overall homeless veteran
    population, which the Department of Veterans Affairs estimates numbers
    more than 500,000 over the course of a year. An appropriation at the
    authorized level of $50 million would enable HVRP grantees to reach
    approximately 24,000 homeless veterans.
        Additionally, HVRP is being used as the account to fund a joint
    Department of Labor and Department of Veterans Affairs initiative
    authorized by Congress to assist veterans incarcerated in their reentry
    to the community. This decision essentially adds a new purpose to the
    HVRP program, for which additional funds are needed.
        We urge Congress to appropriate at least $50 million for HVRP in
    fiscal year 2006 Labor-HHS-Education appropriations legislation.

               FUNDING FOR HOMELESS VETERANS REINTEGRATION PROGRAM
                            [In millions of dollars]
    ------------------------------------------------------------------------
                            Fiscal year                             Amount
    ------------------------------------------------------------------------
    2004.......................................................           19
    2005.......................................................         20.8
    2006--Administration.......................................           22
    2006--NCHV.................................................           50
    ------------------------------------------------------------------------

       FISCAL YEAR 2006 APPROPRIATION RECOMMENDATION--VETERANS WORKFORCE
                               INVESTMENT PROGRAM

        The Veterans Workforce Investment Program (VWIP), within the
    Department of Labor's Veterans Employment and Training Service (VETS),
    provides grants to states and community-based, faith-based, and local
    public organizations to offer workforce services targeted to veterans
    with service connected disabilities, with active duty experience in a
    war or campaign, recently separated from the service, or facing
    significant barriers to employment (including homelessness). At least
    80 percent of total VWIP funds are distributed via competition. VETS
    may reserve 20 percent of total VWIP funds for discretionary grants.
    VETS uses these discretionary funds for studies, demonstration
    projects, and additional funding to supplement competitive grants. The
    fiscal year 2005 appropriation for VWIP is $8.5 million.
        Both those agencies that receive VWIP funds and those hoping to
    apply face the problem of resource scarcity. Due to funding
    limitations, agencies and organizations in less than half of states
    receive VWIP funds. The need for the type of targeted assistance that
    VWIP offers is clearly needed by veterans in all states. Additionally,
    caps on the size of grant awards make it difficult for existing
    grantees to recruit and retain staff. This limits program effectiveness
    and the collaborative process. Sadly, the President's fiscal year 2006
    request is a step backward, reversing the one million increase that
    Congress appropriated just last year.
        We urge Congress to appropriate at least $33.5 million for VWIP in
    fiscal year 2006 Labor-HHS-Education appropriations legislation.

                FUNDING FOR VETERANS WORKFORCE INVESTMENT PROGRAM
                            [In millions of dollars]
    ------------------------------------------------------------------------
                            Fiscal year                             Amount
    ------------------------------------------------------------------------
    2004.......................................................          7.5
    2005.......................................................          8.5
    2006--Administration.......................................          7.5
    2006--NCHV.................................................         33.5
    ------------------------------------------------------------------------

                                   CONCLUSION

        NCHV appreciates the opportunity to submit recommendations to
    Congress regarding the resources and activities of the U.S. Department
    of Labor. We look forward to continuing to work with the Appropriations
    Committee in ensuring that our federal government does everything
    within its grasp to prevent and end homelessness among our nation's
    veterans. They have served our nation well. It is beyond time for us to
    repay the debt.
                                     ______

      Prepared Statement of the Opportunities Industrialization Center of
                                   Washington

        Honorable Chairman Specter and members of the Subcommittee:
    Opportunities Industrialization Center of Washington (OIC) has been
    providing employment and training, educational, nutritional and other
    community services in Central Washington for over 34 years. Since July
    of 1999, we have been the U.S. Department of Labor National Farmworker
    Jobs Program (NFJP) grantee for the state of Washington. Agriculture is
    one of Washington State's principal industries; the value of major
    crops alone is approximately $5.5 billion per year.
        Our NFJP program operates six regional offices and three satellite
    offices in central and western Washington. OIC provides a full range of
    core, intensive, training, and related assistance services to eligible
    farmworkers and dependents. From July of 1999 to June of 2004, we
    provided direct services to approximately 3,200 farmworkers, most all
    of whom had substantial barriers to employment. Approximately 41
    percent of our customers had less than an 8th grade education and an
    additional 29 percent had only up to an 11th grade education. Also, 58
    percent of customers were limited English proficient, 79 percent lacked
    significant work history outside of agriculture, 34 percent lacked
    transportation, and 20 percent were single head of household with
    children. Over 80 percent were unemployed at the time they entered our
    program. In light of these obstacles, our staff did an excellent job in
    obtaining year-round employment for approximately 1,200 of our
    customers, which was 114 percent of program goals during this time
    period.
        OIC has been a part of the development of our state's WorkForce
    Development System (the OneStop system) and are partners in each of the
    Workforce Development Councils within the areas that we provide
    services. This includes participation on key committees as the voice of
    the farmworker, as well as out-stationing of staff in each area's
    WorkSource Center. It is our experience that, while our state's
    WorkSource Centers provide quality services overall, they are not yet
    positioned to provide adequate services to the farmworker community.
        Traditionally, farmworkers in our state have been reluctant to go
    to official/bureaucratic settings in order to receive services. This
    holds true for our WorkSource Centers, most of which are housed in what
    were formerly Washington State Employment Security Department Job
    Service Centers, and which continue to be managed by this agency. Most
    WorkSource Centers maintain traditional business hours, Monday through
    Friday from 8:00 a.m. to 5:00 p.m. Moreover, service delivery is
    designed around a self-service methodology and makes extensive use of
    computer-based systems. As a result migrant and seasonal farmworkers
    are prevented from accessing services due to hours of operation. Also,
    people with low levels of literacy and/or limited/non-existent computer
    skills such as our customers cannot make effective use of available
    resources.
        A compounding problem is the lack of resources needed to adequately
    serve customers with substantial barriers to employment. Our state is
    currently working to develop its biennium budget, which currently has a
    $2.1 billion shortfall. Major cutbacks are targeted for most all state
    agencies, including the Employment Security Department which operates
    the WorkSource centers.
        For years, our WorkSource Centers have struggled to maintain
    adequate staffing due to budgetary constraints. With our state's
    current budget crisis, this problem will only worsen. Our NFJP program
    has helped to alleviate this problem by out-stationing staff on a
    regularly scheduled basis in the eight WorkSource Centers and affiliate
    sites. Our bilingual-bicultural staff provides direct services to
    customers and collaborating with our other WorkSource partners in
    serving the universal access needs of our customers in general, and
    farmworkers and agricultural employers in particular.
        The National Farmworker Jobs Program has been a success both
    nationally and within the state of Washington. To our knowledge, there
    are no resources at the federal or state level to fill the void that
    will occur if its funding is reduced or eliminated. Thus, the vital
    services now provided through the NFJP to Washington State's migrant
    and seasonal farmworkers, as well as to our state's WorkSource system,
    will not be replaced.

                            OIC NFJP SUCCESS STORIES

        The following illustrates both the value provided through the
    National Farmworker Jobs Program, and the perseverance and dedication
    of those whom we are entrusted to serve.
        Mrs. P came to Washington State with her family, not knowing anyone
    here or having any family members. Over most of her 17 years of married
    life, Mrs. P had never worked outside the home, while her husband
    provided for their five children (ages range from 3 years to 16 years)
    and her. Things changed dramatically when her husband suffered a severe
    emotional trauma resulting from his involvement in a fatal accident,
    together with other negative incidents. He has since been unable to
    work and is on long-term disability.
        Without a high school education, no driver's license or work
    experience, Mrs. P was only able to work in agriculture. She found her
    way to our office through the referral of a previous participant.
    Following assessment, an Individual Employment Plan was developed with
    Mrs. P to help her move out of the fields and into a good job that paid
    a livable wage. Mrs. P began work experience training in our Mount
    Vernon office as an Office Assistant and attended GED classes in the
    evenings. Later that fall she received training in our Office
    Technology course, a class developed specifically for our participants
    to teach them keyboarding, Microsoft office professional programs and
    prepare them for an office occupation (classes are held in the evening
    to accommodate participant such as Mrs. P who have to work during the
    day to support families). Mrs. P was also provided with job search/
    resume assistance that lead to an OJT with Housing Authority of Skagit
    County as a full time General Office Clerk earning $9.28 an hour. Mrs.
    P also worked hard to get her Washington State Driver's License and
    after three attempts she finally realized this goal. Through her
    diligence, and the opportunities provided through our program, Mrs. P
    is now working as a Section 8 Specialist earning $11.15 an hour with
    Housing Authority of Skagit County.
        Prior to coming to our program, Ms. A. was, in her words, ``On the
    road to nowhere.'' Abused as a child, she attempted suicide at 11 and
    ran away from home at the age of 13. When she found her way to our
    Wenatchee office, she was unemployed and without any funds to support
    her 16 year old son and herself. Her only meaningful employment was 20
    years spent working in the orchards since she was 13. As might be
    expected, she never attended high school, and her prospects for full-
    time employment were bleak.
        Staff met with Ms. A to perform an assessment to address her
    immediate needs; identify her skills, interests, and goals; and put
    together a plan to meet those goals. Ms. A focused on two goals that
    had always eluded her: to earn her GED and obtain a permanent job
    through which she could support her son.
        Staff immediately provided Ms. A with emergency services for food
    and shelter to stabilize her situation. They then enrolled her into an
    evening High School Equivalency program to provide the instruction and
    tutoring she needed to work towards her GED. Also, a work experience
    placement was developed to help her develop essential job-related
    skills, while also providing income to her household. Staff also
    provided Ms. A with ongoing counseling and support to help her attain
    success.
        Through her hard work, Ms. A felt the pride of having her son watch
    as she received her GED in a gradation ceremony with 22 other
    farmworkers. She also realized her employment goal when she became a
    full-time receptionist and assistant to the housing director for the
    Wenatchee Women's Resource Center. In all, staff worked with Ms. A for
    approximately one year to assist her in moving back onto a ``road to
    somewhere.''
                                     ______

         Prepared Statement of the National Job Corps Association, Inc.

        On behalf of the National Job Corps Association (NJCA) we want to
    thank the Labor, Health and Human Services and Education Appropriations
    Subcommittee for its dedication to Job Corps and our country's most
    vulnerable youth. For 40 years, Job Corps has consistently demonstrated
    its relevance and positive results for employers and youth. The
    program's supporters represent a bipartisan and broad coalition of
    congressional leaders; employers and community organizations; and other
    key decision-makers. They all agree that Job Corps has adapted to
    America's economic changes by listening to local and national
    businesses. In turn, Job Corps has partnered with high demand, high
    growth businesses to develop innovative solutions to meet their
    workforce needs and find life-long careers for America's most
    economically disadvantaged youth.
        We appreciate the Committee's strong support for the Job Corps
    program and urge you to provide Job Corps with $1.6 billion in the
    fiscal year 2006 appropriations process. The NJCA is deeply concerned
    that President's budget request does not go far enough to efficiently
    maintain the effective job training and educational services and the
    requisite infrastructure necessary to serve Job Corps' estimated 68,000
    students entering the 21st century workforce. While we encourage
    spending restraint by the United States Government, we also believe it
    is imperative to provide adequate funding to programs with proven
    positive results. We believe the work that Job Corps accomplishes on a
    daily basis goes hand-in-hand with the economic prosperity and security
    of our local communities and our nation.

                              JOB CORPS SUCCESSES

        Job Corps is known as ``America's first choice for a second
    chance'' for a good reason. Job Corps works. Over the past 40 years,
    Job Corps has instilled in more than 2 million youth the skills and
    attitudes they need to become productive, contributing participants of
    the nation's workforce. For a moment, consider some of Job Corps' most
    shining examples and see for yourself why Job Corps is considered one
    of the most successful job training programs in the country.
        Judge Sergio Gutierrez attended the Wolf Creek Job Corps Center
    (Oregon) in 1970 after he decided to drop out of high school to provide
    additional money for his family which was barely making ends meet at
    the time. The self proclaimed introvert proudly recalls how Job Corps
    enabled him to come into his own as a leader of a carpentry crew. After
    graduating from Job Corps, Judge Gutierrez enrolled at Boise State
    University where he received his B.A. in Elementary Education. After
    teaching fifth grade and English as a Second Language for a few years,
    Judge Gutierrez went back to school to earn his Juris Doctor degree
    from the University of California. In 1993, Judge Gutierrez was
    selected to serve as the district judge for the 3rd Judicial District
    of Idaho. In 2002, he earned a higher judicial appointment, this time
    as a member of the Idaho Court of Appeals. Today, Judge Gutierrez takes
    his children to visit Job Corps centers. Judge Gutierrez said, ``I
    wanted them to see where my success began.''
        Jasmine Small, a Licensed Practical Nursing (LPN) graduate from the
    Keystone Job Corps Center (Pennsylvania) graduated from the program and
    went on to pass the Pennsylvania State Board of Nursing Exam. The
    Tobyhanna, Pennsylvania native completed her clinical rotation at the
    Kingston HCR Manor Care facility, and in August 2004 accepted a job on-
    site. Small aspires to be a Registered Nurse (RN) one-day. ``Job Corps
    helped me grow strong and determined to get things done,'' Small said.
    Thanks to employer partners like HCR Manor Care, Small will continue to
    advance her career within the health care field.

                         NJCA FISCAL YEAR 2006 REQUEST

        The NJCA requests a total of $1.6 billion for Job Corps in the
    fiscal year 2006 budget: $1.486 billion for Job Corps' Operational
    account and $115 million in the Construction, Rehabilitation and
    Acquisitions (CRA) account. The NJCA believes that Job Corps merits a
    $54 million increase over the fiscal year 2005 appropriations. This
    increase would provide a modest cost-of-living increase over the fiscal
    year 2005 enacted levels that unfortunately have not been addressed
    over the last two fiscal cycles. The increase would allow Job Corps to
    maintain its existing student services and allotted slots with a full
    inflationary adjustment for the 122 centers, address infrastructure
    rehabilitation needs, continue to eliminate the $350 million backlog of
    repairs, and provide second year funding for incremental expansion of
    Job Corps.

    Operational Funds
        As the nation's largest residential education and job training
    program, Job Corps is designed to serve our nation's at-risk youth who
    might otherwise ``fall between the cracks.'' Job Corps succeeds by
    providing a safe place to learn the literacy, vocational, and
    employability skills youth need to become productive, taxpaying members
    of their community.
        Job Corps' 24-hour-a-day, 7-day-a-week program of individualized
    attention, discipline, and support has produced long-term results that
    save taxpayer dollars. As a residential program, Job Corps operations
    are particularly vulnerable to fixed cost increases, including
    wholesale food, transportation, utilities/energy, and health care. As
    you are aware, the price of gasoline has spiked to all-time highs in
    the last three years; food and beverage costs have increased by 24
    percent over the last ten years; and medical costs and health insurance
    premiums have risen at double-digit rates. These increases are costs
    Job Corps cannot control. While Job Corps has been implementing
    strategies to decrease costs--particularly energy costs--money has to
    be invested in the short-term to save money in the future. We all know
    that investing in our homes increases the property value. Investing in
    Job Corps increases the value of our local economies through an
    increased number of youth--32 percent of Job Corps youth come from
    families on public assistance--becoming well-positioned taxpaying
    members of their communities.
        Job Corps continues to maintain a high placement rate. In fact,
    more than 90 percent of all Job Corps graduates get jobs, enlist in the
    military, or enroll in higher education, making Job Corps America's
    most effective job training programs for economically disadvantaged
    youth.
        In fiscal year 2006 the NJCA requests the Committee provide $1.486
    billion for Job Corps' Operational account. This would allow Job Corps
    to:
      --Maintain existing student services and allotted slots with a full
            cost-of-living increase for the 122 Job Corps centers across
            the country;
      --Continue Job Corps' rigorous 24-hour-a-day, comprehensive
            residential services for approximately 68,000 economically
            disadvantaged youth per year;
      --Provide funding necessary to cover the escalating costs of staff
            salaries, wholesale food, utilities/energy, transportation,
            medical, mental and dental services, and workers compensation
            insurance; and
      --Develop Job Corps pilot and demonstration projects to strengthen
            academic and vocational offerings in high-growth and emerging
            occupations, including but not limited to health care, homeland
            security, and the military.

    Construction, Rehabilitation and Acquisition (CRA) Funds
        With respect to Job Corps' capital account, the NJCA requests $115
    million in fiscal year 2006. These funds would be targeted to: repair
    dorms, classrooms, and other student facilities on existing Job Corps
    centers; replace deteriorated structures, especially those that
    threaten safety and health or violate minimum building codes, including
    mechanical systems; continue to address the estimated $350 million
    backlog in construction and/or repair needs; and provide second year
    funding for incremental Job Corps expansion.
        As you know, Job Corps gives young people the opportunity to focus
    and learn in a safe, stable, and supportive environment. However, the
    average building on a Job Corps center is 46 years-old--20 years older
    than the industry standard. While the program is trying valiantly to
    address the backlog of construction and repair improvements, it needs
    more funding to allow students to learn in an auspicious setting. Over
    the past several years, the Committee has taken a proactive approach to
    provide the program with the funds necessary to maintain Job Corps'
    physical plant. We thank the Committee for its strong support and urge
    Members to continue that support in fiscal year 2006.

    Incremental Expansion
        Within Job Corps' CRA account, the NJCA strongly supports $15
    million for second year funding for the Congressional supported
    incremental expansion of Job Corps. As part of the NJCA's 10-year
    initiative--Job Corps: For the Nation and the Next Generation--to
    strengthen and improve Job Corps, the NJCA supports the Committee's
    past effort to designate centers as ``High-Growth Centers,'' designed
    specifically to address the country's most vital workforce needs. The
    NJCA envisions these ``High-Growth Centers'' providing academic and
    vocational training in the following high growth, high demand
    industries such as: automotive, construction, financial services,
    health professions, hospitality, information technology, homeland
    security, and transportation. In Job Corps' most recent expansion
    process, more than 50 communities across the nation applied for new
    centers in their communities. Since that time, many other communities
    have expressed interest, including Las Vegas; Nevada, Otttumwa, Iowa;
    and the states of New Hampshire and Wyoming, the only states lacking a
    Job Corps center. The NJCA looks forward to working with the Committee
    to continue the incremental expansion of Job Corps.

    Preparing the Workforce for the 21st Century Job Corps: For the Nation
            and the Next Generation
        Increasingly, private and public employers have turned to the Job
    Corps program for qualified entry-level recruits. While they are
    enthusiastic about the employees they hire from the program, they
    commonly express one limitation: the number of trained and employment-
    ready graduates in these fields is too small. Although Job Corps is the
    nation's largest national residential training and education program,
    it currently can accommodate only about 68,000 students per year.
    Hospitals, pharmacies, nursing homes, the U.S. Army and Navy, civilian
    military support contractors, security firms, local police departments,
    and ambulance companies all say that they can hire as many qualified
    applicants as Job Corps can produce. Job Corps has beds, however, for
    only one percent of youth eligible to attend the program.
        To address these demands, the NJCA has developed a decade-long
    initiative, Job Corps: For the Nation and Next Generation, to
    strengthen and expand Job Corps to help meet our nation's needs for
    trained, entry level workers in three areas: health care, homeland
    security, and military preparedness. This Initiative would leverage the
    contributions of private and public sector partners with federal
    appropriations to expand Job Corps' capacity to train entry-level
    employees in these three crucial areas of shortage. The Initiative
    would produce quantifiable results over 10 years: 60,000 graduates in
    health care occupations, 50,000 graduates defending homeland security,
    and 50,000 military personnel. To support this Initiative, the NJCA
    requests dedicated funds beyond the NJCA's $1.6 billion request in the
    following federal programs and/or Departments:

    Addressing the Nation's Health Care Workforce Shortage
        The NJCA requests dedicated funding--$5 million--for the Health
    Resources and Services Administration (HRSA)'s Bureau of Health
    Professions to address the shortage of health care professionals and
    provide access to health care vocational opportunities for many
    disadvantaged young people enrolled in Job Corps. The NJCA strongly
    believes that Job Corps centers are uniquely qualified to utilize HRSA
    grant programs to train students to pursue health careers while
    generating more health care professionals to serve economically
    disadvantaged communities. The NJCA urges that HRSA funds be dedicated
    to Job Corps in two key grant programs: Pathways to Health Professions
    Demonstration Program and Health Careers Adopt-a-School Demonstration
    Program.

    Ensuring Safer Communities for the Nation
        Within the Department of Homeland Security (DHS) and building upon
    language in the fiscal year 2005 Omnibus Appropriations legislation,
    the NJCA requests funds--$2 million--for a pilot demonstration program
    to establish local relationships between the Transportation Security
    Administration (TSA) at three designated Job Corps centers. The pilot
    program would study the needs of airports and attrition rates of
    airport security personnel and the feasibility of utilizing local Job
    Corps centers with security training programs as suppliers of
    qualified, eager-to-work homeland security and airport screener
    employees.
        The NJCA also requests funds--$3 million--from DHS in fiscal year
    2006 budget to develop fully recognized Federal Emergency Management
    Agency (FEMA) training sites at three designated Job Corps centers. The
    partnership between FEMA and Job Corps would include Homeland Security
    and Fire Safety certifications that are currently incorporated into
    existing Safety/Security vocational programs on Job Corps campuses
    across the country.

    Enhancing America's Security and Readiness
        Building upon the mutually beneficial relationships that Job Corps
    has established with the U.S. Army, U.S. Navy, U.S. Coast Guard, and
    U.S. Army and Air National Guard, the NJCA requests $5 million from the
    Department of Defense (DOD) to develop military-endorsed curriculum in
    order to establish six military preparation programs that would
    increase the number of Tier I high quality accessions recruits joining
    the military. These military preparation programs would be incorporated
    within a student's academic and vocational training. By providing these
    funds, Job Corps can significantly supplement the military's efforts to
    address unmet recruiting and retention needs through a 40-year
    successful residential education and training program for disadvantaged
    youth. Curricula would include the critical components valued by the
    military in grooming and advancing recruits to become high quality
    accession enlistments. Preference would be given to Job Corps centers
    located near military installations.

    President's Community College Initiative
        The NJCA requests that a minimum of $10 million of President Bush's
    proposed $250 million fiscal year 2006 Community College Initiative
    (also called the President's Community-Based Job Training Grants) be
    dedicated to community colleges partnerships with Job Corps centers.
    The NJCA requests this modest portion within the U.S. Department of
    Labor's Employment and Training Administration proposed budget be
    designated to: (1) develop strategic partnerships with community
    colleges, business and industry leaders, and Job Corps centers to train
    students in high, growth, high demand industries; and (2) design ``dual
    enrollment'' programs based on reciprocal agreements between Job Corps
    and adjacent community colleges.
        The NJCA strongly believes it is fitting and proper for community
    colleges to work with Job Corps because both parties share the same
    basic goals of providing access and opportunity to disadvantaged
    Americans. Job Corps and community colleges also have the ability to
    partner with employers looking for higher-skilled workers. Numerous Job
    Corps centers have already established working relationships and
    participated with local community colleges to provide advanced career
    training, increased opportunity to pursue occupations in high-growth
    industries, and greater access to industry-recognized certification
    programs.

                                   CONCLUSION

        As Job Corps looks to the future, we hope you agree that it remains
    a federal program that is worthy of America's support. The NJCA looks
    forward to working with members of this Committee to define, expand and
    advance this decade-long effort to tie Job Corps' training more closely
    to our nation's most critical labor needs. Even in these tough
    budgetary times when no federal program can be above scrutiny, Job
    Corps shines through with versatility of purpose and a record of
    success that can help America address its most serious challenges. Job
    Corps remains a beacon of hope for many young Americans and an
    excellent example of our government's role in helping all sectors of
    our society. Thank you for your strong support.
        The NJCA is a professional trade association comprised of business,
    labor, volunteer, advocacy, academic, and community organizations. All
    are joined in supporting the Association's mission ``to unite the Job
    Corps community through activities and services that strengthen the
    program for the benefit of students, staff and employers.''
                                     ______

                Prepared Statement of Rural Opportunities, Inc.

        On behalf of the Migrant and Seasonal Farmworkers in Pennsylvania,
    Rural Opportunities, Inc. (ROI) extends a sincere thank you to the Sub-
    Committee for the opportunity to share our success as the statewide
    grantee funded by the United States Department of Labor under the
    Workforce Investment Act, Section 167--The National Farmworker Jobs
    Program (NFJP).
        In providing services to migrant and seasonal farmworkers, ROI's 27
    years of experience in Pennsylvania has clearly demonstrated that
    farmworkers are a ``special population'' that have unique needs that
    require not only basic skills, English-as-a-Second Language, and job
    training; but, access to services via outreach in rural communities at
    non-traditional hours of service provision where and when One-Stop
    services are virtually non-existent. Further, should these services be
    required, the language requirements to ensure access are often
    unavailable unless a ROI staff person is on site in the One-Stop.
        In painting a personal picture, examples may be that if a
    farmworker were accessing services in Philadelphia County, they may
    speak Khmer. If a farmworker were accessing services in Franklin County
    or Chester County, he/she may speak Creole and Spanish respectively.
    ROI has continuously hired bilingual staff that is culturally sensitive
    and skilled at working with the predominant farmworker population in
    the specific service-provision area; thus, ensuring access.
        With this said ROI has taken its responsibility seriously for the
    stewardship of the federal funds it is awarded by ensuring access to
    effective employment and training programs that not only ensure the
    transferability of skills, but future upward-mobility both within
    agriculture and out. ROI places a high priority on measuring and
    improving the efficiency and effectiveness of our program by collecting
    detailed data on our farmworker program participants through our
    Management Information System, by monitoring program results as they
    pertain to performance standards, and evaluating our net impact.
        ROI has always been a strong training provider. Thus, again, having
    the NFJP Program ``zeroed out'' for funding, when we are a premiere
    program that truly provides training to the hardest-to-serve, is
    unconscionable. Perhaps, one can better understand the impact of the
    NFJP Program through the words of a program graduate. Alfonso Lua, of
    Dunmoyer Trucking, Inc., states, ``When I came to the program several
    years ago, I had nothing. Rural Opportunities helped me get my
    Commercial Driver's License (CDL) and I became a truck driver. Now I
    own 13 rental properties. I am going to make almost $70,000 this year.
    The program is like a ladder you can use to better yourself. If you
    want to have success, you have to educate yourself and learn something
    new. That's why the program is there to help with this. It is an
    alternative to staying where you are''.
        Alfonso Lua was a program participant who had been a farmworker for
    many years; yet, had always dreamed of becoming a truck driver. In the
    typical One-Stop setting, Alfonso may not have been able to access CDL
    Training because of his, then, language limitations. ROI worked hand-
    in-hand with Alfonso translating the parts of the truck from Spanish to
    English to ensure Alfonso clearly understood the translation. Further,
    ROI Staff provided on-site tutoring, ensuring a positive outcome.
    Another program participant, Madelyn Morales, a Department Manager at
    Wal-Mart, Inc. states, ``Thank you to Rural Opportunities, Inc. who
    believed in me and opened possibilities for me to become someone in
    life''. When program participants confront barriers in accessing
    employment that requires specialized training, ROI has the expertise to
    tailor a curriculum to an individual's needs. This is extremely
    important in working with the farmworker population.
        ROI also has taken the initiative, as a NFJP Grantee, to work hand-
    in-hand with agricultural employers who often are overlooked in the
    One-Stop System. ROI has developed cross-training for agricultural
    upgrade taking harvesters into a variety of demand occupations. Without
    the services provided by ROI under the auspices of the NFJP program,
    these particular training services would be inaccessible. The
    significance of this can not be underestimated as an agricultural
    employer representative, Maria C. Serrano, Human Resource & Benefits
    Specialist of Giorgi Mushroom Company, states, ``We at Giorgi Mushroom
    Company have the practice of employee development and we provide
    advancement opportunities to motivate employees. In our harvesting
    department it is often hard to promote within, since they lack the
    skills for advancement. That is where Rural Opportunities, Inc. comes
    in. They help tremendously, companies like ours to help and motivate
    employees to pursue a different position within the company. Their NFJP
    Program allows our employees the opportunity to advance by providing
    the necessary resources to develop new skills, where there is no
    economic drain to the company. Quite the contrary, it helps our
    company. We have enjoyed a very good relationship with ROI in allowing
    us the opportunity so that we can pass this program on to our
    employees. Their programs have helped not only our employees become a
    better people and gain a new position, but also our company as a whole.
    ROI offers remarkable programs that work for both the company and
    employees by giving them the chance. Without these programs, no one
    wins. We strongly agree that ROI Programs benefit both parties
    involved; and we deeply support their efforts.''
        In closing, ROI believes our success speak volumes about the NFJP
    Program's success. We are just one of the NFJP Grantees that the
    Department of Labor's own assessment stipulates do excellent work every
    day. Let us not forget that Migrant and Seasonal Farmworkers already
    bring multiple barriers to the table. Let us not place another barrier
    in their path by eliminating the NFJP Program. We request the Sub-
    Committee recognize the enormous potential of this program by
    maintaining the NFJP Program in the Appropriations for the Department
    of Labor for 2006; thus, ensuring that the services this population so
    desperately needs is funded.
        Thank you for this opportunity to present testimony today.
                                     ______

                    DEPARTMENT OF HEALTH AND HUMAN SERVICES

      Prepared Statement of the Academic Family Medicine Advocacy Alliance

        Mr. Chairman, the Society of Teachers of Family Medicine, the
    Association of Departments of Family Medicine, the Association of
    Family Medicine Residency Directors, and the North American Primary
    Care Research Group, thank you for the opportunity to provide this
    statement for the record on behalf of funding for family medicine
    training, and the Agency for Health Care Research and Quality (AHRQ).

      HEALTH PROFESSIONS: THE PRIMARY CARE MEDICINE AND DENTISTRY CLUSTER

        Mr. Chairman, the Academic Family Medicine Advocacy Alliance would
    like to thank you and this committee for your commitment to these
    programs. We very much appreciate the funding included in the fiscal
    year 2005 appropriations funding bill, especially in light of fiscal
    constraints. Family medicine training programs are funded under Section
    747, the Primary Care Medicine and Dentistry cluster, of Title VII of
    the Public Health Service Act. We ask that you continue your support
    for family medicine training, and restore the appropriations level for
    section 747, the Primary Care Medicine and Dentistry Cluster, to fiscal
    year 2003 levels of $92 million, a small increase of about $3 million.
        This statement is designed to show the committee how its investment
    is paying off. This statement will discuss the success of these
    programs and include recommendations about what still needs to be done.
    As you look at all the opportunities you have to fund domestic health
    programs you need to be able to make judgments about the value and
    utility of these programs. We have been asked in various venues to show
    proof that these funds actually do what they are designed to do. We
    must show that this money makes a difference. In this statement we
    intend to do just that. In addition, we believe Congress also needs to
    understand the unmet needs that exist in our nation--needs health
    professions programs can successfully help address.

    President's Budget Request for Fiscal Year 2006 Once Again Zeros Out
            Primary Care Funding
        The President's budget zeroes out funding for the Primary Care
    Medicine and Dentistry cluster. In addition, the proposal includes only
    $11 million for all Title VII Health Professions programs, a sharp cut
    from current level funding of $308 million.

    Family Medicine Training Programs Are A Success
        First, let's take a look at health professions training--
    specifically family medicine training. These programs are producing the
    outcomes that Congress has requested. A recent study (Family Medicine,
    June 2002), by the Robert Graham Center For Policy Studies showed that
    federal funding through Title VII of family medicine departments,
    predoptoral programs, and faculty development hps made a difference.
    The study measured the differences in career choices made by students
    exposed to Section 747 funds compared to those who were not, both
    within the same school and in different schools. This research found
    that section 747 funding is associated with:
      --54 percent increase in students going into family practice
      --25 percent more into primary care
      --34 percent more into rural underserved counties
        The increased number of family physicians associated with Title VII
    funding between 1978-1993 was found to be about 7,000. If the same
    continued for the next decade, there would be 12,000 additional family
    physicians attributable to Section 747 funding in 2003. We must
    conclude from this data that this funding means that thousands of
    physicians are making different career choices, choices that positively
    affect millions of patients in underserved areas and in primary care.
    Moreover, if this money were to ``go away'' fewer students would be
    making these career choices.

    Funding primary care training programs improves the health of America
        A greater supply of primary care physicians is associated with
    positive health outcomes due to early detection and an increased
    integration of care and oversight. With the associated rise in primary
    care physicians cited above, we can extrapolate from other sources that
    this increase could mean:
      --4,600 cases of colon cancer prevented and 1,400 deaths from colon
            cancer prevented.
      --7,400 cases of cervical cancer prevented and 3,200 deaths from
            cervical cancer prevented.
      --24,000 individuals quit smoking.
      --7,700 additional physicians serving in rural areas and 970
            additional physicians serving in HPSAs.
      --1.2 million deaths prevented.

    Primary care is cost effective
        A study in Health Affairs (April 2004) demonstrates that the
    associated measures in primary care physicans resulting from Title VII,
    section 747 leads to an estimated $320 billion in saved health care
    expenses and 1.2 million lives saved over 26 years. For example, a
    study in the New England Journal of Medicine (Feb. 1996) looked at
    outcomes and costs of people who came to a primary care physician, a
    chiropractor, or an orthopedic surgeon for their back pain. It was
    determined that the patients all had the same outcome regardless of who
    provided care, but the primary care physicians' care cost $194 per
    person less. According to a study in the Journal of Family Practice
    (May 1998) because back pain is so common, a primary care physician can
    expect to see 82 cases per year; therefore, Title VII funds can be
    thought to have had an estimated overall health care cost savings of
    $2.4 billion from back pain alone.

    Loss of funding for family medicine training would cause tremendous
            impact on service to the underserved
        A study by the Robert Graham Center looked at counties designated
    as HPSAs to determine the degree to which the United States relies on
    family physicians in comparison to more other specialty. Of the more
    than three thousand counties in the United States, 784 are designated
    HPSAs. In a hypothetical exercise, the study removed all family
    physicians from the U.S. counties. Without family physicians, there
    would be 1,184 HPSAs--a 43 percent increase.

    Family Physicians Staff the Nation's Community Health Centers (CHCs)
        The President's fiscal year 2006 budget would provide approximately
    $2 billion to CHCs in fiscal year 2006, an increase of $304 million.
    Since nearly one-half of the physicians who staff the nation's CHCs are
    family physicians, support for Section 747 would mean more trained
    doctors for those centers.

    Family Physicians Have an Economic Impact on States
        On average, the income that comes into a community due to the
    presence of one family physician, and the additional jobs that result
    from his or her practice, amounts to approximately:
      --$1.2milllion in rural areas, and,
      --$0.9 million in urban areas.
        (Oklahoma Physician Manpower Training Commission, October 2003.)

    What Is The Unmet Need? Why Must We Continue To Fund And Grow These
            Programs?
        According to a study by Politzer, et al (The Journal of Rural
    Health, Winter,1999) Title VII funding is key to ending HPSAs. This
    funding has led to the time needed for HPSA elimination to decrease to
    15 years. Doubling the funding for these programs would decrease the
    time for HPSA elimination to as little as 6 years.
        According to the study, without this funding, not only would HPSAs
    not be eliminated, but the number of shortage areas would continue to
    grow. Moreover, success has been attained by an allocation of funds
    more favorable to family medicine than the other two primary care
    specialties.
        Title VII funding has indeed accomplished many of the objectives
    for which it was designed:
      --Funding of innovative projects
      --Providing ``seed money'' for the start-up of new projects
      --The creation and maintenance of departments of family medicine in
            the nation's medical schools
      --The development of 3rd year clerkships in family medicine
      --The increase in students selecting primary care residencies from
            those schools with funded family medicine departments and 3rd
            year clerkships
      --The increased rate of graduates from Title VII funded projects
            entering practice in medically underserved areas (MUAs), with a
            resultant reduction in the time required for Health Professions
            Shortage Area (HPSA) elimination

    Section 747 Advisory Committee Recommends Higher Funding
        In 1998, Congress established an Advisory Committee to review and
    make recommendations on Section 747. The Advisory Committee on Training
    in Primary Care Medicine and Dentistry (ACTPCMD) recently released its
    recommendations to Congress and the Secretary of the Department of
    Health and Human Services. The first recommendation urges greatly
    expanding federal support for Section 747 to $198 million. The
    Committee notes the growing need for primary care providers, as well as
    the success of Title VII funded programs.
        The training enterprise that does not value primary care either
    financially or otherwise is a key part of the problem. Title VII funds
    that support the infrastructure and stability of family medicine
    departments in medical schools have to be sustained in order to keep
    producing the current levels of primary care physicians and, more
    specifically, those who will practice in rural and other underserved
    areas. Clearly, the programs of Title VII are on the right track toward
    meeting the health care challenges of the 21st century. So, while we
    believe that current funding must be maintained, more needs to be done.

    Proposed Performance Measures need to be redefined
        The current proposed performance measures are neither measurable
    nor appropriate. Consequently, assessments of effectiveness of the
    programs based on these measures are highly flawed.
        For example, the target set for the proportion of underrepresented
    minorities (URMs) and disadvantaged students in health professions
    funded programs is set at 50 percent for 2005, even though only 12.5
    percent of current medical school graduates are URMs, and data on
    disadvantaged backgrounds is not routinely, or accurately collected.
    The concept of disadvantaged background varies based on income related
    to family size, or is based on a vague--non-quantifiable--notion of
    persons growing up in environments that don't prepare them to enter
    health professions schools.
        In 2000 approximately 12.5 percent of the medical degrees awarded
    in the United States went to underrepresented minorities. For all of
    health professions minority representation has risen from 8.3 percent
    in 1985 to 11.7 percent in 2000. Given this data, it's simply
    unrealistic to expect any program to increase its minority
    representation in one year from 12.5 percent to 25 or 50 percent.

    Primary Care Training Programs React Quickly to Emerging Health
            Challenges
        Title VII dollars have created an infrastructure that allows
    educational programs to respond to contemporary health care issues.
    Specifically, the ACTPCMD report states that:

        ``Investment in education to provide primary care has effects that
    touch the largest number of people in the country. No other group of
    health care providers can exert such a broad influence on the kind and
    quality of health care in the United States. Primary care training
    programs are ideally positioned to react quickly to meet ever-changing
    health care needs and issues, whether they are related to HIV/AIDS,
    growing numbers of elderly with chronic illnesses, implications of the
    modern genetics revolution, the threat of bioterrorism, or other issues
    that will continue to emerge and demand rapid educational intervention.
    Thus, this infrastructure is uniquely able to play a pivotal role in
    bringing emerging issues in health care to the population at large.''

        Mr. Chairman, we know that this committee has to weigh the value of
    funding various programs against each other. We hope that the evidence
    we have presented here will bring the committee to the conclusion that
    funding spent on these programs would bring value for the money and
    would be money exceptionally well spent.

       FUNDING FOR THE AGENCY FOR HEALTH CARE RESEARCH AND QUALITY (AHRQ)

        Mr. Chairman, once again, we thank you and this committee for
    funding this important agency. It is apparent that the key federal
    agency available to fund primary care research is the Agency for
    Healthcare Research and Quality (AHRQ). In its recent reauthorization,
    Congress established within the Agency a Center for Primary Care
    Research to ``serve as the principal source of funding for primary care
    practice research in the Department of Health and Human Services.'' The
    statute defined primary care research as research that ``focuses on the
    first contact when illness or health concerns arise, the diagnosis,
    treatment or referral to specialty care, preventive care, and the
    relationship between the clinician and the patient in the context of
    the family and community.

    Funding Request For AHRQ
        We recommend appropriations of $440 million for the Agency for
    Healthcare Research and Quality (AHRQ) in fiscal year 2005. AHRQ
    conducts primary care and health services research geared to physician
    practices, health plans and policymakers that helps the American
    population as a whole.

    President's Budget Request for fiscal year 2006 AHRQ Funding
        The President's budget includes $316 million for AHRQ, which is the
    same as actual funding for fiscal year 2005. This figure does not
    recognize the $53 million in authorization that Congress provided AHRQ
    in the Medicare Modernization Act to study ``clinical effectiveness and
    appropriateness of specific health services and treatments.''

    What Does AHRQ Do?
        AHRQ's three goals are to (1) improve physician practice and
    Americans' health outcomes, (2) improve the quality of health care
    (e.g., patient safety), and (3) improve the health care system (e.g.,
    increase access and reduce costs). In brief, AHRQ ``helps to improve
    the health and health care of the American people . . .'' (AHRQ report,
    March, 2001).

    How Does AHRQ Meet Its Goals?
        AHRQ translates research findings from basic science entities like
    the National Institutes of Health into information that doctors can use
    every day in their practice with their patients. Another key function
    of the agency is to support research on the conditions that affect most
    Americans.

    AHRQ Translates Research into Everyday Practice
        Congress has provided billions of dollars to the National
    Institutes of Health, which has resulted in important insights in
    preventing and curing major diseases. AHRQ takes this basic science and
    produces information that physicians can use every day in their
    practices. AHRQ also distributes this information throughout the health
    care system. In short, AHRQ is the link between research and the
    patient care that Americans receive. An example of this link is basic
    science research showing that beta blockers reduce mortality. AHRQ
    supported research to help physicians determine which patients with
    heart attacks would benefit from this medication.

    AHRQ Supports Research on Conditions Affecting Most Americans
        Most Americans get their medical care in doctors' offices and
    clinics. However, most medical research comes from the study of
    extremely ill patients in hospitals. AHRQ studies and supports research
    on the types of illness that trouble most people. AHRQ looks at the
    problems that bring people to their doctors every day--not the problems
    that send them to the hospital. For example, AHRQ supported research
    that found older antidepressant drugs are as effective as new
    antidepressant medications in treating depression, a condition that
    affects millions of Americans.

    Institute of Medicine Recommends $1 Billion for AHRQ
        The Institute of Medicine's report, Crossing the Quality Chasm: A
    New Health System for the 21St Century (2001), recommended $1 billion a
    year for AHRQ to ``develop strategies, goals, and actions plans for
    achieving substantial improvements in quality in the next 5 years. ``
    The report looked at redesigning health care delivery in the United
    States. AHRQ is a linchpin in retooling the American health care
    system.
           recommendations for family medicine training and research
        The Academic Family Medicine Advocacy Alliance have two main
    recommendations for the fiscal year 2006 Labor/HHS Appropriations bill.
    They are as follows:
      --We ask that you continue your support for family medicine training,
            and bring the appropriations level for section 747, the Primary
            Care Medicine and Dentistry Cluster, up to fiscal year 2003
            levels of $92 million, a small increase of approximately $3
            million.
      --In order to support critical practice-oriented primary care
            research, and to ensure that existing grants and contracts will
            not be cut, we are asking that the Agency for Healthcare
            Research and Quality be funded at $440 million.
                                     ______

                       Prepared Statement of AIDS Action

        I am pleased to submit this testimony to the members of this
    committee on the importance of adequate funding for the fiscal year
    2006 HIV/AIDS portfolio. The federal government's commitment to funding
    research, prevention, and care and treatment for those living with HIV
    is critical. We would not be where we are today in responding to this
    epidemic without the federal government's 24-year commitment to funding
    HIV programs here at home. AIDS Action is dedicated to working with the
    federal government to make sure it sustains this commitment.
        Since 1984, AIDS Action's goals have been clear: to ensure
    effective, evidence-based HIV care, treatment, and prevention services;
    to encourage the continuing pursuit of a cure and a vaccine for HIV
    infection; and to support the development of a public health system
    which ensures that its services are available to all those in need.
    Furthermore, our commitment to working toward these goals is constant:
    AIDS Action is here Until It's Over.
        For over 20 years AIDS Action Council, through its member
    organizations and the greater public health community, has worked to
    enhance HIV prevention programs, research protocols, and care and
    treatment services. An important part of this collaborative effort has
    been working to secure comprehensive federal resources to address
    community needs.
        It is therefore on behalf of AIDS Action Council's diverse
    membership, comprising community-based AIDS service organizations,
    public health departments, and other organizations concerned with HIV
    research, education, and advocacy, that I bring your attention to some
    of the issues impacting the funding picture for fiscal year 2006.
        Despite the good news of improved treatments, which have made it
    possible for people with HIV disease to lead longer and healthier
    lives, stark realities remain:
      --There is neither a cure nor a vaccine for HIV.
      --Current treatments do not work for everyone, and some have
            debilitating side-effects.
      --There are nearly 1 million people living with HIV in the United
            States.
      --Access to health care is unequal.
      --Half a million HIV positive Americans are not receiving regular
            medical care.
        The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act,
    which is administered by the Health Resources and Services
    Administration (HRSA) and is funded by this subcommittee, provides
    services to more than 533,000 people living with and affected by HIV
    throughout the United States and its territories. It is the single
    largest source of federal funding solely focused on the delivery of HIV
    services; it provides the framework for our national response to the
    HIV epidemic. As such, CARE Act programs have been critical to reducing
    the impact of the domestic HIV epidemic. Yet, providers of HIV services
    are working from a deficit. In recent years, CARE Act funding has been
    decreased through across-the-board rescissions. The .80 percent
    rescission that was executed on all non-defense and non-homeland
    security discretionary spending during the final negotiations for the
    fiscal year 2005 bill had a devastating impact on the HIV/AIDS
    portfolio in general, and on the Ryan White CARE Act in particular.
    Moreover, President Bush's budget for fiscal year 2006 requests just
    one increase to the CARE Act--an additional $10 million for the AIDS
    Drug Assistance Program (ADAP).
        Now in its fifteenth year, the Ryan White CARE Act is scheduled for
    reauthorization in this session of the 109th Congress, a fact President
    Bush made known to all Americans in his State of the Union address,
    when he voiced his strong support for reauthorization. He stated,
    ``Because HIV/AIDS brings suffering and fear into so many lives, I ask
    you to reauthorize the Ryan White Act to encourage prevention, and
    provide care and treatment to the victims of that disease. And as we
    update this important law, we must focus our efforts on fellow citizens
    with the highest rates of new cases, African American men and women.''
        In June 2004, while discussing the global HIV epidemic, our
    President stated with confidence, ``There's no doubt we can bring hope
    in all parts of the world, not only in Africa, but in neighborhoods in
    our own country where people wonder what the American Dream means.''
        On this point, AIDS Action Council concurs with President Bush:
    hope can be brought to all parts of the world. However, we respectfully
    disagree with the President on what will be needed to ensure hope here
    at home. The delivery of hope relies on the delivery of health care to
    all neighborhoods in this great nation--an effort that will not be
    sufficiently supported by the funding levels the President has
    requested for the HIV/AIDS portfolio in his fiscal year 2006 budget
    request.
        Clearly, it will take more than a $10 million increase for ADAP, a
    single program within the Ryan White CARE Act, to ensure HIV positive
    Americans receive the care and services necessary to remain healthy and
    productive. It is my hope that the Congress, through the good work of
    this subcommittee, will recognize and address the true funding needs of
    the care programs within the domestic HIV/AIDS portfolio.
        Last year, there was an overall increase of 14.5 percent in the
    estimated number of living AIDS cases among the fifty-one hardest hit
    eligible metropolitan areas (EMAs) in the United States, with increases
    as high as 22.6 percent in some areas. Yet fiscal year 2004 funding
    allocations for Title I of the Ryan White CARE Act, which is designed
    to provide services to these areas, were reduced. Forty of the fifty-
    one jurisdictions experienced a decrease in funding, with some
    decreases as high as 15 percent. Similar reductions continued in fiscal
    year 2005 when thirty-three of the EMAs experienced a funding decrease,
    the highest being 14 percent.
        Some of the services provided under Title I include physician
    visits, laboratory services, case management, home-based and hospice
    care, nutrition services, and substance abuse and mental health
    services. According to the most recent data available from the Health
    Resources and Services Administration (HRSA), more than half (51.8
    percent) of Title I funds are allocated to core health care services,
    and more than one-third (35.0 percent) are allocated to services
    closely associated with medical care (including medically-based housing
    and care coordination and referral). These services are critical to
    ensuring patients have access to, and can effectively utilize, life-
    saving therapies.
        Title II of the CARE Act ensures a foundation for HIV related
    health care services in each state and territory, including the
    critically important AIDS Drug Assistance Program (ADAP) and Emerging
    Communities Program. Title II base grants (excluding ADAP and Emerging
    Communities) decreased from $292,279,000 in fiscal year 2004 to
    $282,597,700 in fiscal year 2005 for a total decrease of over $9
    million ($9,681,300).
        Funding for Emerging Communities remained stable at $10 million,
    but it was divided among an increased number of communities. The $5
    million ``tier one'' award was divided among four cities in fiscal year
    2004 and among five cities this fiscal year, which resulted in funding
    reductions. Funding cuts for the original four cities ranged from
    $200,000 to $264,000 so that a fifth could receive $836,000. This type
    of funding variability is not conducive to providing consistent HIV
    care in emerging communities.
        We applaud the President's recommended increase of $10 million for
    ADAP in his fiscal year 2006 budget. ADAP provides medications for the
    treatment of individuals with HIV who do not have access to Medicaid or
    other health insurance. According to the National ADAP Monitoring
    Project, approximately 85,825 clients received medications through ADAP
    in June 2003.
        A single drug in the multiple-drug regimen of highly active anti-
    retroviral therapy (HAART), the standard of care for HIV disease, may
    cost as much as $15,000 annually. Drugs to treat other infections may
    bring the annual cost for a single HIV patient to $40,000 a year. With
    the increasing number of people living with AIDS, the number of newly
    diagnosed infections fixed at 40,000 per year, and cuts in funding to
    state Medicaid programs, pressures on ADAP are increasing. Over the
    years, ADAP has proven to be a remarkable program, allowing people to
    receive the care and treatment they need. Consequently, AIDS Action
    urges Congress both to fully fund ADAP and to consider restructuring
    ADAP to ensure universal access to all needed drugs, regardless of
    state of residence. Moreover, many of the medicines supplied through
    ADAP reach maximum efficacy only in conjunction with proper nutrition.
    Therefore, we urge Congress to continue funding for Ryan White CARE Act
    nutrition programs, funded predominantly through Titles I and II.
        Funding for Title III of the Ryan White CARE Act is awarded under
    the Early Intervention Services program. Title III grant recipients
    include community-based clinics and medical centers, hospitals, public
    health departments, and universities in 22 states and the District of
    Columbia. The grants are targeted toward new and emerging sub-
    populations impacted by the HIV epidemic. The Title III funds are
    particularly needed in rural areas where the availability of HIV care
    and treatment is still relatively new. Urban areas also continue to
    need Title III funds to ensure that emerging populations within these
    areas are not shortchanged as grantees struggle to meet the needs of
    previously identified HIV positive populations.
        The Title IV portion of the Ryan White CARE Act is awarded under
    the Comprehensive Family Services Program to provide comprehensive care
    for HIV positive women, infants, children, and youth, as well as their
    affected families. These grants fund the planning of services that
    provide comprehensive HIV care and treatment and the strengthening of
    the safety net for HIV positive individuals and their families.
        If we are to comprehensively address the HIV care and treatment
    crisis in the United States, we must never forget the smaller--but
    nonetheless significant--programs in the CARE Act: AIDS Education and
    Training Centers (AETC), dental reimbursement, and special projects of
    national significance (SPNS). Like nearly every other CARE Act program,
    AETC and SPNS have been affected by diminishing federal funding.
        Given that the President continues to support increases in funding
    to, and a greater reliance on, community health centers nationwide to
    provide care to the uninsured and under insured, we now find ourselves
    simultaneously faced with a pool of community providers who need to be
    educated about proper HIV care. The role of the AETCs is invaluable in
    ensuring that such education is available to physicians who are being
    asked to treat the increasing numbers of HIV positive patients who
    depend on them for care. Dental care is another crucial part of the
    spectrum of services needed by people living with HIV disease. Oral
    health is one of the first aspects of health care to be neglected by
    those who cannot afford, or do not have access to, proper medical care.
    Furthermore, oral health problems are often one of the first
    manifestations of HIV disease. Reimbursement offered by this CARE Act
    program allows dental education institutions to offer their much needed
    services to people living with HIV.
        As this testimony suggests, rising infections and strapped care
    systems necessitate the research and development of innovative models
    of care. The SPNS program is designed for this very purpose and must
    therefore receive sufficient funding.
        AIDS Action believes the entire Ryan White CARE Act portfolio needs
    $3.2 billion for fiscal year 2006 to address the true needs of the
    approximately 1 million people that the Centers for Disease Control and
    Prevention (CDC) estimates are living with HIV in the United States.
    President Bush has requested just over $2 billion ($2,083,342,088).
        The Housing Opportunities for People with AIDS (HOPWA) program,
    administered by the U.S. Department of Housing and Urban Development
    (HUD), is another integral program in the HIV care system. Stable
    housing is absolutely critical to the ability of people living with HIV
    to access and adhere to an effective HIV treatment plan. Without
    housing, one cannot appropriately store medicine or food and often
    cannot consistently access clean water or clean bathrooms. Furthermore,
    when one has no housing, the need for shelter often rises above the
    need to take care of one's HIV infection, which places the individual
    at higher risk of becoming ill and infecting others.
        AIDS Housing of Washington has estimated that approximately one-
    third to one-half of people living with HIV are homeless, cannot afford
    their current housing, or are at risk of becoming homeless. HOPWA is
    the only program that specifically addresses the housing needs of
    people living with HIV. Despite the importance of the program, HOPWA's
    funding has been dramatically cut. In fiscal year 2005, HOPWA was
    funded at $281.7 million ($281,728,000), down from $294.8 million
    ($294,800,000) in fiscal year 2004--a cut of more than $13 million. In
    his fiscal year 2006 budget proposal, the President proposes an
    additional cut to the program of almost $14 million, to $268 million
    ($268,000,000) total. AIDS Action believes that $385 million should be
    appropriated to the HOPWA program for fiscal year 2006 to address the
    needs of HIV positive people requiring housing assistance.
        HIV continues to be an ongoing public health crisis. Despite
    treatment advances, there was a 2 percent increase in progression from
    HIV to an AIDS diagnosis between 2001 and 2002--the first such increase
    in several years. AIDS-defining illnesses are the leading cause of
    death among African-American women between the ages of 25 and 34 and
    they are the third leading cause of death among all African Americans
    in this age group. They are the sixth leading cause of death for
    Latinos and whites in this age group.
        According to CDC estimates contained in the agency's December 2003
    HIV/AIDS Surveillance Report, 929,985 cumulative cases of AIDS have
    been diagnosed in the United States, with a total of 524,059 deaths
    since the beginning of the epidemic. The CDC also estimates that
    between 850,000 and 950,000 people are living with HIV/AIDS in the
    United States, and approximately one-quarter of them, or 180,000-
    280,000 people, are unaware of their status and could unknowingly
    transmit the virus to another person.
        For several years, estimates of new infections have remained at
    40,000 per year, compared to an estimated 180,000 new infections in the
    mid 1980s: an extraordinary achievement in efforts against HIV.
        To further reduce new infections, the CDC implemented a new
    initiative in April of 2003 called Advancing HIV Prevention: New
    Strategies for a Changing Epidemic (AHP), consisting of four key
    strategies:
      --Make HIV testing a routine part of medical care.
      --Implement new models for diagnosing HIV infection outside medical
            settings.
      --Prevent new infections by working with persons diagnosed with HIV
            and their partners.
      --Decrease mother-to-child transmission of HIV.
        The Urban Coalition for HIV/AIDS Prevention (UCHAPS), which
    represents the six cities that are directly funded by the CDC for HIV
    prevention and is an AIDS Action member, has responded positively to
    the AHP Initiative. UCHAPS members are working with the CDC to
    implement the Initiative effectively in their respective communities.
        This Initiative, however, does not supersede the HIV Prevention
    Strategic Plan that was published by the CDC in 2001, which stated a
    goal of reducing by half the number of new HIV infections by 2005.
    These strategies, though innovative, require additional funding for
    implementation. AIDS Action Council estimates that the CDC HIV/AIDS,
    STD, and TB prevention programs will need $2.33 billion in fiscal year
    2006 to address the true unmet needs of prevention in HIV/AIDS, STDs,
    and TB. AIDS Action Council therefore is concerned that the President
    limited his fiscal year 2006 request for the CDC HIV/AIDS, sexually
    transmitted disease (STD), and tuberculosis (TB) prevention programs to
    $956,283,000--a request that is $4,428,000 less than what the CDC
    received in fiscal year 2005.
        How will we keep apace of the epidemic and meet--albeit belatedly--
    the goal of limiting new infections to 20,000 annually without an
    immediate infusion of new resources, new partnerships, and new funding?
    Without such an infusion, this country will continue to face
    significant challenges in providing urgent care and treatment to HIV
    positive people.
        Research on the domestic HIV epidemic is vital to the control of
    the disease. Research that includes biomedical, behavioral, and social
    services is the cornerstone of HIV prevention research. The research
    agenda for HIV prevention science at the Office of AIDS Research (OAR),
    part of the National Institutes of Health (NIH), targets interventions
    to at-risk individuals, both infected and uninfected, to reduce HIV
    transmission. It is essential that OAR continue its groundbreaking
    research to secure a vaccine that will keep HIV negative people
    negative. It is equally important that this office continue to research
    promising treatment vaccines that may help HIV positive people maintain
    optimal health. The research on microbicides for vaginal and anal
    sexual intercourse is critical as well. The use of microbicides by the
    receptive partner will give them power over their personal health when
    they cannot negotiate condom use with their partner to protect
    themselves from HIV transmission.
        The research at NIH on new medications for drug resistant strains
    of HIV is also critical. The current success of treatment for people
    living with HIV and AIDS is due in large part to early research
    investments in new drugs that now have improved the health of people
    living with HIV. The United States must continue to take the lead in
    the research and development of new medicines to treat current and
    future strains of HIV. Primary prevention of new HIV infections must
    remain a high priority in the field of research.
        Behavioral research to help individuals delay the initiation of
    sexual relations, limit the number of sexual partners, limit the
    consumption of alcohol and drugs prior to sexual relations, and move
    from drug use to drug treatment are all critically important in finding
    a solution to the spread of HIV in the United States. NIH's Office of
    AIDS Research is critical in supporting all of these research arenas.
    Increased funding is necessary to ensure that the resources needed to
    address all the research concerns are available both now and in the
    future. Commitment in research will ultimately decrease the care and
    treatment dollars needed if HIV continues to spread at the current
    rate.
        AIDS Action is concerned that President Bush has only requested
    $2,932,992,000 for the AIDS portfolio at NIH. AIDS Action believes the
    National Institutes of Health AIDS portfolio must be funded at $3.327
    billion for fiscal year 2006.
        On behalf of all HIV positive Americans, and those affected by the
    disease, AIDS Action Council asks that you carefully consider the
    ramifications of the President's suggested cuts to the domestic HIV/
    AIDS portfolio. Help us save lives by allocating sufficient funds to
    address this nation's epidemic.
                                     ______

        Prepared Statement of the American Academy of Family Physicians

        The 94,000-member American Academy of Family Physicians submits
    this statement for the record to the Senate Appropriations Subcommittee
    on Labor/Health and Human Services, Education and Related Agencies. Our
    statement is made in support of the Section 747 Primary Care Medicine
    and Dentistry Cluster. The Academy also supports the Agency for
    Healthcare Research and Quality (AHRQ) and rural health programs.

            SECTION 747 PRIMARY CARE MEDICINE AND DENTISTRY CLUSTER

    Family Medicine Training
        Section 747 is the only federal program that funds family physician
    training. The law requires the program to meet two goals: (1) increase
    the number of primary care physicians (family physicians, general
    internists and general pediatricians) and (2) boost the number of
    people to provide care to the underserved. Regarding family medicine
    specifically, Section 747 offers competitive grants for training
    programs in medical school and in residency programs.
        The fiscal year 2005 spending bill provided $89 million to Section
    747, a figure that was $3 million below the fiscal year 2003 levels,
    which is the highest figure the program has received in the last
    several years. Unfortunately, the President's fiscal year 2006 budget
    provided zero dollars for the program. In contrast, the congressionally
    established Advisory Committee on Training in Primary Care Medicine and
    Dentistry, which was set up solely to evaluate these programs,
    recommended significantly more funding: $198 million.
        Family physicians are the specialists trained to provide
    comprehensive, coordinated and continuing care to patients of both
    genders and all ages and ethnicities, regardless of medical condition.
    These residency-trained, primary care physicians treat babies with ear
    infections, adolescents who are obese, adults with depression and
    seniors with multiple, chronic illnesses. And because they focus on
    prevention, primary care, and integrating care for patients, they are
    able to treat illnesses early and cost-effectively and when necessary,
    they help patients navigate our complex health system and find the
    right subspecialists.

    Section 747 and Rural and Underserved Areas
        In the last few years, there has been a great deal of interest in
    whether Section 747 actually meets its statutory goals, and
    specifically whether or not more physicians are practicing in rural and
    underserved areas as a result of the program. Due to this concern, the
    Robert Graham Center for Policy Studies studied medical schools
    receiving Section 747 family medicine funds and concluded that these
    programs met the law's requirements. According to this research, the
    trainees exposed to Section 747 funding while in these schools were
    more likely to:
      --Practice in family medicine or primary care;
      --Practice in a rural area; or
      --Practice in a whole county Primary Care Health Professions Shortage
            Area (HPSA) (i.e., a county with inadequate numbers of family
            physicians, general pediatricians, general internists or
            obstetrician/gynecologists).
        More specifically, according to this research, students with any
    exposure to Section 747 were 25 percent more likely to go into a
    primary care HPSA and 34 percent more likely to go to a rural county to
    practice. Moreover, the exposure of students to Section 747 funding
    between 1978-1993 was associated with nearly 4,000 additional primary
    care physicians in rural areas and 500 additional physicians in HPSAs
    than would have otherwise occurred. This research showed that Section
    747, was, in fact, meeting the goals of the law.

    Preventing HPSAs
        Along a similar vein, another study by the Robert Graham Center
    looked at counties designated as HPSAs. The research showed that the
    United States relies on family physicians more than any other medical
    specialty. For example, of the more than three thousand counties in the
    United States, 784 are designated HPSAs. In a hypothetical exercise,
    the study removed all family physicians from the U.S. counties and
    found that without these specialists, there would be 1,184 HPSAs--a 43
    percent increase. Section 747 grants contribute to bringing health care
    to underserved areas.

    Family Physicians for Community Health Centers and NHSC
        Family physicians also play a major role in staffing the nation's
    Community Health Centers (CHCs) and National Health Service Corps
    (NHSC). The Academy strongly supports the Administration's commitment
    to funding increases for these programs. However, we believe that
    increasing funding for CHCs and the NHSC is only a partial solution.
    Without support for family physician training, there will be fewer
    physicians who work in these centers or practice in underserved areas.
    Thousands of family physicians will be needed if the necessary number
    of CHCs sites and NHSC staff is to be realized.
        In fact, in 2003, Community Centers depended on primary care
    physicians for 95 percent of their physician staffing, over half of
    whom were family or general practice physicians. And, since 1971, the
    National Health Service Corps has placed more than 18,000 health care
    providers in underserved areas: almost half of the NHSC doctors were
    family physicians. Support for CHCs and the NHSC must go in tandem with
    funding for Section 747.

    Lower Health Care Costs and Improved Quality
        As the only federal program aimed at producing more generalists,
    Section 747 plays a role in lowering our nation's health care costs and
    increasing the quality of U.S. health care. For example, an article in
    Health Affairs (April 2004) demonstrated that states that spent more on
    Medicare had lower quality of care. There were two reasons for this
    result: states' expensive health care did not improve patient
    satisfaction, or, outcomes (e.g., people who were admitted to intensive
    care in the last 6 months of their life.)
        The second reason was also important: the authors found the makeup
    of the health care workforce made a difference. In fact, more primary
    care doctors in a state meant higher quality care and lower cost. In
    contrast, more specialists and fewer generalists led to lower quality
    and higher costs. And, just a small increase in the number of
    generalists in a state was associated with a large boost in that
    state's quality ranking.
        An article in a more recent edition of Health Affairs (March 2005),
    ``The Effects of Specialist Supply on Populations' Health: Assessing
    the Evidence'' went even further. This piece stated that there is a
    ``negative relationship between the supply of primary care physicians
    and death from stroke, infant mortality and low-birthweight, and all-
    cause mortality.'' The article went on to say that just one more
    primary care physician per 10,000 people was associated with a decrease
    of 34.6 deaths per 100,000 population.
        The article also cited breast cancer research for the state of
    Florida, which indicated that ``each tenth-percentile increase in
    primary care physician supply is associated with a statistically
    significant 4 percent increase in odd of early-stage breast cancer. ``
    Statistics were similar for other types of cancers: there was a
    relationship between early identification and the supply of primary
    care physicians. Numerous other research was included in the Health
    Affairs article indicating that a higher ratio of primary care
    physicians to populations led to better health outcomes. These data
    support the need for additional funding for Section 747, the only
    federal program that produces primary care physicians.

    Economic Impact
        In 2003, the Oklahoma Physician Manpower Training Commission
    studied the amount of income that comes into a community due to the
    presence of one family physician, and the additional jobs that result
    from his or her practice. Their research showed that the figure was
    approximately $1.2 million in rural areas and $0.9 million in urban
    areas.

    The Overspecialized U.S. Physician Workforce
        Unlike all other developed countries, the United States does not
    have a primary care-based health care system. While other developed
    countries have about equal numbers of primary care doctors and
    subspecialists, less than one-third of the U.S. physician workforce is
    primary care doctors (including family physicians). As a result, about
    two-thirds of the U.S. physician workforce is made up of
    subspecialists.
        In addition, compared to those in other developed countries, the
    United States spends the most per capita on healthcare--but has the
    worst healthcare outcomes. More than 20 years of evidence have shown
    that a health system based on primary care produces greater health and
    economic benefits. Boosting support for Section 747, which funds
    training for family physicians and for other primary care disciplines,
    could improve the health of patients in the United States to enjoy
    those benefits.

                  AGENCY FOR HEALTHCARE, RESEARCH AND QUALITY

        The Academy recommends $440 million for the Agency for Healthcare,
    Research and Quality (AHRQ). A major purpose of AHRQ is to conduct
    primary care and health services research geared to physician
    practices, health plans and policymakers. What this means is that the
    agency translates research findings from basic science entities like
    the National Institutes of Health (NIH) into information that doctors
    can use every day in their practices. Another key function of the
    agency is to support research on the conditions that affect most
    Americans.
        More recently, AHRQ has become the lead federal agency for research
    on comparative clinical effectiveness; information technology; and
    patient safety. For example, the Medicare Modernization Act asked AHRQ
    to study the ``clinical effectiveness and appropriateness of specified
    health services and treatments,'' and to use this information to
    improve the quality and effectiveness of the costly Medicare, Medicaid
    and SCHIP programs. In fiscal year 2005, $15 million was appropriated
    by Congress for this purpose, and the agency now has determined the top
    10 conditions for initial research. This type of study on ``what
    works'' in clinical therapies is crucial in an era of skyrocketing
    health care costs and limited federal dollars.
        Historically, however, AHRQ has been the lead agency to translate
    research into information for physicians and patients. Over the years,
    Congress has provided billions of dollars to the National Institutes of
    Health, which has resulted in important insights in preventing and
    curing major diseases. However, AHRQ's role has been to take this basic
    science and produce understandable, practical materials for the entire
    healthcare system. In short, AHRQ is the link between research and the
    patient care that Americans receive.
        In addition, AHRQ has long-supported research on conditions that
    affect most people. Most Americans get their medical care in doctors'
    offices and clinics. However, most medical research comes from the
    study of extremely ill patients in hospitals. AHRQ studies and supports
    research on the types of illness that trouble most people. In brief,
    AHRQ looks at the problems that bring people to their doctors every
    day--not the problems that send them to the hospital.

                             RURAL HEALTH PROGRAMS

        Continued funding for rural programs is vital to provide adequate
    health care services to America's rural citizens. We support the
    Federal Office of Rural Health Policy; Area Health Education Centers;
    the Community and Migrant Health Center Program; and the NHSC. State
    rural health offices, funded through the National Health Services Corps
    budget, help states implement these programs so that rural residents
    benefit as much as urban patients.

                                   CONCLUSION

        The Academy urges Congress to increase funding for Section 747
    family medicine training, at a minimum, to the fiscal year 2003 level
    of $92 million; provide $440 million for AHRQ and support rural health
    programs. Federal funding for these initiatives is vital to sustain and
    improve America's health care system.
                                     ______

            Prepared Statement of the American Academy of Pediatrics

        This statement is submitted on behalf of the American Academy of
    Pediatrics (AAP) and the endorsing organizations, the Society for
    Adolescent Medicine (SAM) and the Ambulatory Pediatric Association
    (APA).
        There have been numerous and significant successes in improving the
    health of America's children and adolescents. The number of 2-year-olds
    who have received the recommended series of immunizations is at an all-
    time high. Child death rates have fallen steadily over the past several
    years. And teen pregnancy rates continue to decline. However, despite
    these significant improvements, more than 9 million children and
    adolescents through age 18 remain uninsured. Moreover, racial and
    ethnic health disparities for many children and adolescents continue to
    exist, while the percent of children living in poverty continues to
    climb. Clearly there remains much work to do. As clinicians we must not
    only diagnose and treat our patients but also promote strong preventive
    interventions to improve the overall health and well-being of all
    infants, children, adolescents and young adults. Likewise, as policy-
    makers, you have an integral role to play in improving the health of
    the next generation through adequate and sustained funding of vital
    federal programs.
        The AAP, SAM and APA has identified three key priorities within
    this Committee's jurisdiction key priorities that are at the heart of
    improving the health and well-being of America's children and
    adolescents: access to health care, quality of health care, and
    immunizations.

                                     ACCESS

        We believe that all children and adolescents should have full
    access to health care. From the ability to receive primary care from a
    pediatrician trained in the unique needs of children and adolescents,
    to timely access to pediatric medical subspecialists and pediatric
    surgical specialists, America's children and adolescents deserve access
    to quality pediatric care.
        Maternal and Child Health Block Grant.--The Maternal and Child
    Health (MCH) Block Grant Program at the Health Resources and Services
    Administration (HRSA) is the only federal program exclusively dedicated
    to improving the health of all mothers and children. Nationwide, the
    MCH Block Grant Program provides preventive and primary care services
    to over 28 million women, infants, children, adolescents and children
    with special health care needs. In addition, the MCH Block Grant
    Program supports community programs around the country in their efforts
    to reduce infant mortality, prevent injury and violence, expand access
    to oral health care, and address racial and ethnic health disparities.
    Moreover, the MCH Block Grant Program includes efforts dedicated to
    addressing interdisciplinary adolescent training and services and
    research for adolescents' physical and mental health care needs. HRSA
    also supports adolescent health programs for vulnerable populations,
    including health care initiatives for incarcerated and minority group
    adolescents, and violence and suicide prevention. It also plays an
    important role in the implementation of the State Children's Health
    Insurance Program (SCHIP), which is critically important at a time when
    states are continuing to suffer from ongoing deficits and shifting
    costs. One of the many successful MCH Block Grant programs is the
    Healthy Tomorrows Partnership for Children Program, a public/private
    collaboration between the MCH Bureau and the American Academy of
    Pediatrics. Established in 1989, Healthy Tomorrows has supported over
    140 family-centered, community-based initiatives in over 40 states,
    including Ohio, Wisconsin, Texas, California, Kentucky, and Maryland.
    These initiatives have addressed issues such as access to oral and
    mental health care, abstinence, injury prevention, and enhanced
    clinical services for chronic conditions such as asthma. To continue to
    foster these and other community-based solutions for local health
    problems, in fiscal year 2006 we strongly support an increase in
    funding for the MCH Block Grant Program to $755 million.
        Family Planning Services.--The family planning program, Title X of
    the Public Health Services Act, ensures that all teens have
    confidential access to valuable family planning resources. The
    consequence of adolescent pregnancy, sexually transmitted infections
    (STIs), and HIV/AIDS demands that adolescents be able to make informed,
    responsible sexual decisions. Title X--which does not provide funding
    for abortion services--supports teens in making those decisions.
    According to a January 2005 report from the Henry J. Kaiser Family
    Foundation, the percentage of high school students who report ever
    having had sexual intercourse has declined over the past decade, while
    the rate of contraceptive use among those teens has increased.
    Nevertheless, teen pregnancy rates continue to vary widely over racial
    and ethnic groups, over 4 million teens still contract a sexually
    transmitted infection each year, and nearly half (48 percent) of all
    teens say that they want more information from--and increased access
    to--sexual health care services. Responsible sexual decision-making,
    beginning with abstinence, is the surest way to protect against
    sexually transmitted diseases and pregnancy. However, for adolescent
    patients who are already sexually active, confidential contraceptive
    services, screening and prevention strategies should be available. We
    therefore support a funding level in fiscal year 2006 of $350 million
    for Title X of the Public Health Service Act.
        Mental Health.--It is estimated that one in five children and
    adolescents has a mental health problem such as depression, ADHD, or an
    eating disorder, and for as many as six million this problem may be
    significant enough to disturb school attendance, interrupt social
    interactions, and impact quality of family life. Despite these
    startling statistics, the National Institute of Mental Health (NIMH)
    estimates that fewer than one in five of these children receives
    treatment, due in part to stigma and the lack of affordability of care
    and availability of specialists. One key point of access for helping
    these children receive the mental health care they need is the
    inclusion of mental health services--provided by qualified counselors,
    psychologists, and social workers--in the nation's schools. Grants
    through the Children's Mental Health Services program have been
    instrumental in achieving decreased utilization of inpatient services,
    improvement in school attendance and lower law enforcement contact for
    children and adolescents. To ensure the continued and growing success
    of this and other programs focusing on children and adolescents with
    mental health problems, the AAP and the endorsing organizations
    recommend that $114.7 million be allocated in fiscal year 2006 for the
    Mental Health Services for Children program.
        Health Professions Education and Training.--Critical to building a
    pediatric workforce to care for tomorrow's children and adolescents are
    the Training Grants in Primary Care Medicine and Dentistry, found in
    Title VII of the Public Health Service Act. These grants are the only
    federal support targeted to the training of primary care professionals.
    They provide funding for innovative pediatric residency training,
    faculty development and post-doctoral programs throughout the country.
    For example, at the Cincinnati Children's Hospital, Title VII health
    professions programs have funded critically important programs in
    pediatric medical education. The Residency Training in Primary Care
    grant is designed to train physicians for a career in primary care
    pediatrics, and features a strong emphasis on behavioral and
    developmental pediatrics, pediatrics in a community setting, and care
    for under-represented minorities and medically underserved populations.
    The community settings in which the primary care training takes place--
    and, often, ultimately where the physicians chose to practice--are
    federally-designated HPSAs with diverse populations. This program is
    now an integral part of the Cincinnati Children's pediatric residency
    training program, and widely sought after by physicians entering
    training at Children's.
        Through the enduring support of this subcommittee and Congress, the
    Title VII program has continued to finance critically important
    educational opportunities in a variety of settings that educate and
    train tomorrow's generalist pediatricians to be culturally competent
    and to meet the special health care needs of their communities. We
    recommend fiscal year 2006 funding of at least $40 million for General
    Internal Medicine/General Pediatrics. We also join with the Health
    Professions and Nursing Education Coalition in supporting an
    appropriation of at least $550 million in total funding for Titles VII
    and VIII. We further recommend and support the Administration's
    increase in funds in fiscal year 2006 for the National Health Service
    Corps, a key component to ensuring an adequate distribution of health
    care providers across the country, but emphasize the need for continued
    support of the training and education opportunities through Title VII
    for health care professionals who will work in these areas including
    community health centers.
        Independent Children's Teaching Hospitals.--Equally important to
    the future of pediatric education and research is the dilemma faced by
    independent children's teaching hospitals. Children's hospitals across
    the country are critical to the care of the nation's children and play
    a significant role in research and training tomorrow's pediatricians
    and pediatric subspecialists. This is especially important at a time
    when pediatric neurologists, gastroenterologists, and many other
    specialists for children are in short supply nationally. The children's
    hospitals have the critical mass of patients, physicians, and services
    needed to train these specialists, and their ability to sustain their
    teaching programs contributes to their ability to maintain these
    services. However, these hospitals qualify for very limited Medicare
    support, the primary source of funding for graduate medical education
    in other inpatient environments. As a bipartisan Congress has
    recognized in the past several years, equitable funding for Children's
    Hospitals Graduate Medical Education is needed to continue the
    education and research programs in these child- and adolescent-centered
    settings. We therefore reject the Administration's reduction in funding
    for this vital program and join with the National Association of
    Children's Hospitals to request total funding of $309 million for the
    CHGME program in fiscal year 2006 reflecting an adjustment for the cost
    of inflation. The support for independent children's hospitals should
    not come, however, at the expense of valuable Title VII and VIII
    programs, including grant support for primary care training.

                                    QUALITY

        Access to health care is only the first step in protecting the
    health of all children and adolescents. We must ensure that the care
    provided is of the highest quality. Robust federal support for the wide
    array of quality improvement initiatives is needed if this goal is to
    be achieved.
        Emergency Services for Children.--One program that assists local
    communities in providing quality care to children is the Emergency
    Medical Services for Children (EMSC) grant program. There are 31
    million child and adolescent visits to the nation's emergency
    departments every year. Children under the age of 3 years account for
    most of these visits. Up to 20 percent of children needing emergency
    care have underlying medical conditions such as asthma, diabetes,
    sickle-cell disease, low birthweight, and bronchopulmonary dysplasia.
    Providers must be educated and trained to manage these special health
    care needs in emergency situations, and emergency systems must be
    equipped with the resources needed to care for this especially
    vulnerable population. In order to assist local communities in
    providing the best emergency care to children, we urge that the EMSC
    program be maintained and funded at $20 million in fiscal year 2006.
        Agency for Healthcare Research and Quality.--Quality of care rests
    on quality research--for new detection methods, new treatments, new
    technology and new applications of science. As the lead federal agency
    on quality of care research, the Agency for Healthcare Research and
    Quality (AHRQ) provides the scientific basis to improve the quality of
    care, supports emerging critical issues in health care delivery and
    addresses the particular needs of priority populations, such as
    children. Substantial gaps still remain in what we know about health
    care needs for children and adolescents and how we can best address
    those needs. Children are often excluded from research that could
    address these issues. The AAP and endorsing organizations strongly
    support AHRQ's objective to encourage researchers to include children
    and adolescents as part of their research populations. We also support
    increasing AHRQ's efforts to build pediatric health services research
    capacity through career and faculty development awards and strong
    practice-based research networks. Additionally, AHRQ is focusing on
    initiatives in community and rural hospitals to reduce medical errors
    and to improve patient safety through innovative use of information
    technology--an initiative that we hope would include children's
    hospitals as well. Through its research and quality agenda, AHRQ
    continues to provide policymakers, health care providers, and patients
    with critical information needed to improve health care; therefore, we
    join with the Friends of AHRQ to recommend funding of $440 million for
    AHRQ in fiscal year 2006.
        National Institutes of Health.--Since its inception, the National
    Institutes of Health (NIH) is an integral part of the public health
    continuum. NIH has served as a vital component in improving the
    nation's health through research, both on and off the NIH campus, and
    in the training of research investigators, including pediatric
    investigators. Over the years, NIH has made dramatic strides that
    directly impact the quality of life for infants, children and
    adolescents through biomedical and behavioral research. For example,
    NIH research has led to successfully decreasing infant death rates,
    increasing the survival rates from respiratory distress syndrome, and
    the transmission of HIV from infected mother to fetus and infant has
    dropped from 25 percent to just 1.5 percent. NIH is engaged in a
    comprehensive research initiative to address and explain the reasons
    for a major public health dilemma--the increasing number of obese and
    overweight adults and children in this country. Today U.S. teenagers
    are more overweight than young people in many other developed
    countries. There is also a need for ongoing and increased biomedical
    research and funding support to study pre-term delivery, etiology,
    prevention and treatment regimens. In 2002, more then 480,000 babies
    were born prematurely and the causes of nearly half pre-term births are
    unknown. The pediatric community applauds the prior commitment of
    Congress to maintain adequate funding for the NIH and we urge you to
    sustain this momentum of scientific discovery. We support the
    recommendation of the Ad Hoc Group for Medical Research Funding for a
    funding level in fiscal year 2006 of $30 billion. In addition, to
    ensure ongoing and adequate child and adolescent focused research, such
    as the National Children's Study conducted at the National Institute
    for Child Health and Human Development (NICHD), we join with the
    Friends of NICHD Coalition in requesting $1.35 billion in fiscal year
    2006.
        We commend this committee's ongoing efforts to make pediatric
    research a priority at the highest level of the NIH. We urge continued
    federal support of NIH efforts to increase pediatric biomedical and
    behavioral research, including such proven programs as targeted
    training and education opportunities and loan repayment. We recommend
    continued interest in and support for the Pediatric Research Initiative
    in the Office of the NIH Director and sufficient funding to continue
    the pediatric training grant and pediatric loan repayment programs
    enacted in the Children's Health Act of 2000. This would ensure that we
    have adequately trained pediatric researchers in multiple disciplines
    that will not come at the expense of other important programs.
        Finally, as clinicians, we know first-hand the considerable
    benefits for children and society in securing properly studied and
    dosed medications. The benefits of pediatric drug testing are
    undisputed. Proper pediatric safety and dosing information reduces
    medical errors and adverse events, ultimately improving children's
    health and reducing health care costs. In a very conservative estimate,
    the FDA projected savings from pediatric testing of over $228 million a
    year in reduced hospitalization expenses for just five diseases
    affecting children. But until now there has been little incentive for
    drug companies to study off-patent drugs--older drugs that are
    critically needed therapies for children. The Research Fund for the
    Study of Drugs, created as part of the Best Pharmaceuticals for
    Children Act of 2002, provides support for these critical pediatric
    testing needs, but unfortunately is currently funded at an amount
    sufficient to test only a fraction of the NIH and FDA-designated
    ``priority'' drugs. Therefore, we urge you to provide the NIH with
    sufficient funding to fund the study of generic (off-patent) and
    selected on-patent drugs for pediatric use.
        We believe that these requests represent the best and most reliable
    estimates of the level of funding needed to sustain the high standard
    of scientific achievement embodied by the NIH. However, we encourage
    Congress to explore all possible options to identify additional sources
    of funding needed to support these increases if we are to reach these
    funding goals while not weakening any other valuable component of the
    Public Health Service.

                                 IMMUNIZATIONS

        Immunization remains one of the greatest public health achievements
    of the 20th century and has saved millions of lives. Since the
    widespread use of vaccines, millions of children have avoided terrible
    diseases that can cause great suffering and, in some cases, death. For
    example before immunization, polio paralyzed 10,000-25,000 children and
    adults, rubella (German measles) caused birth defects and mental
    retardation in as many as 20,000 newborns, and measles infected
    millions of children, killing 400-500 and leaving thousands with
    serious brain damage. Immunizations have reduced by more than 95 to 99
    percent the cases of vaccine-preventable infectious diseases in this
    country. And some, like rubella, are virtually eliminated from North
    America, thanks to successful immunization programs.
        Pediatricians, working alongside public health professionals and
    other partners, have brought the United States its highest immunization
    coverage levels in history. As a result, disease levels are at, or
    near, record low levels. We attribute this, in part, to the Vaccines
    for Children (VFC) Program and encourage Congress to maintain its
    commitment to ensuring the program's viability. The VFC program
    combines the efforts of public health and private pediatricians and
    other health care professionals to accomplish and sustain vaccine
    coverage goals for both today's and tomorrow's vaccines. It removes
    vaccine cost as a barrier to immunization for some and reinforces the
    concept of vaccine delivery in a ``medical home.'' However, we are
    concerned that once again the Administration's fiscal year 2006
    proposal to reduce funding for the Section 317 program to expand VFC is
    shortsighted. Additional section 317 funding is necessary to provide
    the pneumococcal conjugate vaccine (PCV-7), a vaccine that prevents an
    infection of the brain covering, blood infections and approximately 7
    million ear infections a year, to those remaining states that currently
    do not provide it. Increased funding also is needed to purchase the
    influenza vaccine. It is now recommended that young children between
    the ages of 6 months and 23 months of age receive an annual influenza
    vaccine. This age cohort is increasingly susceptible to serious
    infection and the risk of hospitalization. And an increase in funding
    is needed to purchase the recently recommended meningococcal conjugate
    vaccine (MCV). Meningococcal disease is a serious illness, caused by
    bacteria, with 10-15 percent of cases fatal and another 10-15 percent
    of cases resulting in permanent hearing loss, mental retardation, or
    loss of limbs.
        The public health infrastructure that now supports our national
    immunization efforts must not be jeopardized with insufficient funding.
    One of the conclusions of the 2000 Institute of Medicine report,
    Calling the Shots, was that unstable funding for state immunization
    programs threatens coverage levels for specific populations and age
    groups and vaccine safety. This continues to be true today. A strong
    and sufficient infrastructure is essential. For example, adolescents
    continue to be adversely affected by vaccine-preventable diseases
    (e.g., chicken pox, hepatitis B, measles and rubella). Comprehensive
    adolescent immunization activities at the national, state and local
    levels are needed to achieve national disease elimination goals. States
    and communities continue to be financially strapped and therefore, many
    continue to divert funds and health professionals from immunization
    clinics in order to accommodate anti-bioterrorism initiatives.
    Moreover, continued investment in the CDC's immunization activities
    must be made to avoid the reoccurrence of childhood vaccine shortages
    by providing and adequately funding a national 6 month stockpile for
    all routine childhood vaccines--stockpiles of sufficient size to insure
    that significant and unexpected interruptions in manufacturing do not
    result in shortages for children.
        While the ultimate goal of immunizations clearly is eradication of
    disease, the immediate goal must be prevention of disease in
    individuals or groups. To this end, we strongly believe that CDC's
    efforts must be sustained. In fiscal year 2006, we recommend an overall
    increase in funding of $232 million to ensure that the CDC's National
    Immunization Program has the funding necessary to accommodate vaccine
    price increases, new disease preventable vaccines coming on the market,
    global immunization initiatives--including funds for polio eradication
    and the elimination of measles and rubella--and to continue to
    implement the recommendations developed by the IOM.

                                   CONCLUSION

        We appreciate the opportunity to provide our recommendations for
    the coming fiscal year. As this Subcommittee is once again faced with
    difficult choices and multiple priorities we know that as in the past
    years, you will not forget America's children and adolescents.

                   OTHER RECOMMENDATIONS FOR FISCAL YEAR 2006

                     DEPARTMENT OF HEALTH AND HUMAN SERVICES
    ------------------------------------------------------------------------
                            Agency                               Amount
    ------------------------------------------------------------------------
    Centers for Disease Control and Prevention (total)...     $8,065,000,000
        Global Immunization (including polio eradication)        153,000,000
        Birth Defects, Disability and Health.............        135,000,000
        Newborn Hearing Screening Technical Assistance...          9,000,000
        National Violent Death Reporting System..........         10,000,000
        Folic Acid Education Campaign....................          4,000,000
    Health Resources and Services Administration (total).      7,500,000,000
        Newborn Screening (Title XXVI)...................         25,000,000
        Newborn Hearing Screening Grants to States.......         10,000,000
        Consolidated Community Health Centers............      2,038,000,000
    Substance Abuse and Mental Health Services                 3,531,000,000
     Administration (total)..............................
    ------------------------------------------------------------------------

                                     ______

       Prepared Statement of the American Academy of Physician Assistants

        On behalf of the more than 55,000 clinically practicing physician
    assistants in the United States, the American Academy of Physician
    Assistants is pleased to submit comments on fiscal year 2006
    appropriations for Physician Assistant (PA) education programs that are
    authorized through Title VII of the Public Health Service Act.
        A member of the Health Professions and Nursing Education Coalition
    (HPNEC), the Academy supports the HPNEC recommendation to provide at
    least $550 million to support the Titles VII and VIII programs in
    fiscal year 2006, including $18 million to support PA educational
    programs, as recommended by the Advisory Committee on Primary Care
    Medicine and Dentistry.
        The Academy believes that the recommended increase in funding for
    the Title VII health professions programs is well justified. The
    programs are essential to the development and training of primary
    health care professionals and contribute to the nation's overall
    efforts to increase access to care by promoting health care delivery in
    medically underserved communities.
        The Academy is very concerned with the Administration's proposal to
    eliminate funding for most Title VII programs, including zero funding
    for training in primary care medicine and dentistry. As Members of the
    Subcommittee are aware, these programs are designed to help meet the
    health care delivery needs of the nation's Health Professional Shortage
    Areas (HPSAs). By definition, the nation's more than 3,800 HPSAs
    experience shortages in the primary care workforce that the market
    alone can't address. We wish to thank the members of this subcommittee
    for your historical role in supporting funding for the health
    professions programs, and we hope that we can count on your support for
    these important programs in fiscal year 2006.

                   OVERVIEW OF PHYSICIAN ASSISTANT EDUCATION

        Physician assistant programs provide students with a primary care
    education that prepares them to practice medicine with physician
    supervision. PA programs are located at schools of medicine or health
    sciences, universities, teaching hospitals, and the Armed Services. All
    PA educational programs are intensive education programs that are
    accredited by the Accreditation Review Commission on Education for the
    Physician Assistant.
        The typical PA program consists of 111 weeks of instruction. The
    first phase of the program consists of intensive classroom and
    laboratory study, providing students with an in-depth understanding of
    the medical sciences. More than 400 hours in classroom and laboratory
    instruction are devoted to the basic sciences, with over 70 hours in
    pharmacology, more than 149 hours in behavioral sciences, and more than
    535 hours of clinical medicine.
        The second year of PA education consists of clinical rotations. On
    average, students devote more than 2,000 hours or 50-55 weeks to
    clinical education, divided between primary care medicine and various
    specialties, including family medicine, internal medicine, pediatrics,
    obstetrics and gynecology, surgery and surgical specialties, internal
    medicine subspecialties, emergency medicine, and psychiatry. During
    clinical rotations, PA students work directly under the supervision of
    physician preceptors, participating in the full range of patient care
    activities, including patient assessment and diagnosis, development of
    treatment plans, patient education, and counseling.
        Physician assistant education is competency based. After graduation
    from an accredited PA program, the physician assistant must pass a
    national certifying examination jointly developed by the National Board
    of Medical Examiners and the independent National Commission on
    Certification of Physician Assistants. To maintain certification, PAs
    must log 100 continuing medical education credits over a two-year cycle
    and reregister every two years. Also to maintain certification, PAs
    must take a recertification exam every six years.

                          PHYSICIAN ASSISTANT PRACTICE

        Physician assistants are licensed health care professionals
    educated to practice medicine as delegated by and with the supervision
    of a physician. In all states, physicians may delegate to PAs those
    medical duties that are within the physician's scope of practice and
    the PA's training and experience, and are allowed by law. Forty-eight
    states, the District of Columbia, and Guam authorize physicians to
    delegate prescriptive privileges to the PAs they supervise.
        PAs are located in almost all health care settings and in every
    medical and surgical specialty. Nineteen percent of all PAs practice in
    non-metropolitan areas where they may be the only full-time providers
    of care (state laws stipulate the conditions for remote supervision by
    a physician). Approximately 41 percent of PAs work in urban and inner
    city areas. Approximately 44 percent of PAs are in primary care. Nearly
    one-quarter practice in surgical specialties. Roughly 80 percent of PAs
    practice in outpatient settings. In 2004, an estimated 206 million
    patient visits were made to PAs and approximately 250 million
    medications were prescribed or recommended by PAs.

      CRITICAL ROLE OF THE TITLE VII, PUBLIC HEALTH SERVICE ACT, PROGRAMS

        A growing number of Americans lack access to primary care, either
    because they are uninsured, underinsured, or they live in a community
    with an inadequate supply or distribution of providers. The growth in
    the uninsured U.S. population increased from approximately 32 million
    in the early 1990s to nearly 45 million today. Simultaneously, the
    number of medically underserved communities continues to rise, from
    1,949 in 1986 to more than 3,800 today.
        The role of the Title VII programs is to alleviate these problems
    by supporting access to quality, affordable, and cost-effective care in
    areas of our country that are most in need of health care services,
    specifically rural and urban underserved communities. This is
    accomplished through the support of educational programs that train
    more health professionals in fields experiencing shortages, improve the
    geographic distribution of health professionals, and increase access to
    care in underserved communities.
        The Title VII programs are the only federal education programs that
    are designed to address the supply and distribution imbalances in the
    health professions. Since the establishment of Medicare, the costs of
    physician residencies, nurses, and some allied health professions
    training has been paid through Graduate Medical Education (GME)
    funding. However, GME has never been available to support PA education.
    More importantly, GME was not intended to generate a supply of
    providers who are willing to work in the nation's medically underserved
    communities. That is the purpose of the Title VII Public Health Service
    Act Programs, which support such initiatives as loans and scholarships
    for disadvantaged students, scholarships for students with exceptional
    financial need, centers of excellence to recruit and train minority and
    disadvantaged students, and interdisciplinary initiatives in geriatric
    care and rural health care.
        Furthermore, now that there is compelling evidence that race and
    ethnicity correlate with persistent, and often increasing, health
    disparities among U.S. populations, increasing the diversity of health
    care professionals is essential. Title VII programs are unique in that
    they seek to recruit providers from a variety of backgrounds. This is
    particularly important, as studies have found that those from
    disadvantaged regions of the country are three to five times more
    likely to return to those underserved areas to provide care versus
    other areas.

                   TITLE VII SUPPORT OF PA EDUCATION PROGRAMS

        Targeted federal support for PA education programs is currently
    authorized through section 747 of the Public Health Service Act. The
    program was reauthorized in the 105th Congress through the Health
    Professions Education Partnerships Act of 1998, Public Law 105-392,
    which streamlined and consolidated the federal health professions
    education programs. Support for PA education is now considered within
    the broader context of training in primary care medicine and dentistry.
        Public Law 105-392 reauthorized awards and grants to schools of
    medicine and osteopathic medicine, as well as colleges and
    universities, to plan, develop, and operate accredited programs for the
    education of physician assistants and faculty, with priority given to
    training individuals from disadvantaged communities. The funds ensure
    that PA students from all backgrounds have continued access to an
    affordable education and encourage PAs, upon graduation, to practice in
    underserved communities. These goals are accomplished by funding PA
    education programs that have a demonstrated track record of: (1)
    placing PA students in health professional shortage areas; (2) exposing
    PA students to medically underserved communities during the clinical
    rotation portion of their training; and (3) recruiting and retaining
    students who are indigenous to communities with unmet health care
    needs.
        The program works. A review of PA graduates from 1990-2003 reveals
    that students graduating from PA programs supported by Title VII are 65
    percent more likely to be from underrepresented minority backgrounds
    and 29 percent more likely to practice in underserved settings, than
    students graduating from PA programs that were not supported by Title
    VII.
        The PA programs' success in recruiting and retaining
    underrepresented minority and disadvantaged students is linked to their
    ability to creatively use Title VII funds to enhance existing
    educational programs. For example, a PA educational program in Iowa
    uses Title VII funds to target recruitment efforts to disadvantaged
    students, providing shadowing and mentoring opportunities for
    prospective students, increasing training in cultural competency, and
    identifying new family medicine preceptors in underserved areas. PA
    programs in Texas use Title VII funds to create new clinical rotation
    sites in rural and underserved areas, including new sites in border
    communities, and to establish non-clinical rural rotations to help
    students understand the challenges faced by rural communities. One
    Texas program uses Title VII funds for the development of web based and
    distant learning technology and methodologies so students can remain at
    clinical practice sites. A PA program in New York, where over 90
    percent of the students are ethnic minorities, uses Title VII funding
    to focus on primary care training for underserved urban populations by
    linking with community health centers, which expands the pool of
    qualified minority role models that engage in clinical teaching,
    mentoring, and preceptorship for PA students. Several other PA programs
    have been able to use Title VII grants to leverage additional resources
    to assist students with the added costs of housing and travel that
    occur during relocation to rural areas for clinical training.
        Without Title VII funding, many of these special PA training
    initiatives would not be possible. Institutional budgets and student
    tuition fees simply do not provide sufficient funding to meet the
    special, unmet needs of medically underserved areas or disadvantaged
    students. The need is very real, and Title VII is critical in meeting
    it.

         NEED FOR INCREASED TITLE VII SUPPORT FOR PA EDUCATION PROGRAMS

        Increased Title VII support for educating PAs to practice in
    underserved communities is particularly important given the market
    demand for physician assistants. Without the Title VII funding to
    expose students to underserved sites during their training, PA students
    are far more likely to practice in the communities where they were
    raised or the communities in which they attended school. Title VII
    funding is a critical link in addressing the natural geographic
    maldistribution of health care providers by exposing students to
    underserved sites during their training, where they frequently choose
    to practice following graduation. Currently 36 percent of PAs met their
    first clinical employer through their clinical rotations.
        Changes in the health care marketplace reflect a growing reliance
    on PAs as part of the health care team. Currently, the supply of
    physician assistants is inadequate to meet the needs of society, and
    the demand for PAs is expected to increase. A 1994 report of a
    workgroup of the Council on Graduate Medical Education (COGME),
    ``Physician Assistants in the Health Workforce,'' estimated that the
    anticipated medical market demand and the estimated workforce
    requirements for PAs would exceed supply. Additionally, the Bureau of
    Labor Statistics projects that the number of available PA jobs will
    increase 49 percent between 2002 and 2012. Title VII funding has
    provided, and continues to provide, a crucial pipeline of trained PAs
    to underserved areas. One way to assure an adequate supply of physician
    assistants, especially PAs likely to practice in underserved areas, is
    to continue offering financial incentives, such as funding preferences,
    to PA programs that emphasize recruitment and placement of people
    interested in primary health care in medically underserved communities.
        Despite the increased demand for PAs, funding has not
    proportionately increased for the Title VII programs that are designed
    to educate and place physician assistants in underserved communities.
    Nor has the Title VII support for PA education kept pace with increases
    in the cost of educating PAs. A review of PA program budgets from 1984
    through 2003 indicates an average annual increase of seven percent, a
    total increase of 245 percent over the past 19 years, yet federal
    support has remained relatively static.

                  RECOMMENDATIONS ON FISCAL YEAR 2006 FUNDING

        The American Academy of Physician Assistants urges members of the
    Appropriations Committee to consider the inter-dependency of all the
    public health agencies and programs when determining funding for fiscal
    year 2006. For instance, while it is important to fund clinical
    research at the National Institutes of Health (NIH) and to have an
    infrastructure at the Centers for Disease Control (CDC) that ensures a
    prompt response to an infectious disease outbreak or bioterrorist
    attack, the good work of both of these agencies will go unrealized if
    the Health Resources and Services Administration (HRSA) is inadequately
    funded. HRSA administers the ``people'' programs, such as Title VII,
    that bring the cutting edge research discovered at NIH to the
    patients--through providers such as PAs who have been educated in Title
    VII-funded programs. Likewise, CDC is heavily dependent upon an
    adequate supply of health care providers to be sure that disease
    outbreaks are reported, tracked, and contained.
        The critically important programs administered by NIH, HRSA, and
    CDC are integral components within the nation's public health
    continuum. One component is not more important than another, and no one
    component can succeed without adequate support from each of the other
    elements.
        Furthermore, while the Academy applauds the Administration's
    proposal to strengthen national security by increasing support for
    health emergency preparedness initiatives, it should not do so at the
    expense of Title VII programs. Training is the key to preparedness, and
    Title VII, section 747, is an ideal mechanism for educating primary
    care providers in public health competencies, facilitating population
    based and community-based skills and training, and increasing the
    alliance between public health and primary care providers. This is
    particularly important for our Nation's most disadvantaged and
    underserved populations, because they are the most vulnerable during
    medical emergencies because of a lack of resources and access to care.
        The Academy respectfully requests that the Title VII and VIII
    health professions programs receive $550 million in funding for fiscal
    year 2006, including $18 million to support PA educational programs, as
    recommended by the Advisory Committee on Primary Care Medicine and
    Dentistry.
        Thank you for the opportunity to present the American Academy of
    Physician Assistants' views on fiscal year 2006 appropriations.
                                     ______

     Prepared Statement of the American Association of Nurse Anesthetists
                                     (AANA)

                                     FISCAL YEAR 2006 APPROPRIATIONS REQUEST SUMMARY
    ----------------------------------------------------------------------------------------------------------------
                                                Fiscal year 2005 actual     Fiscal year 2006 budget    AANA request
    ----------------------------------------------------------------------------------------------------------------
    HHS /HRSA /BHPr Title VIII Advanced       Awaiting grant allocations  Grant allocations not           $3,000,000
     Education Nursing, Nurse Anesthetist      $3.5 MM fiscal year 2004.   specified.
     Education Reserve.
    Title VIII HRSA BHPr Nursing Education    $150,674,000..............  $150,471,000..............     210,000,000
     Programs.
    ----------------------------------------------------------------------------------------------------------------

        Chairman Specter, Ranking Member Harkin, and members of the
    Subcommittee: The AANA is the professional association for more than
    30,000 Certified Registered Nurse Anesthetists (CRNAs) and student
    nurse anesthetists representing over 90 percent of the nurse
    anesthetists in the United States. Today, CRNAs are directly involved
    in approximately 65 percent of all anesthetics given to patients each
    year in the United States. CRNA services include administering the
    anesthetic, monitoring the patient's vital signs, staying with the
    patient throughout the surgery, as well as providing acute and chronic
    pain management services. CRNAs provide anesthesia for a wide variety
    of surgical cases and are the sole anesthesia providers in almost 70
    percent of rural hospitals, affording these medical facilities
    obstetrical, surgical, and trauma stabilization, and pain management
    capabilities. CRNAs work in every setting in which anesthesia is
    delivered including hospital surgical suites and obstetrical delivery
    rooms, ambulatory surgical centers (ASCs), pain management units and
    the offices of dentists, podiatrists and plastic surgeons.
        Having provided anesthesia since the Civil War, masters' educated
    nurse anesthetists today have set for ourselves the most rigorous
    continuing education and recertification requirements in the field. We
    are humbled and honored that the Institute of Medicine reported in 1999
    that anesthesia is 50 times safer than 20 years ago. And a recent study
    by Dr. Michael Pine of over 400,000 cases in 22 states involving CRNAs,
    anesthesiologists, or both together finds ``the type of anesthesia
    provider does not affect inpatient surgical mortality.'' In addition, a
    recent AANA workforce study's data showed that CRNAs and
    anesthesiologists are substitutes in the production of surgeries.
    Through continual improvements in research, education, continuing
    education and practice, nurse anesthetists are vigilant to continue
    improving patient safety.
        And CRNAs provide the lion's share of the anesthesia care required
    by our U.S. Armed Forces through active duty and the reserves, from
    here at home to the leading edge of the field of battle. In May 2003,
    at the beginning of ``Operation Iraqi Freedom'' 364 CRNAs had been
    deployed to the Middle East to ensure military medical readiness
    capabilities. For decades CRNAs have staffed ships, remote U.S.
    military bases, and forward surgical teams without physician
    anesthesiologist support.

          IMPORTANCE OF TITLE VIII NURSE ANESTHESIA EDUCATION FUNDING

        Our chief request before the Subcommittee today, for at least $3
    million to be reserved for nurse anesthesia education from Title VIII,
    is based on two facts. First, there is a 12 percent vacancy rate of
    nurse anesthetists in the United States impacting people's healthcare.
    And second, the Title VIII program supported strongly by members of
    this Subcommittee in the past is an effective means to help address the
    nurse anesthesia workforce demand. This demand for CRNAs is something
    we as a profession are addressing every day with success, and with the
    critical assistance of federal funding through HHS' Title VIII
    appropriation.
        In 2003 the AANA conducted a nurse anesthesia workforce study,
    which concluded a 12 percent vacancy rate in hospitals for CRNAs, and a
    lower vacancy rate in ambulatory surgical centers for 2002. The supply
    has increased in recent years, stimulated by increases in the number of
    CRNAs trained. However, these increases had not been enough to offset
    the number of retiring CRNAs. This trend, as of 2003, will require
    raising the number of nurse anesthesia graduates to fill the growing
    vacancy rate. This is compounded by rising number of Medicare-eligible
    Americans, from about 34 million today, to more than 40 million in
    2010, who will require the care that CRNAs provide.
        The problem is not that our 94 accredited schools of nurse
    anesthesia are failing to attract qualified applicants. These CRNA
    schools are located all across the country including ten in
    Pennsylvania, five each in Ohio and Florida and Texas, four each in
    Illinois and New York, three each in California and Connecticut and
    Maryland, two in Rhode Island, and one in Wisconsin. It is that they
    are full. Each CRNA school continues to turn away qualified
    applicants--bachelor's educated nurses who had spent at least one year
    serving in a critical care environment. Recognizing the importance of
    nurse anesthetists to quality healthcare, the AANA has been working
    with its 94 accredited schools of nurse anesthesia to increase the
    number of qualified graduates, and to expand the number of CRNA
    schools. The Council on Accreditation of Nurse Anesthesia Educational
    Programs (COA) reports that in 1999, our schools produced 948 new
    graduates. By 2005, that number had increased to 1,628, a 72 percent
    increase in just five years. The growth is expected to continue. The
    COA projects CRNA schools to produce 1,800 graduates in 2005. But to
    meet the challenge, we simply must continue expanding the capacity and
    number of CRNA schools. With the help of competitively awarded Title
    VIII funding, we are making significant progress, expanding both the
    number of clinical practice sites and the number of graduates.
        We are pleased to report that this progress is extremely cost-
    effective from the standpoint of federal funding. Anesthesia can be
    provided by nurse anesthetists, physician anesthesiologists, or by
    CRNAs and anesthesiologists working together. And we know what the Pine
    study confirms, ``the type of anesthesia provider does not affect
    inpatient surgical mortality.'' Yet, for what it costs to train just
    one anesthesiologist, eleven CRNAs may be educated for the same task at
    the same superlative level of safety. This represents an eleven to one
    educational cost/benefit for supporting CRNA educational programs with
    federal dollars vs. supporting other anesthesia providers' education.
    This also contributes to a three or four to one anesthesia delivery
    cost/benefit. These ratios represent a cost/benefit unprecedented in
    any other healthcare specialty.
        So is this $3 million Title VIII investment in nurse anesthesia
    education effective? In February 2003, AANA surveyed its CRNA school
    program directors, to gauge the impact of the Title VIII funding. Of
    those that had reported receiving competitive Title VIII Nurse
    Education and Practice Grants funding, and there were eleven such
    schools from 1998 to 2003, they said they on average had increased
    their number of graduating CRNAs by more than 15 each per year. They
    reported on average more than doubling their number of CRNA graduates
    per school, who provide care to patients during and following their
    education. Moreover, they reported producing additional CRNAs that went
    to serve in rural or medically underserved areas. Under both of these
    circumstances, an increased number of student nurse anesthetists and
    CRNAs are providing healthcare to the people of medically underserved
    America.
        We believe it is important for the Subcommittee to allocate $3
    million for nurse anesthesia education for several reasons. First, as
    we have shown, the funding is cost-effective and well-needed. Second,
    the Title VIII authorization previously providing such a reserve
    expired in September 2002. The amount we request is consistent with
    what Title VIII provided in fiscal year 2001. Third, this particular
    funding is important because nurse anesthesia for rural and medically
    underserved America is not affected by increases in the budget for the
    National Health Service Corps and community health centers, since those
    initiatives are for delivering primary and not surgical healthcare.
    And, last, this funding meets an overall objective to increase access
    to quality healthcare in medically underserved America.

           TITLE VIII FUNDING FOR STRENGTHENING THE NURSING WORKFORCE

        Mr. Chairman, the AANA joins a growing coalition of nursing
    organizations and others in support of the Subcommittee providing a
    total of $210 million in fiscal year 2006 for nursing shortage relief
    through Title VIII. This amount is approximately $60 million over the
    fiscal year 2005 level, and over the President's fiscal year 2006
    budget. Every district in America is familiar with the importance of
    nursing.
        I understand that this request is a significant increase over the
    President's request. Thanks to your leadership and that of the
    Subcommittee, Congress increased nurse education funding $5 million
    over the President's request in fiscal year 2005 for which we are
    grateful, though we are concerned the Division of Nursing ``expert
    panel'' report that motivated requests to reduce Advanced Education
    Nursing is itself fraught with shortfalls, pitfalls and problems.
        Another perspective is that America spends more than $1.7 trillion
    on healthcare this year, paid by private and public sources. About $298
    billion of that is estimated to be Medicare outlays in 2005. About $8.7
    billion of that Medicare funds direct and indirect GME, with some 99
    percent of that funding helping to educate physicians and allied health
    professionals, and about 1 percent to help educate nurses. $301 million
    of the fiscal year 2005 appropriations bill supports a GME-type program
    for pediatricians through children's hospitals. These are all worthy
    things. But for every present and future healthcare patient, Congress
    must put some focus on nurses and nurse anesthesia care.
        From each dollar America spends in healthcare our request is that
    the federal government should allocate at least 15 thousandths of a
    cent to ensure we have enough nurses, and at least two ten-thousandths
    of a cent to ensure we have the safe anesthesia care we need when we
    need it. This action will improve patients' healthcare, and strengthen
    seniors' Medicare, all at once.
        Thank you.
                                     ______

        Prepared Statement of the American College of Obstetricians and
                                 Gynecologists

        The American College of Obstetricians and Gynecologists (ACOG), on
    behalf of its 46,000 partners in women's health care, is pleased to
    offer this statement to the Senate Committee on Appropriations,
    Subcommittee on Labor, Health and Human Services, and Education. We
    thank Chairman Specter, Ranking Member Harkin, and the entire
    subcommittee for their leadership to continually address maternal and
    child health care services.
        The Nation has made important strides to improve women and
    children's health over the past several years, and ACOG is grateful to
    this Committee for its commitment to research. We look forward to
    working with the Members of this Committee to ensure that vital
    research continues to eliminate disease and to ensure valuable new
    treatment discoveries are implemented. The NIH has examined and
    determined many disease pathways, while the Health Resources and
    Services Administration has been successful in translating research
    findings into valuable public health policy solutions. This dedicated
    commitment to elevate, promote and implement medical research faces an
    uncertain future at a time when scientists are on the cusp of new
    cures.
        It is vital that the Committee provide strong support for current
    studies, and for future advances, as well. We urge the Committee to
    support a 6 percent increase for the National Institutes of Health
    (NIH) in fiscal year 2006, and a 6 percent increase for the National
    Institute of Child Health and Human Development (NICHD). We also
    continue to support efforts to secure adequate funds for important
    public health programs such as the Health Resources and Services
    Administration (HRSA). Continued appropriations to these agencies will
    ensure ongoing and new research initiatives continue to yield positive
    results for women and children's health.

            NATIONAL INSTITUTES OF HEALTH--RESEARCH LEADING THE WAY

    Ob-Gyn Representation on the NICHD Advisory Council
        ACOG is most concerned that research conducted through the National
    Institute on Child Health and Human Development (NICHD) receives
    adequate funding, that the Institute can attract new ob-gyn
    researchers, and that individuals who have expertise and knowledge
    about its work guide NICHD.
        NICHD has overseen tremendous advancements for women including
    improving pregnancy and childbirth outcomes, and identifying cures for
    diseases and conditions affecting women of all ages and at all stages
    in life. NICHD is, in fact, the Institute where the vast majority of
    ob-gyn related research takes place and the only Institute where ob-
    gyns have a prominent role. It's critical, then, to require that the
    NICHD Advisory Council include an adequate number of individuals who
    have distinguished themselves in ob-gyn clinical practice and research.
        Currently, this important Council, which guides the Institute's
    research funding decisions, is composed of 17 appointed members,
    including pediatricians, ob-gyns, sociologists, biologists, media
    consultants, and nurses. The ob-gyns on the Council bring years of
    expertise and knowledge of women's health care needs, research
    priorities, and the impact of research discoveries on women's lives. In
    November 2004, the number of ob-gyns on the Council was reduced from 3
    to 2.
        ACOG worked actively with the NICHD to advocate the appointment of
    another ob-gyn to this position, and we are deeply troubled that NICHD
    filled this position with an attorney, rather than with another ob-gyn.
    Research conducted at NICHD helps shape the future of women's health
    care. Women across America and the world suffer from issues of maternal
    morbidity, uterine fibroids, vulvodynia and numerous other health care
    issues that are far from being understood and cured. The world faces
    global challenges, too, of the spread of sexually transmitted diseases,
    which have barely been acknowledged, much less challenged and defeated.
        The NICHD Advisory Council must include an adequate number of ob-
    gyns who are experts in these clinical and research areas. We object
    strongly to any attempt to reduce the ability of our specialty to
    contribute to the research direction of this Institute which is
    obviously so critical to the area that we know better than any other
    group or medical specialty--women's health.
        We look to Congress to amend the NICHD statute to require that its
    Advisory Council include no fewer than three experts in the field of
    ob-gyn. This action is necessary to ensure that decisions that will
    affect the future of women's health care are made by individuals with
    expertise and a deep level of commitment to the field. We hope to work
    actively with this Committee and the Congress to restructure the
    Council representation requirements.

    Research at the NICHD
        The NICHD conducts research that holds great promise to improve
    maternal and fetal health and safety. With the support of Congress, the
    Institute has initiated research addressing the causes of cerebral
    palsy, gestational diabetes and pre-term birth. However, much more
    needs to be done to reduce the rates of maternal mortality and
    morbidity in the United States. More research is needed on such
    pregnancy-related issues as the impact of chronic conditions during
    pregnancy, racial and ethnic disparities in maternal mortality and
    morbidity, and drug safety with respect to pregnancy.
        A commitment to research in maternal health sheds light on a
    breadth of issues that save women's lives. Important research examining
    the following issues must continue:

                Reducing High Risk Pregnancies
        NICHD's Maternal Fetal Medicine Unit Network, working at 14 sites
    across the United States (University of Alabama, University of Texas-
    Houston, University of Texas-Southwestern, Wake Forest University,
    University of North Carolina, Brown University-Women and Infant's
    Hospital, Columbia University, Drexel University, University of
    Pittsburgh-Magee Women's Hospital, University of Utah, Northwestern
    University, Wayne State University, Case Western University, and Ohio
    State University), will help reduce the risks of cerebral palsy,
    caesarean deliveries, and gestational diabetes. This Network discovered
    that progesterone reduces preterm birth by one-third.

                Reducing the Risk of Perinatal HIV Transmission
        In the last 10 years, NICHD research has helped decrease the rate
    of perinatal HIV transmission from 27 percent to 1.2 percent. This
    advancement signals the near end to mother-to-child transmission of
    this deadly disease.

                Reducing the Effects of Pelvic Floor Disorders
        The Institute has made recent advancements in the area of pelvic
    floor disorders. The NICHD is investigating whether women that have
    undergone cesarean sections have fewer incidences of pelvic floor
    disorder than women who have delivered vaginally.

                Reducing the Prevalence of Premature Births
        NICHD is helping our Nation understand how adverse conditions and
    health disparities increase the risks of premature birth in high-risk
    racial groups.

                Drug Safety During Pregnancy
        The NICHD recently created the Obstetric and Pediatric Pharmacology
    Branch to measure drug metabolism during pregnancy.
    The Challenge of the Future: Attracting New Researchers
        Despite the NICHD's critical advancements, reduced funding has made
    it difficult for this research to continue, largely due to the lack of
    new investigators. Congressional programs such as the loan repayment
    program, the NIH Mentored Research Scientist Development Program for
    reproductive health, and a small grant program, all attract new
    researchers, but low pay lines make it difficult for the NICHD to
    maintain these researchers. Due to the structure of the peer review
    system, previous grant recipients have an advantage because their
    grants require fewer funds. This makes it more difficult for new
    investigators to get into the system, jeopardizing the future of
    women's health research. We urge the Committee to significantly
    increase funding at the NICHD to maintain a high level of research
    innovation and excellence, in turn reducing the incidence of maternal
    morbidity and mortality and discovering cures for other chronic
    conditions.

      HEALTH RESOURCES AND SERVICES ADMINISTRATION: TURNING RESEARCH INTO
                                   SOLUTIONS

        It is critical that we rapidly transform women's health research
    findings into public health solutions. The Health Resources and
    Services Administration (HRSA) has created women and children's health
    outreach programs based on research conducted on prematurity, high risk
    pregnancies, gestational diabetes, and a variety of other health
    issues. The National Fetal Infant Mortality Review and the Provider's
    Partnership are two examples of the successful programs under the
    Healthy Start Initiative.
        For example, research shows tobacco abuse and health disparities
    are risk factors for infant mortality. Healthy Start offers programs
    for states, which fund provider and community education programs that
    improve maternal health through tobacco cessation programs, and finds
    ways to decrease the infant mortality rate by investigating cultural
    and institutional health disparities.

                     NATIONAL FETAL INFANT MORTALITY REVIEW

        The Fetal and Infant Mortality Review (FIMR) is a cooperative
    federal agreement between ACOG and the Maternal Child Health Bureau at
    HRSA. FIMR uses the expertise of ob-gyns and local health departments
    to find solutions to problems related to infant mortality. In light of
    the recent increase in the infant mortality rate for 2002, the FIMR
    program is vital to develop community-specific, culturally appropriate
    interventions. Today 220+ local programs in 42 states are implementing
    FIMR and finding it is a powerful tool to bring communities together to
    address the underlying problems that negatively affect the infant
    mortality rate.
        In order to meet the demand of the increasing number of FIMR
    programs, NFIMR must be able to continue its activities at an adequate
    funding level. A rigorous national evaluation of FIMR conducted by
    Johns Hopkins University has concluded that the FIMR methodology is an
    effective perinatal initiative. Based on that new research, FIMR can
    now be called an evidence based MCH intervention. All Healthy Start
    programs and every locality with disparities in infant outcomes should
    be actively encouraged to implement this FIMR process.
        We urge this Committee to recognize the many positive contributions
    of the FIMR program and ensure it remains a fully funded program within
    HRSA.

                             PROVIDER'S PARTNERSHIP

        Through May 2003, HRSA funded the Provider's Partnership, a
    cooperative agreement between the Federal Maternal and Child Health
    Bureau and ACOG. This Partnership includes a series of state-level
    projects initiated to address key women's health issues, while
    simultaneously building partnerships between ACOG Members and public
    health leadership.
        The Partnership works specifically with psychosocial issues that
    greatly impact the health and well being of women. The morbidity and
    mortality attributed to issues such as a woman's depression, tobacco
    use, substance abuse and domestic violence are becoming increasingly
    apparent as they weigh on both the woman and her entire family. Without
    treatment, these psychosocial issues place a heavy financial burden on
    state and federal resources. Obstetrician-gynecologists play a critical
    role in addressing these problems within their current practice,
    however because of the complexity and the importance of promptly
    linking at-risk women with appropriate services, responsibility for
    full psychosocial assessment and treatment cannot fall solely on
    obstetrician-gynecologists. Partnerships between women's health care
    physicians and state and community programs are needed that allow for
    integration of medical care with psychosocial services. Partnerships
    increase coordination thereby minimizing demands on both the behavioral
    health care system and individual providers. Provider's Partnership
    enables stakeholders to improve prevention interventions, so that later
    complications can be avoided.
        There are currently 30 state-level Partnership teams focused on
    depression in women, tobacco use, perinatal HIV transmission and oral
    health. These teams have been successful at surveying obstetric
    providers on their screening; counseling and referral practices for
    perinatal depression and tobacco use, the results of which have been
    the basis for the development of statewide legislative and practice
    policy guidelines; establishing pilot screening and intervention
    initiatives for depression in women; and instituting provider training
    and technical assistance for depression and tobacco use screening and
    intervention. Despite their successes, these teams still struggle for
    funds to offset administrative and program costs. Representatives from
    additional states have expressed an interest in developing an ACOG
    Provider's Partnership, however, any new efforts are being postponed
    until additional funding can be identified.
        Interagency cooperation to address the multiple factors that affect
    maternal and child health will help us increase our Nation's overall
    health. By continuing to translate research done at the NICHD on high-
    risk pregnancies, drug metabolism, and preterm births, into positive
    outreach programs such as NFIMR and the Provider's Partnership, we can
    further improve maternal health and reduce infant mortality.
        Again, we would like to thank the Committee for its continued
    support of maternal and child health research and programs. We strongly
    urge this Committee to support increased funding for the National
    Institute of Child Health and Human Development (NICHD), and renewed
    appropriations for the National Fetal Mortality Review (NFIMR) and the
    Provider's Partnership programs. This funding would significantly
    increase the number of women and families who benefit from smoking
    cessation programs, depression screening, and community specific
    solutions to infant mortality. Through joint community and government
    efforts we can decrease the harmful consequences these issues have on
    the Nation's health.
        We further urge the Committee and the Congress to pass a
    requirement that the NICHD Advisory Council include no fewer than three
    experts in the field of ob-gyn, to ensure a bright future for
    advancements in women's health.
                                     ______

              Prepared Statement of the American Heart Association

        Heart disease, stroke and other cardiovascular diseases kill more
    Americans each year than the next 5 leading causes of death combined,
    putting people of all ages at risk. Cardiovascular diseases remain our
    nation's No. 1 killer and a major cause of disability. We are concerned
    that our government is still not devoting sufficient resources for
    research and prevention to America's No. 1 killer--heart disease--and
    to our country's No. 3 killer--stroke.

                      STILL NO. 1--AN UNHAPPY DISTINCTION

        Cardiovascular diseases represent a continuing crisis of pandemic
    proportions. More than 70 million Americans suffer from these diseases,
    and risk factors are on the rise. About 65 percent of American adults
    are overweight or obese and an estimated 9.2 million children and
    adolescents ages 6-19 are overweight or obese. Also, an estimated 65
    million Americans have high blood pressure, nearly 38 million adults
    have high cholesterol, and nearly 14 million have diagnosed diabetes.
    Cardiovascular diseases cost Americans more than any other disease--an
    estimated $394 billion in medical expenses and lost productivity in
    2005. Heart defects are the most common birth defect and cause more
    infant deaths than any other birth defect.

                   HEART DISEASE AND STROKE. YOU'RE THE CURE

        Now is the time to capitalize on our progress in understanding
    heart disease, stroke and other cardiovascular diseases. Promising,
    cost-effective breakthroughs in treatment and prevention are available,
    and new ones are on the horizon. A continued, sustained investment in
    the NIH and appropriate funding for NIH heart disease and stroke will
    support critically needed new initiatives, especially in the
    translation of that research into useful clinical and state programs.
    For fiscal year 2006, we urge you to:

    Appropriate $30 billion for the National Institutes of Health (NIH)--to
            provide a continued, sustained investment in life-saving
            medical research
        NIH research provides new treatment and prevention strategies,
    creates jobs, and maintains America's status as the world leader in the
    biomedical and biotechnology industries.

    Provide $2.3 billion for NIH heart research and $341 million for NIH
            stroke research
        Researchers are on the brink of advances to enhance prevention and
    to provide new treatments so you and your loved ones can be spared the
    pain and suffering of heart disease and stroke. For example, the impact
    of co-morbidities on the progression of atherosclerosis and on its
    prevention and treatment needs further study. In terms of the well-
    recognized epidemic of obesity, research is needed on the science of
    weight regulation, on both the genetic and environmental bases of
    obesity, and on nutrition and exercise science. Inter-Institute
    communication and joint programs, which have been encouraged by the
    Director, should continue to grow, particularly in areas such as growth
    and development, atherosclerosis, obesity and diabetes among others.

    Allot $55.6 million for Heart Disease and Stroke for the CDC to expand,
            intensify and coordinate prevention initiatives such as the
            State Heart Disease and Stroke Prevention Program and the Paul
            Coverdell National Acute Stroke Registry
        Science must be translated into state programs that hearten
    Americans to make healthy lifestyle choices to avert and control heart
    disease and stroke and track and improve stroke care delivery.

    Allocate $15 million to continue to help rural and community areas
            treat cardiac arrest in time to save lives by initiating
            automated external defibrillator (AEDs) programs
        The Rural Access to Emergency Devices Act (part of Public Law 106-
    505) and the Community Access to Emergency Defibrillation Act (part of
    Public Law 107-188) help rural and community areas purchase AEDs and
    train emergency and lay responders in their use.

                HEART AND STROKE RESEARCH BENEFITS ALL AMERICANS

        Thanks to advances in addressing risk factors and in treating
    cardiovascular diseases, more Americans are surviving these often
    deadly and disabling diseases. Heart disease and stroke research,
    prevention and treatment breakthroughs are saving and improving lives.
    Several examples follow.
        Automated External Defibrillator.--Each year, 250,000 Americans die
    from cardiac arrest. Training volunteers to perform cardiopulmonary
    resuscitation and to use an AED--a briefcase-size device that shocks
    the heart into a normal rhythm--distributed in shopping malls, sports
    venues and other public places can double the survival rate of cardiac
    arrest victims.
        Implantable Cardioverter Defibrillator.--An ICD, which provides an
    electrical impulse to correct an often fatal irregular heart beat,
    notably reduces deaths in heart failure patients. So, the government
    announced an expansion of the number of Medicare recipients eligible to
    receive ICDs. They estimate that about 25,000 Medicare beneficiaries
    will receive ICDs in the first year, possibly saving up to 2,500 lives.
    These patients are required to share information about their condition,
    so medical professionals can assess which individuals are helped the
    most by ICDs.
        Women and Low-Dose Aspirin.--A study found that low-dose aspirin on
    alternative days did not prevent first heart attacks or death from
    cardiovascular diseases in women, but clot-based strokes were
    significantly reduced, with the greatest benefit in women age 65 and
    older.
        Ultrasound in Combination with tPA Enhances Drug's Effectiveness
    Against Stroke.--Tissue plasminogen activator (tPA) effectively
    dissolves clots that are causing an acute clot-based stroke. But, using
    ultrasonography, a non-invasive technique that uses sound waves, in
    combination with tPA improves the drug's clot busting abilities,
    leading to improved chances for a better recovery from stroke.
        We join other members of the research community in advocating for
    an fiscal year 2006 appropriation of $30 billion for the NIH to provide
    a continued, sustained investment in life-saving medical research and
    support investigation into new therapies. The NIH budget for heart
    disease and stroke remains disproportionately under-funded compared to
    the enormous burden of these diseases and the numerous promising
    scientific opportunities that could advance the fight against these
    disorders. Heart disease, stroke and other cardiovascular diseases meet
    the NIH's criteria for priority setting (public health needs,
    scientific quality of research, scientific progress potential,
    portfolio diversification and adequate infrastructure support), but the
    NIH continues to invest only 7 percent of its budget on heart research
    and a mere 1 percent on stroke research. We have a particular interest
    in individual NIH components that relate directly to our mission. Our
    funding recommendations for these Institutes follow.

             HEART RESEARCH CHALLENGES AND OPPORTUNITIES FOR NHLBI

        Advances have been made by more than 50 years of American Heart
    Association-funded research and more than a half-century of investment
    by Congress in the National Heart, Lung, and Blood Institute. While
    more people survive heart disease and stroke, they can cause permanent
    disability, requiring costly medical care and loss of productivity and
    quality of life.
        We urge this Committee to appropriate funding for the NHLBI and for
    its heart disease and stroke-related efforts to support and expand
    current activities and to invest in promising and critically needed new
    initiatives to aggressively advance the battle against heart disease
    and stroke. To accomplish this goal, we advocate an appropriation of
    $3.1 billion for the NHLBI, including $1.9 billion for heart disease
    and stroke. This added investment is needed to focus on heart disease
    and stroke challenges and opportunities. Several of these follow.
        Heart Failure Clinical Research Network.--Despite advances in
    treatment, the number of new cases and the number of Americans
    suffering from heart failure continue to grow. And, the long-term
    prognosis for patients remains poor. A planned research network with
    the capability of implementing multiple concurrent clinical studies
    would conduct clinical studies of new approaches to improve outcomes
    and would provide an infrastructure to enable rapid translation of
    promising research findings into patient care.
        Novel Targets and Therapy Development for Clot-based Stroke.--There
    is only one FDA-approved emergency treatment for clot-based stroke: t-
    PA. However, fewer than 5 percent of patients receive it, largely
    because it must be given within three hours from the onset of symptoms.
    To address an urgent need to develop new therapies, the NHLBI and the
    National Institute of Neurological Disorders and Stroke (NINDS) have
    planned a collaborative effort to identify new molecular targets,
    explore promising agents, and develop innovative therapies to quickly
    restore blood flow to the brain and limit stroke damage.
        Technologies for Engineering Small Blood Vessels.--A need exists to
    develop alternatives to natural blood vessels for patients who require
    heart artery bypass surgery and for children born with complex heart
    defects because the supply of native blood vessels to use as grafts
    does not meet the demand and prosthetic grafts fail at an unacceptable
    rate. Planned research would address the development of functional,
    small blood vessel substitutes.
        Specialized Centers of Clinically Oriented Research for Vascular
    Injury, Repair, and Remodeling.--The NHLBI has planned a new SCCOR
    program to conduct interdependent clinical and multidisciplinary basic
    research projects on the molecular and cellular mechanisms of vascular
    (blood vessel) injury, repair, and remodeling. This program would
    promote patient-oriented research to improve prevention, detection, and
    treatment of vascular diseases, such as stroke. The SCCORs would
    provide resources to enable new clinical investigators to develop
    skills and research capabilities to conduct relevant research in this
    area.

             STROKE RESEARCH CHALLENGES AND OPPORTUNITIES FOR NINDS

        Stroke is the No. 3 killer of Americans and a major cause of
    permanent disability. Many of America's 5.4 million stroke survivors
    face debilitating physical and mental impairment, emotional distress
    and huge medical costs. About 1 in 4 stroke survivors is permanently
    disabled. An estimated 700,000 Americans will suffer a stroke this
    year, and nearly 163,000 will die. In addition to the elderly, stroke
    also strikes newborns, children and young adults.
        We urge you to provide sufficient funding for the NINDS to support
    and expand current activities and to invest in promising and critically
    needed new initiatives to aggressively prevent stroke, protect the
    brain during stroke and enhance rehabilitation. To accomplish this
    goal, we advocate for an fiscal year 2006 appropriation of $1.6 billion
    for the NINDS, including $183 million for stroke. Some challenges and
    opportunities follow.
        Strategic Stroke Research Plan.--As a result of congressional
    report language during the fiscal year 2001 appropriations process, the
    NINDS convened a Stroke Progress Review Group (SPRG). Their report
    serves as a guide for a long-range strategic planning for stroke and
    includes 5 research priorities and 7 resource priorities to be
    addressed in the coming years. Multiple scientific programs initiated
    since the SPRG report are making impressive progress. But, more funding
    is needed to continue to implement these activities and other
    components of the plan.
        Emerging Stroke Risk Factors.--Although more Americans are
    controlling major stroke risk factors, such as high blood pressure and
    smoking, the number of stroke victims continues to rise. Scientists are
    defining new risk factors and re-examining the role of existing ones.
    Researchers are studying the role of inflammation in damaging arteries,
    heart valve disease, irregular heartbeats, and the long-term effects of
    high blood pressure. Increased funding for new approaches in these
    areas may lead to new ways to prevent stroke.
        Therapeutic Strategies for Stroke.--Several major clinical trials
    have identified new methods for preventing and treating stroke in high-
    risk populations, including stroke survivors. But, as the number of
    strokes increases and disparities in treatment persist, funding for
    translational and clinical studies is vital to providing cutting-edge
    stroke treatment and prevention.
        Stroke Education.--As a member of the Brain Attack Coalition,
    organizations devoted to fighting stroke, we work with the NINDS to
    increase public awareness of stroke symptoms and the need to call 9-1-
    1. Together, we initiated a public education campaign, Know Stroke:
    Know the Signs, Act in Time, and we are striving to develop systems to
    make tPA available to appropriate patients. In partnership with the
    CDC, the NINDS extended this campaign to launch a grassroots program
    called Know Stroke in the Community to enlist the aid of ``Stroke
    Champions'' who educate communities about stroke signs and symptoms. A
    pilot phase of the program in 5 cities has just been completed. When
    these measures are implemented, stroke treatment will shift from
    supportive care to early brain-saving intervention. But more funding is
    needed to educate the public and health providers about stroke.

       RESEARCH IN OTHER NIH INSTITUTES BENEFIT HEART DISEASE AND STROKE

        Research seeking to prevent and find better treatments for heart
    disease, stroke and other cardiovascular diseases is supported by other
    NIH entities like the National Institute on Aging, the National
    Institute of Diabetes and Digestive and Kidney Diseases, the National
    Institute of Nursing Research, the National Institute of Child Health
    and Human Development and the National Center for Research Resources.
    It is important to provide sufficient additional resources for these
    entities to continue and expand their critical work.

                   AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

        The AHRQ is a critical partner with the public and private health
    care sectors. They help develop evidence-based information needed by
    consumers, providers, health plans and policymakers to improve health
    care decision making. We join with the Friends of AHRQ in advocating
    for an appropriation of $440 million for the AHRQ to advance health
    care quality, cut medical errors and expand the availability of health
    outcomes information.

                   CENTERS FOR DISEASE CONTROL AND PREVENTION

        Prevention is the best way to protect Americans' health and ease
    the financial and human burden of disease. Resources must be made
    available to bring the benefits of research to places where heart
    disease and stroke strike--our towns and neighborhoods. The CDC builds
    a bridge between what we learn in the lab, translating findings into
    programs in the communities where we live. We advocate an fiscal year
    2006 appropriation of $8.7 billion for the CDC, with a 10 percent
    increase over current funding for state-based chronic disease
    prevention and health promotion programs.
        Within that figure, we support an appropriation of $55.6 million
    for the CDC's Heart Disease and Stroke line--which would bring per
    capita spending for heart disease, stroke and other cardiovascular
    disease prevention from 10 cents to about 12 cents. This would allow
    the CDC to better expand, intensify and coordinate prevention
    activities against these diseases, such as enhancing the State Heart
    Disease and Stroke Prevention Program and the Paul Coverdell National
    Acute Stroke Registry. It would also allow the CDC to begin the
    development of a state-based cardiac arrest registry, augment current
    health communication projects on heart attack and stroke signs and
    symptoms, as well as public and health care provider education; and
    support critical standardization of lipid and other measurements.
        We commend Congress for encouraging the CDC to create a Heart
    Disease and Stroke Division. With ample resources and capacity, a
    Division would further enable CDC's efforts in this area. Thanks to
    this Committee's support since fiscal year 1998, the CDC's State Heart
    Disease and Stroke Prevention Program covers 33 states, allowing them
    to design and/or implement state-tailored prevention programs. But only
    12 states receive funding to actually implement programs to prevent and
    control heart disease and stroke. The other 21 states were only
    provided funds to support program planning; which is now largely
    complete. Since cardiovascular diseases remain the No. 1 killer in
    every state, each state needs funding for basic implementation of a
    State Heart Disease and Stroke Prevention Program. With fiscal year
    2005 funding, the CDC can only elevate up to two states from planning
    to program implementation.
        An appropriation of $55.6 million would allow the CDC to add up to
    4 new states to the State Heart Disease and Stroke Prevention Program,
    allowing them to conduct a state-tailored prevention plan, and would
    elevate 4 more states to from planning to program implementation. It
    would enhance the Paul Coverdell National Acute Stroke Registry, which
    tracks and improves delivery of acute stroke care that can mean the
    difference between a fairly normal life and long-term disability. After
    developing and conducting 8 registry prototypes (fiscal year 2001-
    2003), the CDC funded 4 state health departments to implement
    registries in fiscal year 2004.
        We recommend the following fiscal year 2006 funding levels for the
    following CDC programs:
      --$132 million for the Preventive Health and Health Services Block
            Grant;
      --$70 million for the Obesity, Physical Activity and Nutrition
            Program;
      --$50 million for the Youth Media Campaign;
      --$82.4 million for the School Health Education Program; and
      --$145 million for the Office of Smoking and Health.
                 health resources and services administration.
        About 95 percent of cardiac arrest victims die before reaching a
    hospital. AEDs are small, easy-to-use devices that can shock a heart
    back into normal rhythm and restore life. The Rural Access to Emergency
    Devices Act and the Community Access to Emergency Defibrillation Act
    authorize funds for state and local governments to start AED programs.
    States, cities and towns nationwide eagerly await funds from these
    vital public health service grant awards, with available funds far
    below requests. An appropriation of $15 million is required to support
    these authorized programs.

                            DEPARTMENT OF EDUCATION

        Physical inactivity is a key risk factor for heart disease and
    stroke. Yet, our youth have fewer chances for physical education.
    Congress has been appropriating money for the Carol M. White Physical
    Education Program (PEP) to provide funding for school-based physical
    education initiatives that teach life-long physical activity habits and
    thus prevent diseases, like heart disease and stroke. We advocate for
    an appropriation of $100 million for PEP.

                                 ACTION NEEDED

        Despite progress, heart disease, stroke and other cardiovascular
    diseases remain America's No. 1 killer. Cardiovascular diseases meet
    the NIH's criteria for priority setting, but NIH continues to invest
    only 7 percent of its budget on heart research and a mere 1 percent on
    stroke research. Increasing funding for promising research
    opportunities and for proven prevention and treatment programs will
    allow continued strides against these diseases. Our government's
    response to this challenge will help define the health and well being
    of Americans for decades.
                                     ______

        Prepared Statement of the Americans for Nursing Shortage Relief
                                    Alliance

        The ANSR Alliance (Americans for Nursing Shortage Relief)
    appreciates the opportunity to submit written comments for the record
    regarding funding for nursing workforce and research programs in fiscal
    year 2006. ANSR is a coalition of 48 nursing organizations representing
    a diverse cross section of healthcare and professional organizations,
    healthcare providers, and friends of nursing that have united to
    address the ever-growing nursing shortage.
        To ensure that the nation has a sufficient and adequately prepared
    nursing workforce to provide quality care to all well into the 21st
    century, ANSR and the nation's 2.7 million registered and advanced
    practice registered nurses (RNs and APRNs) advocate at least $210
    million for the nursing workforce programs within Title VIII of the
    Public Health Service Act at the Health Resources and Services
    Administration (HRSA) as well as $160 million for the National
    Institute of Nursing Research (NINR) at the National Institutes of
    Health (NIH) in fiscal year 2006. ANSR stands ready to work with
    policymakers at the federal level to advance policies and programs that
    will sustain and strengthen the nation's nursing workforce.

                          NURSING SHORTAGE BACKGROUND

        Nursing is the nation's largest healthcare provider group with an
    estimated 2.7 million licensed nurses. Nurses play a critical role in
    the health care system because they represent approximately 54 percent
    of all health care workers and provide patient care in virtually all
    locations in which health care is delivered. Our ability, as a nation
    to meet these projected workforce needs is complicated by a number of
    factors.
      --The total nursing workforce is aging. By 2010, the average age of
            RNs is forecasted to be 45.4 years, an increase of 3.5 years
            over the current age, with more than 40 percent of the RN
            workforce expected to be older than 50 years.
      --Approximately half of the RN workforce is expected to reach
            retirement age within the next 10 to 15 years. The average age
            of new RN graduates is 31 years; RNs are entering the
            profession older and will have fewer years to work than nurses
            traditionally have had.
      --For the first time, registered nurses top the U.S. Bureau of Labor
            Statistics list of occupations with the largest projected 10-
            year job growth. Nurses have been on the list for some time but
            never as number one. The Bureau's latest projections put the
            demand for registered nurses at 2.9 million in 2012, up from
            2.3 million in 2002.
      --The national nursing shortage also is affecting our nation's 7.6
            million veterans who receive care through the 1,300 Veterans
            Administration (VA) health care facilities.
      --Nearly 1,800 faculty members leave their positions and fewer than
            400 potential faculty candidates receive doctoral degrees each
            year.
      --For the 2003-2004 academic year, an estimated 125,000 qualified
            applicants were turned away from nursing programs at all levels
            due largely to a faculty shortage.

                 ADEQUATE NURSING WORKFORCE: HOMELAND SECURITY

        Homeland security efforts try to prevent harm to our country, and
    nurses play a critical role. These efforts involve the health system,
    and nurses represent the largest group of health care providers who
    will be called on to respond to an emergency, disaster, or mass-
    casualty event. The estimates for the nurse workforce demand in 2010 do
    not take into account the healthcare system's ability to meet the
    healthcare needs of a surge of patients that could be expected from a
    mass-casualty event, whether natural or man-made. Given the findings of
    the bipartisan 9-11 Commission, it seems particularly relevant now to
    ensure an adequate supply of all levels of nurses, who are often front-
    line, first-responders in the case of tragedy. Unless steps are taken
    now, the nation's ability to respond to a natural or intentional
    disaster will be impeded by the growing nationwide nursing shortage. An
    investment in the nurse workforce is a step in the right direction to
    re-build the public health infrastructure and increase our nation's
    healthcare readiness and emergency response capabilities.

                               GROWING UNMET NEED

        Fortunately--after years of failing to have enough interested
    individuals to pursue nursing--our nation is finally seeing a slight
    upturn in nursing school applications. Many Americans, who have lost
    their jobs due to the economy, and others interested in a second
    career, find nursing attractive because of the job security, sufficient
    pay, and the opportunity it affords to help others. However, nursing
    organizations are hearing from prospective nursing students that they
    face waiting periods of up to 3 years before they can matriculate
    because there is not enough teaching faculty available. In many cases,
    students who have been accepted into programs face long waits to
    matriculate in nursing school due to these challenges. For example, in
    2004, U.S. nursing schools turned away more than 32,000 qualified
    applicants to entry-level baccalaureate and graduate nursing programs
    due to insufficient faculty, clinical sites, classroom space, clinical
    preceptors, and budget constraints, including almost 3,000 students who
    could potentially fill faculty roles. When nursing programs of all
    levels are considered, the number of qualified applicants turned away
    during the 2003-2004 academic year grows to more than 125,000. Without
    sufficient support for current nursing faculty and adequate incentives
    to encourage more nurses to become faculty--our nation will fail to
    have the teaching infrastructure necessary to educate and train the
    next generation of nurses we need so desperately to care for our family
    and friends, neighbors, colleagues, and ourselves.
        Enacted in 2002, the Nurse Reinvestment Act included new and
    expanded initiatives, including loan forgiveness, scholarships, career
    ladder opportunities, and public service announcements to advance
    nursing as a career. Despite the enactment of this critical measure,
    HRSA fails to have the resources necessary to meet the current and
    growing demands for our nation's nursing workforce. For example, in
    fiscal year 2003, HRSA received 8,321 applications for the Nurse
    Education Loan Repayment Program, but only had the funds to award 7
    percent (602) of all applications. Also in fiscal year 2003, HRSA
    received 4,512 applications for the Nursing Scholarship Program, but
    only had funding to support a mere 2 percent (94) of all applications.
        Therefore, the ANSR Alliance strongly urges Congress to provide
    HRSA with a minimum of $210 million in fiscal year 2006 to ensure that
    the agency has the resources necessary to fund a higher rate of Nurse
    Education Loan Repayment and Nursing Scholarship applications as well
    as implement other essential endeavors to sustain and boost our
    nation's nursing workforce.

                SUSTAIN AND SEIZE NURSING RESEARCH OPPORTUNITIES

        The National Institute of Nursing Research (NINR) supports basic
    and clinical research to establish a scientific basis for the care of
    individuals across the life span--from management of patients during
    illness and recovery to the reduction of risks for disease and
    disability and the promotion of healthy lifestyles. These efforts are
    crucial in translating scientific advances into cost-effective health
    care that does not compromise quality of care for patients.
    Additionally, NINR fosters collaborations with many other disciplines
    in areas of mutual interest such as long-term care for older people,
    the special needs of women across the life span, bioethical issues
    associated with genetic testing and counseling, and the impact of
    environmental influences on risk factors for chronic illnesses such as
    cancer. The ANSR Alliance supports a fiscal year 2006 appropriation
    level of $160 million for the NINR at the National Institutes of
    Health.

                                   CONCLUSION

        The ANSR Alliance stands ready to work with policymakers to advance
    policies and support programs that will sustain and strengthen our
    nation's nursing workforce. We thank you for this opportunity to
    discuss the funding levels necessary to ensure that our nation has a
    sufficient nursing workforce to care for the patients of today and
    tomorrow.

    ----------------------------------------------------------------------------------------------------------------
                                                                                   President's
                       Programmatic area                     Final fiscal year    budget fiscal      ANSR's request
                                                                    2005            year 2006
    ----------------------------------------------------------------------------------------------------------------
    Nurse Workforce Development Programs...................       $151,889,000       $150,000,000       $210,000,000
    National Institute of Nursing Research.................        138,000,000        139,000,000        160,000,000
    ----------------------------------------------------------------------------------------------------------------

        ANSR Alliance Organizations that endorse this testimony: American
    Association of Critical-Care Nurses; American Association of
    Occupational Health Nurses, Inc.; American Academy of Nurse
    Practitioners; American College of Nurse Practitioners; American
    Nephrology Nurses Association; American Society of PeriAnesthesia
    Nurses; Association of periOperative Registered Nurses; Association of
    State and Territorial Directors of Nursing; Association of Women's
    Health, Obstetric and Neonatal Nurses; Emergency Nurses Association;
    Infusion Nurses Society; National Association Nurse Massage Therapists;
    National Association of Orthopaedic Nurses; National Association of
    Pediatric Nurse Practitioners; National Association of School Nurses;
    National Council of State Boards of Nursing; National League for
    Nursing; National Nursing Centers Consortium; National Student Nurses'
    Association; Nurses Organization of Veterans Affairs; Oncology Nurses
    Society; Society of Trauma Nurses; and Society of Urologic Nurses and
    Associates.
                                     ______

             Prepared Statement of the American Nurses Association

        The American Nurses Association (ANA) appreciates this opportunity
    to comment on fiscal year 2006 appropriations for nursing education,
    workforce development, and research programs. Founded in 1886, ANA is
    the only full-service national association representing registered
    nurses. Through our 54 constituent member associations, we represent
    registered nurses (RNs) across the nation in all practice settings.
        The ANA gratefully acknowledges this Subcommittee's history of
    support for nursing education and research. We appreciate your
    continued recognition of the important role nurses play in the delivery
    of quality health care services. This testimony will give you an update
    on the status of the nursing shortage, its impact on the nation, and
    the outlook for the future.

                           THE NURSING SHORTAGE TODAY

        The nursing shortage is far from solved. Here are a few quick
    facts:
      --On February 11, 2004, the Bureau of Labor Statistics reported that
            registered nursing will have the greatest job growth of all
            U.S. professions in the time period spanning 2002-2012. During
            this 10-year period, health care facilities will need to fill
            more than 1.1 million RN job openings.
      --The Division of Nursing at the Health Resources and Services
            Administration projects that, absent aggressive intervention,
            the supply of nurses in America will fall 29 percent below
            requirements by the year 2020.
      --The American College of Healthcare Executives reported in October,
            2004 that 72 percent of hospitals were experiencing a nursing
            shortage at their facility.
      --According to the National Council of State Boards of Nursing, the
            number of first-time, U.S. educated nursing school graduates
            who sat for the NCLEX-RN (the national licensure examination
            for registered nurses) decreased by 20 percent from 1995-2003.
            A total of 19,820 fewer students in this category of test
            takers sat for the exam in 2003 as compared with 1995.
        This growing nursing shortage is having a detrimental impact on the
    entire health care system. Numerous recent studies have shown that
    nursing shortages contribute to medical errors, poor patient outcomes,
    and increased mortality rates. A study based on a review of more than 6
    million patients was published in the New England Journal of Medicine
    in May, 2002. The researchers found that hospitalized patients had
    better outcomes when the number of hours of RN care per day increased.
    Specifically, nursing shortages were found to correlate with longer
    lengths of stay, increased incidence of urinary tract infections and
    upper gastrointestinal bleeding, higher rates of pneumonia, shock and
    cardiac arrest. Increased hours of RN care resulted in fewer ``failure-
    to-rescue'' deaths from pneumonia, shock or cardiac arrest, upper
    gastrointestinal bleeding, sepsis and deep venous thrombosis.
        Research published in the October 23, 2002 Journal of the American
    Medical Association demonstrated that more nurses at the bedside could
    save thousands of patient lives each year. In reviewing more than
    232,000 surgical patients at 168 hospitals, researchers from the
    University of Pennsylvania concluded that a patient's overall risk of
    death rose roughly 7 percent for each additional patient above four
    added to a nurse's workload.
        A Joint Commission on the Accreditation of Healthcare Organizations
    (JCAHO) study published in 2002 shows that nearly one-quarter of all
    unanticipated deaths or injuries result from a lack of adequate nursing
    care.

              THE IMPACT ON PREPAREDNESS AND MILITARY HEALTH CARE

        This growing nursing shortage has effects well beyond domestic
    health care. RNs are integral in everything from adequate terrorism
    preparedness, to veterans' health delivery, to disaster response. In
    the event of a terrorist attack, nurses will be needed to evaluate
    patients, administer vaccines and medications, perform disease
    surveillance, and to train non-licensed staff. The Agency for
    Healthcare Research and Quality has developed a model to determine the
    number of health staff needed for these activities. According to this
    model, a small-scale anthrax attack in New York City would require
    18,981 trained staff working around the clock for four days to provide
    needed testing and antibiotics. A contained, small-scale smallpox
    attack in Columbus, OH would require 2,296 patient-care staff working
    around the clock for 4 days. The GAO reports that five out of 7 states
    have claimed that nursing shortages are hindering their bioterrorism
    preparedness efforts.
        The nursing shortage is also stressing military health care
    delivery. Because the military holds the vast majority of its health
    care assets in the reserves, the reserve activation has been
    particularly hard on nursing. There are currently more than 19,000 RNs
    providing care through the military reserves. As these nurses are drawn
    out of the domestic labor pool, the shortage is exacerbated.
        The Army, Navy, and Air Force are offering lucrative RN recruitment
    packages that include large sign-on bonuses, generous scholarships, and
    loan forgiveness packages. Yet, for the last 2 years the Army has not
    met its RN recruiting goals for either the active service or the
    reserves. The Air Force has not met its recruiting goals for the last 5
    years. Therefore, this shortage impacts our very strength as a nation.

                     NURSING WORKFORCE DEVELOPMENT PROGRAMS

        Federal support for the Nursing Workforce Development Programs
    contained in Title VIII of the Public Health Service Act is
    unduplicated and essential. In 2002, the 107th Congress recognized the
    detrimental impact of the developing nursing shortage and passed the
    Nurse Reinvestment Act (Public Law 107-205). This law improved the
    programs of Title VIII to meet the unique characteristics of today's
    shortage. This significant achievement holds the promise of recruiting
    new nurses into the profession, promoting career advancement within
    nursing and improving patient care delivery. This promise will not be
    met, however, without a significant investment.
        In fiscal year 2004 this Subcommittee allocated $142 million in
    funding for Title VIII, this supported 28,253 individual student
    nurses. In fiscal year 2005, the hard work of this Subcommittee
    resulted in $151 million in funding for Title VIII programs. ANA
    strongly urges you to increase funding for Title VIII programs by at
    least $24 million to a total of $175 million in fiscal year 2006. The
    nursing shortage and its impact on the health care of the nation demand
    this continued investment.
        In 1974, this Subcommittee invested $153.6 million Title VIII.
    Inflated to today's dollars, this long-ago appropriation would equal
    $592 million, approximately four times the current appropriation.
    Certainly, today's shortage is more dire and systemic than that of the
    1970's; it deserves an equivalent response.
        Title VIII includes the following program areas:
        Nursing Education Loan Repayment Program & Scholarships.--This line
    item is comprised of the Nurse Education Loan Repayment Program (NELRP)
    and the Nursing Scholarship Program (NSP), the Secretary of HHS has the
    authority to allocate funds between the two areas. The NELRP repays
    nursing student loans in return for at least two years of practice in a
    facility with a critical nursing shortage. For the first two years of
    service, the NELRP will repay 60 percent of the RN's student loan
    balance. If the nurse elects to stay for another year, an additional 25
    percent of the loan will be repaid. Within 3 years, a nurse can pay off
    85 percent of his/her student loans.
        The NELRP boasts a proven track record of delivering nurses to
    facilities hardest hit by the nursing shortage. HRSA has given NELRP
    funding preference to RNs who work in skilled nursing facilities,
    disproportionate share hospitals, and departments of public health.
    However, lack of funding has hindered the full implementation of this
    program. In fiscal year 2004, HRSA received more than 4,800
    applications for the NELRP. Due to lack of funding, only 857 loan
    repayments were awarded. Therefore, 82 percent of the nurses willing to
    immediately begin practicing in facilities hardest hit by the shortage
    were turned away from this program.
        The nursing scholarship program offers funds to nursing students
    who, upon graduation, agree to work for at least two years in a health
    care facility with a critical shortage of nurses. Preference is given
    to students with the greatest financial need. Like the loan repayment
    program, the nursing scholarship program as been stunted by a lack of
    funding. In fiscal year 2004, HRSA received more than 8,800
    applications for the nursing scholarship. Due to lack of funding, a
    mere 126 scholarships were awarded. Therefore, 98 percent of the
    nursing students willing to work in facilities with a critical shortage
    of nurses were denied access to this program.
        Nurse Faculty Loan Program.--This program establishes a loan
    repayment fund within schools of nursing to increase the number of
    qualified nurse faculty. Nurses may pursue a master's or doctoral
    degree. They must agree to teach at a school of nursing in exchange for
    cancellation of up to 85 percent of their educational loans, plus
    interest, over a 4-year period. Loans can cover the costs of tuition,
    fees, books, laboratory expenses, and other reasonable education
    expenses.
        This program is vital given the critical shortage of nursing
    faculty. America's schools of nursing can not increase their capacity
    without an influx of new teaching staff. Last year, schools of nursing
    were forced to turn away tens of thousands of qualified applicants due
    largely to the lack of faculty. In fiscal year 2004, HRSA awarded 61
    nurse faculty loan repayments.
        Nurse Education, Practice, and Retention Grants.--This section
    contains grant areas designed to expand enrollments in baccalaureate
    nursing programs; develop internship and residency programs to enhance
    mentoring and specialty training, and; provide new technologies in
    education including distance learning. Practice grant are designed to
    expand practice arrangements in non-institutional settings to improve
    primary health care in medically underserved communities; provide care
    for underserved populations; provide skills necessary to practice in
    existing and emerging health systems, and; develop cultural
    competencies. Retention grant areas include career ladders and improved
    patient care delivery systems. The career ladders program supports
    education programs that assist individuals in obtaining the educational
    foundation required to enter the profession, and to promote career
    advancement within nursing.
        Enhancing patient care delivery system grants are designed to
    improve the nursing work environment. It provides grants to facilities
    to enhance collaboration and communication among nurses and other
    health care professionals, and to promote nurse involvement in the
    organizational and clinical decision-making processes of a health care
    facility. These best practices for nurse administration have been
    identified by the American Nurse Credentialing Center's Magnet
    Recognition Program. These practices have been shown to double nurse
    retention rates, increase nurse satisfaction, and improve patient care.
        Nursing Workforce Diversity.--This program provides funds to
    enhance diversity in nursing education and practice. It supports
    projects to increase nursing education opportunities for individuals
    from disadvantaged backgrounds--including racial and ethnic minorities,
    as well as individuals who are economically disadvantaged. Racial and
    ethnic minorities currently comprise more than 25 percent of the
    nation's population and will comprise nearly 40 percent by the year
    2020. Only 12 percent of the RNs in the United States come from diverse
    backgrounds. Increasing the number of RNs from diverse races helps to
    address the prevention, treatment, and rehabilitation needs of an
    increasingly diverse population. For fiscal year 2004, HRSA received
    144 submissions for nursing workforce diversity grants. HRSA was only
    able to fund 20 (14 percent of applications).
        Advanced Nurse Education.--Advanced practice registered nurses
    (APRNs) are RNs who have attained advanced expertise in the clinical
    management of health conditions. Typically, an APRN holds a master's
    degree with advanced didactic and clinical preparation beyond that of
    the RN. Most have practice experience as RNs prior to entering graduate
    school. Practice areas include, but are not limited to: anesthesiology,
    family medicine, gerontology, pediatrics, mental health, midwifery,
    neonatology, and women's & adult health. Title VIII grants have
    supported the development of virtually all initial state and regional
    outreach models using distance learning methodologies to provide
    advanced study opportunities for nurses in rural and remote areas.
        These grants also provide traineeships for masters and doctoral
    students. Title VIII funds more than 60 percent of U.S. nurse
    practitioner education programs and assists 83 percent of nurse
    midwifery programs. Over 45 percent of advanced nursing graduates go on
    to practice in medically underserved communities, and in areas with
    large Medicaid populations. Many provide care to minority or
    disadvantaged patients. In fiscal year 2004, HRSA funded 82 advanced
    education nursing grants (78 percent of applications), 335 advanced
    education nursing traineeships (every application), and 73 nurse
    anesthetist traineeships (every application).
        Comprehensive Geriatric Education Grants.--This authority awards
    grants to train and educate nurses in providing health care to the
    elderly. Funds are used to train individuals who provide direct care
    for the elderly, to develop and disseminate geriatric nursing
    curriculum, to train faculty members in geriatrics, and to provide
    continuing education to nurses who provide geriatric care. The growing
    number of elderly Americans and the impending health care needs of the
    baby boom generation make this program critically important. In fiscal
    year 2004, HRSA continued 17 previously awarded grants.

                 NATIONAL INSTITUTE OF NURSING RESEARCH (NINR)

        ANA also urges the Subcommittee to increase funding for the NINR,
    one of the institutes at the National Institutes of Health (NIH).
    Nursing research is an integral part of the effectiveness of nursing
    care. Advances in nursing care arising from nursing and other
    biomedical research improves the quality of patient care and has shown
    excellent progress in reducing health care costs. Research programs
    supported by NINR address a number of critical public health and
    patient care questions. The research is driven by real and immediate
    problems encountered by patients and families.
        Recent studies have revealed the difference in heart attack
    symptoms in women versus men, the most effective means to prevent
    infectious diseases in inner city households, the incidence and risk
    factors for uterine rupture in pregnancies following cesarean section,
    and the means to help family caregivers provide high-quality long, term
    care for loved ones with chronic health care needs. NINR is leading the
    NIH research on end-of-life and palliative care. NINR is the lowest
    funded institute at NIH. ANA recommends $160 million in fiscal year
    2006 funding for the NINR.

                                   CONCLUSION

        While we appreciate the continued support of this Subcommittee, ANA
    is concerned by the fact that Title VIII funding levels have not been
    sufficient to assist qualified students enter the nursing profession.
    The nursing shortage will continue to worsen if significant investments
    are not made in nursing workforce development programs. Recent efforts
    have shown that aggressive and innovative recruitment efforts can help
    avert the impending nursing shortage--if they are adequately funded.
        ANA asks you to meet today's shortage with a relatively modest
    investment of $175 million in Title VIII programs. Additionally, an
    investment of $160 million in the NINR will help assure that these
    nurses are equipped with the information needed to provide the best
    care possible.
                                     ______

      Prepared Statement of the American Public Health Association (APHA)

        The American Public Health Association (APHA), the oldest
    organization of public health professionals, represents more than
    50,000 members from over 50 public health occupations. We are pleased
    to submit our views on federal funding for public health activities in
    fiscal year 2006.

             RECOMMENDATIONS FOR FUNDING THE PUBLIC HEALTH SERVICE

        APHA's budget recommendation concurs with the estimate developed by
    the Coalition for Health Funding: we believe the Public Health Service
    needs an increase of $3.5 billion in fiscal year 2006. This figure is
    based on the professional estimate of need and opportunity within each
    agency of the Public Health Service and would accommodate needed
    increases for the Centers for Disease Control and Prevention (CDC), the
    Health Resources and Services Administration (HRSA), the Substance
    Abuse and Mental Health Services Administration (SAMHSA), the Agency
    for Healthcare Research and Quality (AHRQ), and the National Institutes
    of Health (NIH), as well as agencies outside this subcommittee's
    jurisdiction--the Food and Drug Administration (FDA) and the Indian
    Health Service (IHS).

                   CENTERS FOR DISEASE CONTROL AND PREVENTION

        APHA supports a funding level for the Centers for Disease Control
    and Prevention that enables it to carry out its mission to protect and
    promote good health and to assure that research findings are translated
    into effective state and local programs. It is time to support CDC as
    an agency--not just the individual programs that it funds. In the best
    professional judgment of the American Public Health Association, in
    conjunction with the CDC Coalition--given the challenges of terrorism
    and disaster preparedness, new and re-emerging infectious diseases, the
    epidemic of obesity, particularly among children, and our many unmet
    public health needs and missed prevention opportunities--the agency
    will require funding of at least $8.65 billion to support its mission
    for fiscal year 2006.
        APHA is pleased with the support the Subcommittee has given to CDC
    programs over the years, including your recognition of the need to fund
    Severe Acute Respiratory Syndrome (SARS) response efforts, obesity
    prevention, chronic disease prevention, and solutions to the shortage
    of the flu vaccine. By translating research findings into effective
    intervention efforts in the field, the agency has been a key source of
    funding for many of our state and local programs that aim to improve
    the health of communities. Perhaps more importantly, federal funding
    through CDC provides the foundation for our state and local public
    health departments, supporting a trained workforce, laboratory capacity
    and public health education communications systems.
        CDC also serves as the command center for our nation's public
    health defense system against emerging and reemerging infectious
    diseases. From anthrax to West Nile to smallpox to avian flu, the
    Centers for Disease Control and Prevention is the nation's--and the
    world's--expert resource and response center, coordinating
    communications and action and serving as the laboratory reference
    center. States and communities rely on CDC for accurate information and
    direction in a crisis or outbreak.
        In fiscal year 2002, Congress appropriated $7.7 billion for CDC. In
    fiscal years 2003, 2004 and 2005, Congress appropriated $7.1 billion,
    $7.2 billion, and $8.0 billion, respectively. Now the President's
    proposed budget for the agency in fiscal year 2006 is $7.5 billion--a
    $500 million cut from last year's funding, and $200 million below the
    fiscal year 2002 funding level. We are moving in the wrong direction.
    Public health is being asked to do more, not less. As far as we can
    tell, in light of the current workload placed on the public health
    service--in addition to the threat of emerging diseases such as the
    avian flu--it simply does not make any sense to cut the budget for CDC
    at a time when the threats to public health are so great. Funding
    public health outbreak by outbreak is not an effective way to ensure
    either preparedness or accountability.
        Furthermore, the President's budget proposes the elimination of two
    very important chronic disease prevention programs: the Preventive
    Health and Health Services Block Grant and the Childhood Obesity
    Prevention Program (COPP), also referred to as the VERB or CDC Youth
    Media campaign. As states use their Prevention Block Grant dollars to
    address high priority needs such as emerging and chronic diseases,
    child safety seat programs, suicide prevention, smoke detector
    distribution and fire safety programs, adult immunization, oral health,
    worksite wellness, infectious disease outbreaks, food safety, emergency
    medical services, safe drinking water, and surveillance needs--we can
    scarcely understand why the Prevention Block Grant should be
    eliminated. And the success of the COPP program shows that over 30
    percent of the target audience, children ages 9 to 10 years, increased
    their physical activity as a direct result of the VERB media campaign.
    This type of success warrants continued funding of a program to empower
    our children to respond to the growing concerns of the obesity epidemic
    and improve the health of this nation. We encourage the Subcommittee to
    restore the cuts and fund the Prevention Block Grant at $132 million
    and the COPP program at $70 million.
        Until we are committed to a strong public health system, every
    crisis will force trade offs. For instance, the Administration's recent
    reprogramming request to make up for the vaccine shortage with money
    originally appropriated by Congress for chronic disease prevention
    programs (COPP and the Preventive Health and Health Services Block
    Grant) and bioterror preparedness funds is the most recent concrete
    example of attention to one disease coming at the expense of another.
        We also encourage the Subcommittee to provide $10 million for CDC's
    Environmental Public Health Services Branch to revitalize environmental
    public health services at the national, state and local level. As with
    the public health workforce, the environmental health workforce is
    declining. Furthermore, the agencies that carry out these services are
    fragmented and their resources are stretched. These services are the
    backbone of public health and are essential to protecting and ensuring
    the health and well being of the American public from threats
    associated with West Nile virus, terrorism, E. coli and lead in
    drinking water.

                  HEALTH RESOURCES AND SERVICES ADMINISTRATION

        HRSA programs assure that all Americans have access to our nation's
    best available health care services. HRSA provides a health safety net
    for medically underserved individuals and families, including 45
    million Americans who lack health insurance; African American infants,
    whose infant mortality rate is more than double that of whites; and the
    estimated 850,000 to 950,000 people living with HIV/AIDS. Programs to
    support the underserved place HRSA on the front lines in erasing our
    nation's racial/ethnic and rural/urban disparities in health status.
    HRSA funding goes where the need exists, in communities all over
    America. The agency's overriding goal is to achieve 100 percent access
    to healthcare, with zero disparities. In the best professional judgment
    of APHA, in conjunction with the Friends of HRSA Coalition, to respond
    to this challenge, the agency will require a funding level of at least
    $7.5 billion for fiscal year 2005.
        We are grateful to the Subcommittee for your consistent strong
    support for all of HRSA's programs, including the initiatives in
    terrorism preparedness and response in the past. Unfortunately, the
    president's budget overall recommends a massive $838 million or over 12
    percent cut to the agency for fiscal year 2006. We urge the members of
    the Subcommittee to restore the cuts and fund the agency at a level
    that allows HRSA to effectively implement these important programs.
        APHA is pleased that the Administration has requested a significant
    17.5 percent increase for Community Health Centers. More than 4,000 of
    these sites across the nation provide needed primary and preventive
    care to nearly 15 million poor and near-poor Americans. Health centers
    provide access to high-quality, family-oriented, culturally and
    linguistically competent primary care and preventive services,
    including mental and behavioral health, dental and support services.
    Nearly three-fourths of health center patients are uninsured or on
    Medicaid, approximately two-thirds are people of color, and more than
    85 percent live below 200 percent of the poverty level.
        However, we are once again very concerned that the HRSA health
    professions programs under Title VII and VIII have once again landed on
    the chopping block. Today our nation faces a widening gap between
    challenges to improve the health of Americans and the capacity of the
    public health workforce to meet those challenges. An adequate, diverse,
    well-distributed and culturally competent health workforce is
    indispensable to our national readiness efforts and to address critical
    health care needs. These programs help meet the health care delivery
    needs of the areas in this country with severe health professions
    shortages, at times serving as the only source of health care in many
    rural and disadvantaged communities. Therefore, the elimination of most
    funding for the Title VII health professions training programs and flat
    funding for Title VIII nurse training will only make certain that the
    needs of these medically underserved populations will not be met.
        Furthermore, we believe the elimination of the Healthy Community
    Access Program, universal newborn hearing screening programs, and the
    Emergency Medical Services for Children Program, especially when
    coupled with the flat-funding of the Maternal and Child Health Block
    Grant, will further undermine the availability of health services for
    some that are most in need--especially children. The Healthy Community
    Access Program is an example in which communities build partnerships
    among health care providers to deliver a broader range of health
    services to their neediest residents. This program of coordinated
    service delivery is innovative, not duplicative of other available
    programs, and therefore its elimination it of grave concern. Also, the
    proposed zero funding of universal newborn hearing screening programs
    in the Administration's budget will likely cause many hearing
    impairments in infants to go undetected, which can negatively impact
    speech and language acquisition, academic achievement, and social and
    emotional development. The proposed elimination of the Emergency
    Medical Services for Children Program will hurt many children who are
    eligible for Medicaid and SCHIP, but not enrolled due to state
    enrollment limits and budgetary pressures, and therefore frequently use
    emergency health services.
        We are very concerned that most programs under the Ryan White CARE
    Act, administered by HRSA's HIV/AIDS Bureau, would be flat-funded
    should the figures requested by the Administration be implemented. The
    CARE Act program is an important safety net program, providing an
    estimated 533,000 people access to services and treatments each year.
    At a time when HIV/AIDS is the fifth leading cause of death for people
    who are 25 to 44 years old in the United States, and the number of new
    domestic HIV/AIDS cases is increasing, not decreasing, flat funding
    these critical Ryan White Act programs does not make much sense.
        Through its many programs and new initiatives, HRSA helps countless
    individuals live healthier, more productive lives. In the 21st century,
    rapid advances in research and technology promise unparalleled change
    in the nation's health care delivery system. HRSA is well positioned to
    meet these new challenges as it continues to provide first-rate health
    care to the nation's most vulnerable citizens. We recommend growth in
    HRSA's budget to meet the needs of vulnerable populations served by the
    agency.

                   AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

        We request a funding level of $443 million for the Agency for
    Healthcare Research and Quality for fiscal year 2006, an increase of
    $124 million over last year. This level of funding is needed for the
    agency to fully carry out its Congressional mandate to improve health
    care quality, including eliminating racial and ethnic disparities in
    health, reducing medical errors, and improving access and quality of
    care for children and persons with disabilities. The cuts proposed in
    the administration budget will severely hamper these efforts.

           SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

        APHA supports a funding level of $3.5 billion for the Substance
    Abuse and Mental Health Services Administration for fiscal year 2006,
    an increase of $262 million over last year. This funding level would
    provide support for substance abuse prevention and treatment programs,
    as well as continued efforts to address emerging substance abuse
    problems in adolescents, the nexus of substance abuse and mental
    health, and other serious threats to the mental health of Americans.

                    DEPARTMENT OF HEALTH AND HUMAN SERVICES

        The budget of the Office of Minority Health has been decreased in
    the last several years. In fiscal year 2004, OMH received $55 million;
    in fiscal year 2005, OMH received $50 million; and the proposed budget
    in fiscal year 2006 is $47 million. APHA is concerned that at a time
    when we have increasing evidence of disparities in health care
    delivery, access and health outcomes, the budget of OMH is getting cut.
    We support restoring OMH funding to the fiscal year 2004 level.

                                   CONCLUSION

        In closing, we emphasize that the public health system requires
    financial investments at every stage. Successes in biomedical research
    must be translated into tangible prevention opportunities, screening
    programs, lifestyle and behavior changes, and other interventions that
    are effective and available for everyone. While we have said this
    before, in the post-September 11th era, we need to apply this to our
    spending growth in terrorism preparedness as well. We must think in a
    broad and balanced way, leveraging homeland security programs and
    funding whenever possible to provide public health benefits as a matter
    of routine, rather than emergency.
        We thank the subcommittee for the opportunity to present our views
    on the fiscal year 2006 appropriations for public health service
    programs.
                                     ______

      Prepared Statement of the Association of Maternal and Child Health
                                    Programs

        Mr. Chairman and members of the subcommittee, I am pleased to
    submit testimony on behalf of the Association of Maternal and Child
    Health Programs (AMCHP) regarding the critical need for funding of the
    Title V Maternal and Child Health Services Block Grant in fiscal year
    2006. As AMCHP's President and the director of Iowa's Child Health
    Specialty Clinics program, which uses MCH block grant funds to serve
    Iowa's children and their families, I know these funds make a
    difference. Because of the MCH Block Grant, states are able to fund a
    variety of activities to improve the health of your constituents. I
    urge you to provide $755 million for the MCH Block Grant this year.
        AMCHP is a national non-profit organization representing the
    leaders of state public health programs for maternal and child health,
    and children with special health care needs in all 50 states, the
    District of Columbia, and eight additional jurisdictions. Every state
    health department receives Title V Maternal and Child Health Services
    Block Grant funds to improve the health of all mothers and children.
        This modest increase to $755 million (3 percent) is necessary to
    help states maintain current levels of service. Between 1999 and 2003,
    the number of women and children served by this program increased by
    almost 4 million (16 percent). Federal funding has declined since 2003.
    The President's request of $723.9 million for fiscal year 2006 would be
    the fourth straight year of level or reduced funding. States are being
    called to do more with less and state MCH programs have done their best
    to make sure that the women and children we served are not adversely
    affected. However, maternal and child health programs in every state
    have reached a breaking point, with many states experiencing reductions
    in both state and federal funding; without additional funds, more
    severe cuts may have to be made.
        I also urge you to reject the Administration's proposal to
    eliminate funding for HRSA's Emergency Medical Services for Children
    program, Universal Newborn Hearing Screening program, trauma program
    and CDC's preventive health and health services block grant. The budget
    request argues that states will be able to use their MCH Block Grant
    funds to support some of these activities. States already work with
    these programs to avoid duplication and to ensure that each federal
    dollar, whether obtained through the block grant or not, goes further.
    The reality is that states have less federal and state funds available
    for maternal and child health programs and would not be able to support
    the current activities without cutting funds for other health
    priorities. Eliminating Newborn Hearing Screening grants will force
    states to cut other worthy MCH programs in order to continue hearing
    screening or to scale back or not conduct newborn hearing screening
    activities. According to a recent report, thanks to the HRSA funding,
    over 86 percent of infants born in hospitals nationwide are screened
    for hearing loss, up from 25 percent in 1999. Additionally, continued
    funding ($5 million) within the Special Projects of Regional and
    National Significance (SPRANS) set-aside for MCH oral health activities
    is critical. Most state dental programs for children are part of the
    state's maternal and child health program and are supported through the
    Maternal and Child Health block grant and support ongoing leadership to
    states to address long-term oral health problems.
        The Title V Maternal and Child Health Block Grant is one of the
    nation's oldest health programs and plays a pivotal part in states'
    current maternal and child health policy. The authorization of funding
    for the Maternal and Child Health Block Grant goes back to the Social
    Security Act of 1935. The legislation represented one of the very first
    state ``grant-in-aid'' programs, allocating federal revenues to states
    that agreed to meet the program's basic conditions of participation,
    which revolved around two main goals. The first was to help states
    lessen the negative social and public health impact of the Great
    Depression through promotion of maternal and child health services and
    the development of a basic preventive and primary health care
    infrastructure for women and children. The second, and one directly
    tied to the terrible epidemic of polio, was to assist states through
    grants to develop services for ``crippled children.''
        Today, Maternal and child health programs have expanded their roles
    and lead state efforts to increase immunization and newborn screening
    rates, reduce infant mortality, prevent childhood accidents and
    injuries, and reduce adolescent pregnancy. Each year, more than 27
    million women, infants, children and adolescents, including those with
    special health care needs, are served by MCH Block Grant funds. Half of
    the 4 million women who give birth annually receive health services
    made possible by the MCH Block Grant.
        While the block grant now represents a much smaller funding stream
    for states, it still remains one of the few resources that gives
    states' the ability to provide numerous services to meet needs
    identified by the states, to millions of women, children, and their
    families annually. And in every state, the MCH Block Grant still
    provides a health safety net for low-income women and children, by
    being a payor of last resort for needed medical services when other
    sources of payment (either public or private) are not available.

        WHO DO WE SERVE? WHAT DOES THE TYPICAL TITLE V CLIENT LOOK LIKE?

        Every year, over 4 million babies are born in this country. Many of
    them are healthy and families leave the hospital confident of a better
    future. I can discuss the many ways that MCH Block Grant dollars and
    state programs help in producing those healthy outcomes. However, I
    want to focus on the case of those families with children who may have
    special health care needs present at birth or shortly afterwards. Like
    the parent from Massachusetts with a son who was eventually diagnosed
    with congenital heart disease, abnormal heart rhythms, and is now
    pacemaker dependent. Immediately after birth, the parent made countless
    visits to the pediatrician sensing that something seemed wrong with her
    son, but she didn't know what. He was jaundiced for weeks after he was
    born and didn't gain weight, as he should. Even on formula, her son
    still did not gain weight. In a span of two calendar years, her son was
    hospitalized for 134 consecutive days. For all the ``I feel for you''
    visits she had from hospital social workers, no one ever told her son
    was eligible for SSI after the first 30 consecutive calendar days as an
    inpatient, or that her family could apply for Massachusetts Medicaid
    buy-in option to offset their exorbitant out-of-pocket costs for the
    healthcare services her son was receiving. This parent, like many
    others, continued to have great difficulty in coordinating health care
    services. She had to make thousands of phone calls to state agencies
    and search the Internet, plead with her insurance company to pay for
    things, call state agencies, surf the Internet late into the night
    looking for support services, for other parents, or for anything that
    would help.
        Another family in Pennsylvania juggle 11 doctors who treat their
    son with special health care needs and who constantly struggle to
    navigate the health care system for as many options that are available
    to improve the quality of life for their son. These are just a few
    examples of what is unfortunately a very common occurrence throughout
    the country.
        MCH Block Grant funds help assure that every state has the ability
    to connect families like the one described above to services and when
    those services are not otherwise available, to pay for that care. In
    Missouri, a child was born with an infection similar to a form of
    meningitis and was in the NICU for the first 8 weeks of his life.
    Within a day after mother and child went home, a nurse from the Bureau
    of Special Health Care Needs contacted the family. The support from the
    state's children with special health care needs program did not stop
    but continued and even now 16 years later, is available when the family
    needs it. Anything from adaptive equipment, to personal care attendant
    services have been provided when necessary.
        State Maternal and Child Health Programs play a primary role in
    assuring health care for children with special health care needs and
    their families. The services that each state provides may vary but by
    law, 30 percent of each state's Maternal and Child Health Block Grant
    allocation must be used to provide services for these kids. Why?
    Because the experiences for families that I outlined above have
    occurred too often. Since 1935, Congress has provided funding to states
    to make sure that we put an end to stories like these. A recent
    national survey by the Maternal and Child Health Programs estimated 13
    percent of children in the United States have a special health care
    need. Maternal and Child Health Block Grant funded programs are
    reaching slightly over 1 million but more can be done with increased
    funding for this important program.
        In Iowa, Child Health Specialty Clinics is the designated Title V
    Children with Special Health Care Needs program. We operate a statewide
    program that works with families, service providers and communities to
    provide subspecialty health care and support to children, from birth
    through age 21, who have a chronic condition (physical, developmental,
    behavioral or emotional) or who have an increased risk of a chronic
    condition and need special services. Like similar programs in all
    states, the program is primarily funded through the Maternal and Child
    Health Block Grant. Each specialty clinic center can offer from one to
    four evaluation and planning clinics per month. These clinics are
    staffed by community pediatricians, nurses, and nutritionists and serve
    mostly children with behavioral and developmental problems. Clinics
    serve children with chronic health problems like heart disease,
    diabetes, sickle cell disease, and bone and joint disease. Fees for the
    clinics are based on a sliding scale that accounts for family size and
    income.
        Besides the clinics, Iowa uses MCH block grant funds to provide
    other services for children and their families including making sure
    family support is available and organizing care plans for children.
    Through a statewide parent-to-parent network, we provide one-on-one
    emotional support, problem-solving assistance and help with
    understanding health insurance to families. The network connects
    parents new to the program with parents who have already been through
    many of the same experiences When one child can have as many as 11
    doctors, the burden on families to navigate the health care maze can be
    crushing. Another way we help is helping families navigate the health
    care system. Some children with complicated health problems require
    different services from varied agencies and we help coordinate needed
    care with local agencies within the family's community. These are
    provided as free services to families.
        Child Health Specialty Clinics serve approximately 9,000 children
    yearly, including 800 infants and 1,500 preschoolers, including making
    phone, mail and face-to-face contacts with families and health care
    providers. A few years ago I had 14 of these centers throughout Iowa.
    Today, we have 13 centers and in most other locations are now open only
    four days a week. Funding reductions at the state and federal level
    mean less clinics, families have to travel farther, and no ability to
    address emerging needs such as care for children with special emotional
    and behavioral health needs, one of the largest needs that we are
    currently seeing in the state.

                               STATE BUDGET CUTS

        More MCH Block Grant funds are needed. Below are specific examples
    of reductions in services that states have made due to declining
    federal and state funding for maternal and child health.

                                      IOWA

        Because of decreased state and federal funding along with increases
    in personnel costs (inflation), Iowa closed pediatric mobile clinics,
    eliminated nutrition services for children, closed the Waterloo center
    and reduced services at other centers. Without increased funding, we
    are looking at:
      --Closing centers in Burlington, Council Bluffs, Sioux City
      --Consolidating the Dubuque and Davenport with other centers
      --Increased waiting time up to 12 months for families and their kids
            to get the services they need
      --Ending behavioral pilot programs, a medical home project and other
            activities to make sure these children and their families get
            the right services when they need them.

                                      OHIO

        Ohio received one of the steepest cuts in federal MCH block grant
    funding, losing $1.5 million (or 6 percent) between fiscal year 2003
    and fiscal year 2004. Combined with a $7.5 million decline in the state
    funds available to support MCH, the ability for the program to maintain
    services to the 266,000 women, infants, and children who received
    services in 2002 has been severely compromised. Ohio's Children with
    Special Health Care Needs (CSHCN) program, because of both state cuts
    and cuts in the Ohio MCH Block Grant, has had to decrease the number of
    diagnoses covered by the CSHCN Treatment Program and to change the
    eligibility rules to reduce the services provided. Three diagnosed
    conditions were eliminated from coverage, affecting almost 600
    children.
        Other changes may affect up to 5,000 children who rely on the
    program. Co-payments are increased for families. Raising co-payments
    can significantly impact the financial and physical health of these
    families and their children if they are unable to pay them. These
    families turn to Title V when insurance (either private or public)
    cannot provide the services. The Ohio Specialty Field Clinic Program
    received a 20 percent decrease in MCH block grant and other funding
    support. The Specialty Clinic Program provides access to pediatric
    specialists for children in Ohio. The number of clinics will be cut,
    all in rural Ohio where the greatest need for services exists. This
    will affect the access to care for 300 children in Ohio's rural areas.
    Cardiac Specialty Clinics will be closed as of July 1, 2004. Funding
    reductions also slow the ability to respond to emerging issues, such as
    an increase in Ohio's infant mortality rate, which rose from 7.5 per
    1,000 births in 2000 to 7.9 in 2002.

                                     TEXAS

        Texas received a reduction of $753,000 (3 percent) in federal MCH
    funds. That reduction along with a reduction in state funds for MCH in
    2004-2005 will drastically increase the unmet needs of the MCH
    population in Texas. Currently, the MCH program addresses less than 10
    percent of the MCH population-in-need. For example, Title V MCH fiscal
    year 2004 contracts for services (i.e., initiatives directed toward
    teen pregnancy, childhood obesity, immunization, etc) decreased by 33
    percent and by 13 percent for direct services (prenatal care, child
    well-check visits, dental, family planning, etc.). In 2001, the Texas
    Children with Special Health Care Needs program instituted a waiting
    list that has grown to 1,200 families and is expected to continue to
    increase.

                                   CONCLUSION

        Since its creation, the Title V Maternal and Child Health Block
    Grant has grown from a $2.7 million program in fiscal year 1936 to a
    $723.9 million program in fiscal year 2005, and despite its relatively
    modest size, it has been revisited by Congress repeatedly over the
    years as new maternal and child health related concerns become evident.
    Even with the enactment of Medicaid in 1965, the Early and Periodic
    Screening, Diagnostic, and Treatment (EPSDT) program in 1967 (which
    simultaneously amended Medicaid and Title V to increase support for
    primary care) and SCHIP in 1997, Title V continues as a source of
    flexible funding that allows states to invest in the child health
    ``infrastructure'' for both basic and specialty care. Increased funding
    is crucial to helping state MCH programs navigate the changing maternal
    and child health world. Please provide $755 million for the Maternal
    and Child Health Block Grant in fiscal year 2006. Again, thank you for
    this opportunity to testify.
                                     ______

    Prepared Statement of the Association of Women's Health, Obstetric and
                                Neonatal Nurses

        The Association of Women's Health, Obstetric and Neonatal Nurses
    (AWHONN) appreciates the opportunity to comment on the fiscal year 2006
    appropriations for nursing education, research, and workforce programs
    as well as programs designed to improve maternal and child health.
    AWHONN is a membership organization of 22,000 nurses whose mission is
    to promote the health of women and newborns. AWHONN members are
    registered nurses, nurse practitioners, certified nurse-midwives, and
    clinical nurse specialists who work in hospitals, physicians' offices,
    universities, and community clinics across North America as well as in
    the Armed Forces around the world.
        AWHONN appreciates the support that this Subcommittee has provided
    for nursing education, research and workforce programs as well as
    maternal and child health programs in the past. We realize that there
    are many competing priorities for the Subcommittee members, and we
    appreciate your consistent support.

                            GROWING NURSING SHORTAGE

        AWHONN supports the advancement of quality care through an adequate
    nurse workforce Data from the Bureau of Health Professions, Division of
    Nursing's National Sample Survey of Registered Nurses--February 2002,
    confirm that of the approximately 2.7 million registered nurses in the
    nation, only about 82 percent of these nurses were working full-time or
    part-time in nursing. In addition to the shrinking pipeline of nurses
    coming into the program, the dominant factor in this shortage is the
    impending retirement of up to 40 percent of the workforce by 2010 or
    soon thereafter. This will occur at the same time that the needs of the
    aging baby boomer population will markedly increase demand for health
    care services and the services of registered nurses.
        This critical demand is reinforced by the fact that in February
    2004, the U.S. Bureau of Labor released statistics detailing how
    registered nurses have the largest projected 10-year job growth in the
    United States, with about 1 million new job openings by 2010. In
    addition to the care provider shortage, nursing faculties are also
    decreasing in number, requiring universities to decline acceptance to
    qualified nursing school applicants. The Southern Regional Education
    Board states that with faculty vacancies and newly budgeted positions,
    there has been a 12 percent shortfall in the number of nurse educators
    needed to train nursing applicants. The entire nursing workforce needs
    strengthening. As a result, it will take long-term planning and
    innovative initiatives at the local, state and federal level to assure
    an adequate supply of a qualified nurse workforce for the nation.

                      NURSE WORKFORCE DEVELOPMENT PROGRAMS

    AWHONN recommends a total of $210 million for fiscal year 2006 to fund
            the Nurse Workforce Development programs in Title VIII
        The Nurse Education Act (Public Health Service Act, Title VIII),
    enacted in 1964, represents the only comprehensive federal legislation
    to provide funds for nursing education. The programs authorized in this
    portion of Public Law 105-392 help schools of nursing and nursing
    students prepare to meet patient needs in a changing health care
    delivery system, favoring programs in institutions that train nurses
    for practice in medically underserved communities and Health
    Professional Shortage Areas.
        Reauthorized as the Nursing Workforce Development section in 1998,
    the new NEA gives the Department of Health and Human Services more
    discretion over the focus of federal spending. In 2002, Congress
    enacted the Nurse Reinvestment Act, which provides funding for new and
    expanded programs. These programs include scholarships, career ladders,
    internships and residencies, retention programs, and faculty loans
    designed to encourage students to consider nursing, keep nurses in the
    field, and ensure that nurse educators are plentiful enough to educate
    future nurses that we desperately need. The new programs received an
    initial appropriation of $20 million in fiscal year 2003, which was in
    addition to $93 million in funding provided for existing Title VIII
    programming. Unfortunately, due to limited funding in the first 2 years
    of the new authorization, the loan and scholarship programs have not
    been successful in providing support to students in nursing schools. In
    the first year, only 574 loan repayment contracts were made nationally,
    averaging roughly 11 loan repayment agreements per state, and less than
    2 percent of all scholarship applicants were funded.
        The shortage of registered nurses and the effect of the shortage on
    nurse staffing and patient safety demand a significant increase in
    funding for these programs. Nursing is the largest health profession
    with over 2.7 million nurses, yet only one-fifth of 1 percent of
    federal health funding is directed to nursing education. A significant
    increase in funding for these programs would lay the groundwork to
    expand the nursing workforce, through education and clinical training
    and retention programs, in order to address some of the serious
    shortage issues.
        The nursing shortage is not confined solely to care providers;
    there is also a growing, significant shortage of nurse faculty. The
    American Association of Colleges of Nursing (AACN) reports that the
    average age of nursing professors is 52, and for associate professors
    the average age is 55. The impending retirement of these seasoned
    educators will impact the ability of our schools and universities to
    meet the educational health care needs of the nation. According to
    AACN, U.S. nursing schools turned away almost 16,000 qualified
    applicants to baccalaureate nursing programs in 2003 due to
    insufficient faculty, clinical sites, classroom space, and budget
    constraints. Additionally, 125,000 qualified applicants were turned
    away from nursing programs at all levels across the United States in
    2004 according to the National League for Nursing.
        While the capacity to implement faculty development is currently
    available through Section 811 and Section 831, adequate funding and
    direction is needed to ensure that these programs are fully
    operational. Options to provide support for full-time doctoral study
    are essential to rapidly prepare the nurse educators of the future.
    AWHONN recommends that a portion of the funds be allocated for faculty
    development and mentoring.
        Further, AWHONN recognizes the importance of appropriate
    investments in advanced practice nursing programs. As in other
    professions the advanced degree has become a necessary achievement for
    career advancement, and registered nurses who pursue the MSN degree are
    a part of the cadre of nurses who go on to become faculty. Our nation
    needs more nurses with basic training to enter the field, but focusing
    only on these nurses addresses just half of the problem. The nursing
    shortage encompasses nursing faculty; both advanced practice nursing
    and basic nursing must receive additional funding but not one at the
    expense of the other.

                        MATERNAL AND CHILD HEALTH BUREAU

    AWHONN recommends $850 million in funding in fiscal year 2006 for the
            Maternal and Child Health Bureau
        This program provides comprehensive, preventive care for mothers
    and young children, as well as an array of coordinated services for
    children with special needs. In fact, the Maternal Child Health Block
    Grant (MCH) serves over 80 percent of all infants in the United States,
    half of all pregnant women, and 20 percent of all children.
        MCH programs are facing increased demands for services due to
    continued growth in the Children's Health Insurance Program, which in
    turn identifies more children who are eligible for other MCH Services.
    Title V complements Medicaid and the State Children's Health Insurance
    Program by providing ``wrap-around'' services and enhanced access to
    care in underserved areas. Additional funding would give states the
    resources they need to expand prenatal and infancy home visitation
    programs, an approach that has been shown, in NINR research, to improve
    the prenatal health-related behavior of women and reduce rates of child
    abuse and neglect as well as maternal welfare dependence.

                             INDIAN HEALTH SERVICE

    AWHONN recommends an fiscal year 2006 appropriation of $5.54 billion
            for IHS
        The Indian Health Service (IHS) is the principal federal health
    care provider and health advocate for Indian people with the goal of
    ``ensur[ing] that comprehensive, culturally acceptable personal and
    public health services are available and accessible to all American
    Indian and Alaska Native people.'' IHS is tasked with an enormous
    responsibility in providing care to over half of the American Indian
    population.
        The American Indian and Alaska Native people have long experienced
    lower health status when compared with other Americans. Lower life
    expectancy and the disproportionate disease burden exist perhaps
    because of inadequate education, poverty, discrimination in the
    delivery of health services, and cultural differences. These are broad
    quality of life issues rooted in economic adversity and poor social
    conditions.
        A recent study of federal health care spending per capita found
    that the United States spends $3,803 per year per federal prisoner,
    while spending about half that amount for a Native American: $1,914.
    Per capita health care spending for the U.S. general population is
    $5,065 per year. A significant increase in funding over fiscal year
    2005 spending levels is necessary for the federal government to fulfill
    its responsibility to Indian Country and achieve its stated goals.
        While the nursing shortage continues nationwide, IHS has been
    disproportionately affected by the lack of RNs. IHS nurses are older,
    with an average age of 48, and nearly 80 percent of RNs are over the
    age of 40. Further, the average vacancy rate for RNs is 14 percent. IHS
    administers three interrelated scholarship programs designed to meet
    the health professional staffing needs of IHS and other health programs
    serving Indian people. These programs are severely under-funded.
    Targeted resources need to be invested in the IHS health professions
    programs in order to recruit and retain registered nurses in Indian
    Country.
        Additionally, Section 112 of the Indian Health Care Improvement
    Act, Public Law 94-437, authorizes grants to public or private schools
    of nursing, tribally-controlled community colleges and tribally-
    controlled post secondary vocational institutions for the purpose of
    recruiting, training and increasing the number of professional nurses
    who deliver health care services to Indian people. On average, Section
    112 programs provide five undergraduate scholarships per year and two
    master's program scholarships. This important program should be
    expanded to provide many more scholarships, both at the undergraduate
    and graduate levels, in an effort to offer meaningful relief to the
    nursing shortage for IHS healthcare providers and the patients they
    serve.

                 NATIONAL INSTITUTE OF NURSING RESEARCH (NINR)

    AWHONN recommends an increase of $22 million over fiscal year 2005
            funding levels for the NINR, resulting in an fiscal year 2006
            appropriation of $160 million
        NINR engages in significant research affecting areas such as health
    disparities in ethnic groups, training opportunities for management of
    patient care and recovery, and telehealth interventions in rural/
    underserved populations. This research allows us to refine the practice
    and provide quality patient care in its current challenging
    environment.
        NINR research contributes to or results in improved health outcomes
    for women. Recent public awareness campaigns target differences in the
    manifestation of cardiovascular disease between men and women. The
    differing symptoms are the source of many missed diagnostic
    opportunities among women suffering from the disease, which is the
    primary killer of American women. In a study funded by NINR,
    researchers were able to qualitatively analyze the intensity of pain
    and limitation of activity experienced by women suffering from angina,
    both of which were found to be of greater intensity than that
    experienced by men. The study concluded that the gender variation could
    significantly impact diagnosis and treatment of female patients
    suffering from related cardiovascular problems.
        Because of the emphasis on biomedical research in this country,
    there are few sources of funds for high-quality behavioral research for
    nursing other than NINR. It is critical that we increase funding in
    this area in an effort to optimize patient outcomes and decrease the
    need for extended hospitalization.

        NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT (NICHD)

    AWHONN supports an increase in funding for NICHD for fiscal year 2006,
            bringing the appropriation to $1.35 billion
        NICHD seeks to ensure that every baby is born healthy, that women
    suffer no adverse consequences from pregnancy, and that all children
    have the opportunity for a healthy and productive life unhampered by
    disease or disability. With increased funding, NICHD could expand its
    use of the NICHD Maternal-Fetal Medicine Network to study ways to
    reduce the incidence of low birth weight. Prematurity/low birthweight
    is the second leading cause of infant mortality in the United States
    and the leading cause of death among African American infants. AWHONN,
    like many organizations directly involved in programs to improve the
    health of women and newborns, looks to NICHD to provide national
    initiatives, such as the Maternal-Fetal Medicine Network that assists
    with the care of pregnant women and babies.
        Recently NICHD released research indicating they may have found a
    test to predict preeclampsia in patients before the life-threatening
    complication, affecting five percent of all pregnancies, occurs.
    Abnormal levels of placental growth factor (PlGF) were found in the
    urine of pregnant women who later developed preeclapmsia. Once NICHD
    screens for women who are high risk for developing preeclampsia, this
    group can be studied to prevent or cure this complication. This finding
    is a promising lead in the effort to prevent and cure preeclampsia.

          NATIONAL INSTITUTES OF ENVIRONMENTAL HEALTH SCIENCES (NIEHS)

    AWHONN supports an increase in funding for NIEHS for fiscal year 2006,
            bringing the appropriation to $680 million
        Research conducted by the NIEHS plays a critical role in what we
    know about the relationship between our environmental exposures and
    disease onset. Through the research sponsored by this Institute, we
    know that Parkinson's disease, breast cancer, birth defects,
    miscarriage, delayed or diminished cognitive function, infertility,
    asthma and many other diseases and ailments have confirmed
    environmental triggers. Our expanded knowledge, as a result, allows
    both policy makers and the general public to make important decisions
    about how to reduce toxin exposure and reduce the risk of disease and
    other negative health outcomes.
        One impressive collaborative research project spearheaded by the
    NIEHS is the recent partnering of public and private funding agencies
    that will examine how better community design encourages people to be
    more physically active in their daily lives. Researchers will identify
    how our built environment contributes to obesity and how environmental
    changes can combat a growing public health problem. The NIEHS will
    examine the program's impact on physical activity, obesity, and other
    health indicators.

                CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)

    AWHONN recommends an fiscal year 2006 appropriation of $8.65 billion
            for the CDC
        For nearly 60 years, the Centers for Disease Control and Prevention
    (CDC) has evolved to assume responsibility for programs in infectious
    disease surveillance, control and prevention, injury control, health in
    the workplace, prevention of heart disease, cancer, stroke, obesity and
    other chronic diseases, improvements in nutrition and immunization,
    environmental effects on health, prevention of birth defects,
    laboratory analyses, outbreak investigation and epidemiology training,
    and data collection and analysis on a host of vital statistics and
    other health indicators. Now more than ever, CDC's role in protecting
    the nation's health through prevention has become evident as we address
    issues of terrorism, emergency preparedness and health system capacity
    and infrastructure. Increased funding for CDC is critical.
                Birth Defects
        For over 30 years, CDC has been deeply involved in the prevention
    of birth defects through programs like the Folic Acid Education
    Campaign and the new National Center on Birth Defects and Developmental
    Disabilities (NCBDDD). The public health impact of birth defects is
    tremendous. Of the four million babies born each year in the United
    States, approximately 120,000 are born with a serious birth defect.
    According to CDC, the lifetime costs of caring for infants born in
    1992, with at least one birth defect \1\ or cerebral palsy was about $8
    billion. The emotional and financial burden for the families with
    affected children is devastating. CDC funds several programs critical
    to reducing the number of children born with birth defects, including
    funding to states for birth defects tracking systems. Due to lack of
    funds, CDC is only able to fund 15 states in fiscal year 2005, which is
    down from 28 states in fiscal year 2004. Additional funding for these
    grants is needed to fund all of the states seeking CDC assistance for
    these critical surveillance programs.
    ---------------------------------------------------------------------------
        \1\ These birth defects include: Spina bifida, truncus arteriosus,
    single ventricle, transposition/double outlet right ventricle,
    Tetralogy of Fallot, tracheo-esophageal fistula, colorectal atresia,
    cleft lip or palate, atresia/stenosis of small intestine, renal
    agenesis, urinary obstruction, lower-limb reduction, upper-limb
    reduction, omphalocele, gastroschisis, Down syndrome, and diaphragmatic
    hernia.
    ---------------------------------------------------------------------------
                Cardiovascular Disease
        Cardiovascular disease is the leading cause of death in the United
    States, causing one death every 34 seconds and $393.5 billion a year in
    direct and indirect healthcare costs, according to the American Heart
    Association. The CDC reports that almost one-fourth of the U.S.
    population has some form of cardiovascular disease. Additionally, 65
    percent of American adults are overweight or obese and nearly 16
    percent of children and adolescents are overweight. Obesity is
    considered a major public health problem because it serves as the
    gateway disease for many other illnesses including but not limited to:
    depression, type 2 diabetes, hypertension, stroke, and poor female
    reproductive health and pregnancy complications.
        These are but two examples of illnesses with programmatic public
    health funding through CDC. Any cuts to these programs will potentially
    leave millions of Americans without primary prevention programs that
    ultimately save lives and money. AWHONN urges $8.65 billion in funding
    for CDC chronic disease prevention and health promotion programs to
    ensure that these programs have the resources necessary to translate
    preventive health research into practice. This investment will save
    lives and billions in health care costs and productivity.

                            SUMMARY RECOMMENDATIONS

        A summary of AWHONN formal funding recommendations for these and
    other federal health programs:

    ----------------------------------------------------------------------------------------------------------------
                                                                                   President's
                       Programmatic area                     Final fiscal year    budget fiscal     AWHONN's request
                                                                  2005 \1\          year 2006
    ----------------------------------------------------------------------------------------------------------------
    Nurse Workforce Development Programs...................       $151,889,000       $150,000,000       $210,000,000
    Maternal & Child Health Block Grant....................        729,817,000        724,000,000        850,000,000
    Indian Health Service..................................      2,985,000,000      3,048,000,000      5,540,000,000
    Title X--Family Planning...............................        288,283,000        286,000,000        350,000,000
    Newborn Hearing Screening..............................          9,872,000  .................         13,000,000
    AHRQ...................................................        319,000,000        319,000,000        440,000,000
    NIH....................................................     28,649,000,000     28,845,000,000     30,368,000,000
    NINR...................................................        138,000,000        139,000,000        160,000,000
    NICHD..................................................      1,271,000,000      1,278,000,000      1,350,000,000
    NIEHS..................................................        645,000,000        648,000,000        680,000,000
    CDC....................................................      4,572,000,000      4,017,000,000      8,650,000,000
    ----------------------------------------------------------------------------------------------------------------
    \1\ Fiscal year 2005 numbers taken from conference report on omnibus bill do not reflect a further .8% across-
      the-board rescission.

        Thank you for the opportunity to submit testimony on these critical
    areas of funding.
                                     ______

        Prepared Statement of the Blue Cross and Blue Shield Association

        The Blue Cross and Blue Shield Association (BCBSA), which
    represents 40 independent, locally operated Blue Cross and Blue Shield
    Plans throughout the nation, is pleased to submit written testimony to
    the subcommittee on fiscal year 2006 funding for Medicare contractors.
        Blue Cross and Blue Shield Plans play a leading role in
    administering the Medicare program. Many Plans contract with the
    federal government to run much of the daily work of paying Medicare
    claims accurately and timely. Blue Cross and Blue Shield Plans serve as
    Part A Fiscal Intermediaries (FIs) and/or Part B carriers and
    collectively process most Medicare claims.
        This testimony focuses on three areas:
        Background, including a description of Medicare contractor
    functions;
        Current financial challenges facing Medicare contractors; and
        BCBSA recommendations for Medicare contractor fiscal year 2006
    funding.

                                   BACKGROUND

        Blue Cross and Blue Shield Medicare contractors are proud of their
    role as Medicare administrators. While workloads have soared, operating
    costs--on a unit cost basis--have declined about two-thirds from 1975
    to 2005. In fact, contractors' administrative costs represent less than
    1 percent of total Medicare benefits.
        Medicare contractors have four major areas of responsibility:
        1. Paying Claims.--Medicare contractors process all the bills for
    the traditional Medicare fee-for-service program. In fiscal year 2006,
    it is estimated that contractors will process over 1.1 billion claims,
    nearly 4 million every working day.
        2. Providing Beneficiary and Provider Customer Services.--
    Contractors are the main points of routine contact with Medicare for
    both beneficiaries and providers. Contractors educate beneficiaries and
    providers about Medicare and respond to over 50 million inquiries
    annually.
        3. Handling Hearings and Appeals.--Beneficiaries and providers are
    entitled by law to appeal the initial payment determination made by
    carriers and FIs. These contractors handle nearly 8 million annual
    hearings and appeals.
        4. Special Initiatives to Fight Medicare Fraud, Waste, and Abuse.--
    All contractors have separate fraud and abuse departments dedicated to
    assuring that Medicare payments are made properly. Few government
    expenditures produce the documented, tangible savings of taxpayers'
    dollars generated by Medicare anti-fraud and abuse activities. For
    every $1 spent fighting fraud and abuse, Medicare contractors save the
    government $14.

                          CURRENT FINANCIAL CHALLENGES

        Of utmost importance to attaining outstanding performance is an
    adequate budget. Medicare contractors have been underfunded since the
    early 1990's, however, and the largest portion of the contractor
    budget--Medicare operations--faces particularly severe funding
    pressures. Medicare operations activities include claims processing,
    beneficiary and provider education and communications, hearings and
    appeals of claims initially denied, and systems maintenance and
    security.
        The underfunding of CMS and its Medicare contractors has gotten
    even more acute since the passage of the Health Insurance Portability
    and Accountability Act (HIPAA), the Benefits Improvement and Protection
    Act (BIPA), and the Medicare Modernization Act (MMA), which places new
    responsibilities on contractors, without sufficient resources to
    perform those duties. For example, between 1992 and 2002, Medicare
    benefits outlays increased 97 percent; claims volume increased 50
    percent; yet Medicare operations funding increased a mere 26 percent.
    Contractor staffing only increased by 6 percent during this time even
    though many new responsibilities were added and claims volume continued
    to rise. Clearly funding has not kept pace with additional work. In
    addition, the Medicare reform legislation includes significant changes
    that will require additional resources on an ongoing basis for
    contractors to implement.
        Whenever possible, contractors respond to reduced funding by
    achieving significant efficiencies in claims processing, but it is not
    enough to keep pace with rising Medicare claims volume and diminishing
    funding levels. It should be noted that contractors are already
    extremely efficient. Currently, contractors' administrative costs
    represent less than 1 percent of total Medicare benefits.
        Inadequate budgets for Medicare operations also impact Medicare's
    fight against fraud and abuse. While many think of Medicare operations
    activities as simply paying claims, these activities are Medicare's
    first line of defense against fraud and abuse and are critically linked
    to activities under the separately-funded Medicare Integrity Program
    (MIP). As an example, many of the front-end computer edits (e.g.,
    preventing duplicate payments and detecting inaccurately coded claims
    or claims requiring additional screening) are funded through Medicare
    operations.
        Inadequate funding impacts different functions at different times,
    but always disrupts the integration of all the functional components
    needed to ``get things right the first time.'' It thus results in
    inefficiency and higher costs.
    bcbsa fiscal year 2006 funding recommendations for medicare contractors
        BCBSA is pleased that many Members of this subcommittee recognize
    the need for adequate administrative resources at CMS. We are concerned
    the Administration's fiscal year 2006 budget would significantly cut
    Medicare operations funding by nearly $43 million. BCBSA urges Congress
    to take the following steps to allow Medicare contractors to meet
    increased workloads as well as beneficiary and provider needs:

    A. Increase Medicare Contractor Operations Funding to $2,240 Million
            for fiscal year 2006
        Medicare contractors continue to face increases in Medicare claims
    volume. Further reductions in administrative costs, as proposed in the
    President's budget, would seriously jeopardize contractors' ability to
    administer Medicare. BCBSA recommends:
        1. Claims processing funding must be maintained at $812 million
    ($10 million more than President's budget).--The President's budget
    would decrease claims processing funding by $10 million under the
    assumption that beneficiary movement to Medicare Advantage plans will
    decrease contractor workloads, particularly in claims processing,
    appeals and inquiries. BCBSA disagrees with this assumption.
        While BCBSA recognizes a slight reduction in claims, appeals, and
    inquiries could occur, the amount is highly uncertain. In fact, data
    suggests claims volume will increase by 4 percent in fiscal year 2006.
    Congress must ensure funding is available should volume and costs be
    higher than anticipated. Otherwise, contractors will be faced with
    budget shortfalls that will result in reduced services for
    beneficiaries and providers.
        2. Appeals funding must be restored to $109 million ($12.5 million
    more than the President's budget).--The President's budget would
    decrease appeals funding by $25 million under the assumption that the
    new Qualified Independent Contractors (QICs) will take on certain
    appeals responsibilities, lessening the load for contractors. BCBSA
    disagrees with this assumption.
        Appeals workloads and costs are on the rise for several reasons.
    First, implementation of the QICs is behind schedule, requiring
    contractors to continue some of this work. Second, contractor
    interfaces with QICs require funding to prepare the case and transfer
    information. Third, CMS recently announced it will eliminate provider
    phone appeals, which cost $10 compared to $19 for written appeals, and
    require separate written notification of favorable determinations.
        3. Inquires funding must be increased to $232 million ($27 million
    more than the President's budget).--The President's budget would
    decrease inquiries funding by $17 million under the assumption that
    CMS' 1-800-MEDICARE call volume will continue to increase, diminishing
    work at the contractor site. BCBSA disagrees with this assumption.
        While Medicare contractor call volume may decrease, the complexity
    and length of the call is increasing significantly. CMS often refers
    complex beneficiary and provider inquiries to the Medicare contractor
    that originally processed the claim. Further, CMS implemented a new
    Provider Customer Service Program required by the Medicare
    Modernization Act, but did not account for its costs in the fiscal year
    2006 budget.

    B. Increase Flexibility and Funding for the Medicare Integrity Program
            (MIP)
        Congress created MIP in 1996 to provide a permanent, stable funding
    authority for the portion of the Medicare contractor budget that is
    explicitly designated as fraud and abuse detection activities. Despite
    the continued rise in claims, MIP funding has been capped at $720
    million since fiscal year 2003. In fact, claims volume increased by
    more than 16 percent (158 million claims) since MIP was last increased.
    Clearly, benefit integrity activities cannot keep pace with rising
    claims volumes without additional funding. BCBSA recommends Congress:
      --Authorize an automatic yearly increase in MIP consistent with the
            rate of inflation and increase in claims volume;
      --Direct a portion ($20 million) of the new Part D oversight funding
            toward MIP Part A and B activities; and
      --Urge CMS to give contractors greater flexibility to manage their
            Medicare Integrity budgets.
        The following chart highlights BCBSA's request compared to fiscal
    year 2005 and the President's fiscal year 2006 request.

                                                [In millions of dollars]
    ----------------------------------------------------------------------------------------------------------------
                                                                                        President's
                                                                        Fiscal year     fiscal year    BCBSA fiscal
                       Medicare contractor budget                          2005            2006          year 2006
                                                                                      recommendation  recommendation
    ----------------------------------------------------------------------------------------------------------------
    Medicare Operations.............................................           2,233           2,190           2,240
    Medicare Integrity Program......................................             720             720             740
                                                                     -----------------------------------------------
          Total Contractor Budget...................................           2,953           2,910           2,980
    ----------------------------------------------------------------------------------------------------------------

                                     ______

         Prepared Statement of the Coalition of Northeastern Governors

        The Coalition of Northeastern Governors (CONEG) is pleased to
    provide this testimony for the record to the Senate Subcommittee on
    Labor, Health and Human Services, Education, and Related Agencies
    regarding fiscal year 2006 appropriations for the Low Income Home
    Energy Assistance Program (LIHEAP). The Governors appreciate the
    Subcommittee's consistent support for the LIHEAP program, and we
    recognize the difficult decisions facing the Subcommittee in this time
    of severe fiscal constraints. However, in light of sharply higher home
    energy prices, we request the Subcommittee provide $3.4 billion in
    regular fiscal year 2006 LIHEAP funding as well as the authority to
    release emergency contingency funds for unforeseen circumstances, such
    as price spikes in home heating fuels, severe weather and other
    potential emergencies.
        LIHEAP is a vital tool in making home energy more affordable for
    almost 5 million of the nation's very low-income households--the
    elderly and disabled on fixed incomes and families with young children.
    The percentage of income spent on total home energy by these low-income
    households can be four times higher than average households. For many
    of these households, annual income is simply not sufficient to pay high
    winter heating bills, even in periods of economic growth. Even after
    taking constructive actions to reduce their home energy use, too many
    low-income residents are forced to make dangerous choices between
    heating their homes, paying the full rent or mortgage, seeking medical
    attention, or purchasing food or vital medications.
        The substantial rise in home heating fuel prices hits these
    vulnerable citizens especially hard. The Northeast is heavily dependent
    on deliverable home heating fuels such as home heating oil, kerosene,
    and propane. In addition, price volatility in these fuels adversely
    affects the low-income households who, without the disposable income to
    purchase fuels off-season, typically enter the market when both the
    demand for and price of fuels are high.
        The Energy Information Administration predicts that the price of
    home heating oil, propane, and natural gas will continue to rise this
    year. Compared with 2001 to 2002, households can expect this winter to
    pay 55 percent more to heat a home with natural gas, 93 percent more
    for those heating with home heating oil, and 51 percent more for those
    heating with propane. However, within this same time period, the annual
    LIHEAP appropriation has increased modestly. In spite of the welcomed
    increase in LIHEAP funding, only a fraction--approximately 15 percent
    of eligible households--can be served at current LIHEAP funding. As a
    result, states across the country in recent years have seen significant
    increases in their regular LIHEAP caseloads, as well as in requests for
    emergency assistance from those households in imminent danger of a
    utility or fuel service cut-off. At current funding levels, states may
    be faced with the prospect of serving even fewer eligible households,
    reducing benefits, or curtailing the duration of the program. Clearly,
    the projected need far outweighs the available funding.
        Higher energy prices diminish the purchasing power of available
    LIHEAP funding assistance. In addition, without funds to carryforward
    to the new heating season, state LIHEAP programs lack the capability to
    undertake the ``pre-buy'' programs that help stabilize heating fuel
    prices for low-income households and expand the reach of limited
    program funds. An increased federal appropriation would allow states to
    manage the program resources in a manner to better take advantage of
    market opportunities.
        The current uncertainty of world energy markets underscores the
    importance of states being able to prepare for rising and potentially
    volatile energy prices. These preparedness activities, while critical,
    cannot fully shield our lowest-income citizens from the impacts of
    higher heating fuel prices. An increase in the regular LIHEAP
    appropriation to $3.4 billion in fiscal year 2006 will enable states
    across the nation to reach more of those vulnerable citizens in need of
    assistance and more fully implement cost-effective measures to meet
    their continuing energy needs.
        Your support for fiscal year 2006 LIHEAP appropriations at the $3.4
    billion level, as well as the authority to release emergency
    contingency funds for unforeseen circumstances, is urgently needed to
    enable our states to help mitigate the potential life-threatening
    emergencies and economic hardship that confront the nation's most
    vulnerable citizens.
        We thank the Subcommittee for this opportunity to share the views
    of the Coalition of Northeastern Governors, and we stand ready to
    provide you with any additional information on the importance of the
    Low Income Home Energy Assistance Program to the Northeast.
                                     ______

              Prepared Statement of the Community Medical Centers

        Mr. Chairman and Members of the Subcommittee: My name is Dr. Philip
    Hinton and I am the Chief Executive Officer of Community Medical
    Centers in Fresno, California. Community Medical Centers is a not-for-
    profit, locally owned health care corporation that is committed to
    improving the health of the community. I am pleased to provide the
    subcommittee with a request for assistance in securing federal monies
    for a critical project in the Central San Joaquin Valley that would
    improve access to health care to the uninsured in Fresno County.
        The challenges and struggles facing our nation's public hospitals
    and health systems are ever-increasing. The nation's uninsured
    population continues to grow while there are significant reductions in
    state and federal government support. Hence, it is imperative for
    public hospitals to maximize their public funding sources while being
    proactive and creative in its strategies to deliver care to those who
    need it most.
        Community Medical Centers serves as the ``safety net'' provider for
    Fresno County. In its 1996 partnership with the County of Fresno,
    Community assumed the obligations of indigent care. In order to fulfill
    this obligation, last year Community provided over $90 million in
    uncompensated care. However, as Community looks to the future, it has
    determined the need for a more bold and aggressive strategy to meet the
    tremendous need for health care services in Fresno County.
        In its efforts to make health care available to the over 30 percent
    of the County's residents who are uninsured, Community has planned an
    Outpatient Care Center on the campus of the Regional Medical Center in
    downtown Fresno. This proposed facility will provide primary and
    specialty care including a children's clinic, a women's clinic focusing
    on prenatal, obstetrical and gynecological needs, asthma treatment and
    education, diabetes education and treatment, and surgical follow-up.
    This facility addresses the need for primary care services to the
    underinsured and uninsured population while attempting to reduce the
    number of unnecessary visits to local emergency departments. Although
    the overcrowding of emergency departments by the uninsured is a
    national problem, the Fresno area is particularly impacted with a
    larger percentage of uninsured.
        In addition to a high percentage of uninsured, the region boasts
    some equally sobering statistics:
      --An unemployment rate hovering at 15 percent
      --Over 25 percent of the residents living below the poverty line
      --The third highest asthma mortality rate in the nation
      --The highest rates of teen pregnancy in the state
      --Late or no prenatal care for pregnant women
        We believe that an Outpatient Care Center is critical to begin
    addressing these challenges, and we would like to ask for your
    assistance in securing $1 million towards the construction of this
    facility. We at Community Medical Centers are working diligently to
    secure significant private foundation monies for this facility as well.
    We understand that this request would require a special earmark under
    the Health Resources Services Administration account in the Labor/
    Health and Human Services/Education appropriations bill. We know that
    funds are limited, but feel that this project merits funding. It is a
    project which will improve the quality of life in the Central San
    Joaquin Valley.
                                     ______

          Prepared Statement of the Council of State and Territorial
                                Epidemiologists

        The Council of State and Territorial Epidemiologists (CSTE) is
    pleased to provide the Subcommittee with its fiscal year 2006 funding
    recommendations for nine priorities all of which are programs and
    activities administered by the Centers for Disease Control and
    Prevention.
        CSTE is a professional association with over 850 public health
    epidemiologists working in all 50 states as well as local and
    territorial health agencies to detect, prevent and control conditions
    that impact the public's health. CSTE members possess expertise in
    surveillance and epidemiology in a broad range of areas including
    communicable diseases, immunization, environmental health, chronic
    diseases, occupational health, injury control, maternal and child
    health and oral health.

     PUBLIC HEALTH WORKFORCE: INCREASING STATE AND LOCAL EPIDEMIOLOGY AND
                              LABORATORY CAPACITY

      --$4 million increase for CDC's Office of Workforce and Career
            Development in fiscal year 2006 to support 65 CDC/Council of
            State and Territorial first year applied epidemiology fellows
            at a cost of $60,000 per year;
      --$2 million in increased funding for CDC's National Center for
            Infectious Diseases in fiscal year 2006 to support 35 CDC/
            Association of Public Health Laboratory applied research
            training fellows.
        The disciplines of epidemiology and laboratory science are the
    pillars and backbone of public health practice. States and local
    communities have come to rely on well trained public health
    epidemiologists and laboratory scientists to investigate, monitor, and
    respond aggressively to public health threats. Every state's residents
    have become familiar with the ``disease detectives'' who they know will
    be in the lead for communicating risks and recommending preventive
    action for outbreaks of SARS, flu, West Nile virus, Monkeypox and
    epidemics of obesity, diabetes, HIV/AIDS and a host of other serious
    threats the public has experienced during recent years. These are the
    ``go to'' professionals in every state. Yet, a new 2004 epidemiology
    capacity survey shows the number and the level of training of
    epidemiologists is perceived as seriously deficient in most states.
    Federal funding has increased the number of epidemiologists engaged in
    bioterrorism preparedness since 2002, but has done so at the expense of
    state environmental health, injury and occupational health activities--
    shifting epidemiologists from these activities to federal bioterrorism
    preparedness priorities. Those engaged in chronic disease activities
    have increased since 2002, but are still viewed as too low in number
    and training and the number of epidemiologists engaged in infectious
    disease activities has stagnated.
        Efforts under the leadership of CDC have been made to begin
    addressing these gaps at both the federal and state level. In addition
    to expanded CDC Epidemic Intelligence Service and Career Epidemiology
    Field Officers for state and local health departments, CDC is
    supporting training fellowship programs for epidemiologists and
    laboratory scientists who are expected to increase state capacity and
    provide future leadership in these professions. CSTE applauds these
    efforts and proposes aggressive expansion of existing state-focused
    programs to increase the number of epidemiologists and public health
    laboratory scientists at state and local health departments. The
    proposed fiscal year 2006 increase will provide CSTE and APHL with the
    resources to accelerate much needed expansion of the state and local
    workforce in these critical disciplines to approximately 75
    epidemiologists and 75 laboratory scientists in training during fiscal
    year 2006.
        The overall benefits to the states and localities will be
    additional well trained epidemiologists and laboratory scientists
    entering employment through training programs that include the
    following characteristics:
      --national recruiting through a partnership between CSTE and the
            Association of Schools of Public Health
      --orientation and training course with CDC and CSTE and APHL faculty
      --a ready-made applicant pool for state and local positions with
            adequate time to evaluate job performance
      --a structured, individualized training curriculum for each fellow
      --technical and administrative support for fellows and state mentors

      PUBLIC HEALTH INFRASTRUCTURE ENHANCEMENT AND TERRORISM PREPAREDNESS

        CSTE supports $927 million, at a minimum, for CDC's State and Local
    preparedness grants to enhance capacity to prepare for and respond to
    terrorist attacks. The President's fiscal year 2006 request for CDC's
    State and local terrorism preparedness grants cuts funding by $130
    million and appears to shift this funding to National Stockpile
    activities, including a new $50 million Federal Mass Casualty
    Initiative. CSTE opposes this cut to on-going efforts to build strong
    state and local capacity which means, in many cases, eliminating
    personnel already hired. New federal initiatives, if they are deemed
    needed, should be funded from new resources.
        After decades of neglect of governmental public health systems,
    documented in numerous Institute of Medicine (IOM) reports, and Reports
    to Congress (The Future of the Public's Health in the 21st Century,
    IOM, 2003; Emerging Microbial Threats to Health in the 21st Century,
    IOM, 2003; Report to Congress, Public Health's Infrastructure: a Status
    Report, CDC, 2001; Emerging Infectious Diseases: Consensus on Needed
    Laboratory Capacity could Strengthen Surveillance, GAO, 1999), Congress
    and the Administration began a substantial effort to repair the damage
    following the events of 9/11 and the ensuing anthrax attacks. This
    effort to restore and enhance the system to protect the public against
    terrorist attacks, as well as naturally occurring disease threats, such
    as SARS, pandemic influenza, and West Nile virus, is beginning to have
    positive effect, but progress can only continue with sustained support.
        Reasons for maintaining funding levels in fiscal year 2006:
      --No single State, and no community in any State, has reached a full
            level of national security preparedness to address the health
            consequences of a terrorist event.
      --Few public health preparedness investments are one-time expenses.
            State and local health departments have been strongly urged to
            use preparedness funding to increase their personnel capacity
            in epidemiology, laboratory science, communications and
            logistics. Personnel are on-going expenses.
      --State and local health departments are in the third year of
            expanded funding for terrorism preparedness. The effect of
            reducing the amount of available funding by 14 percent will
            seriously jeopardize their momentum in addressing critical
            capacity needs.
      --The CDC cooperative agreement guidance listed several new
            eligibility areas for State spending, including mental health,
            chemical preparedness, and food security and newly expanded
            guidance is expected for fiscal year 2005. In addition, States
            are being asked to help administer several new federal programs
            such as BioWatch, BioSense, ChemPack, additional smallpox
            vaccination program activities, and consequence management for
            postal facility Biohazard Detection Systems. This requires
            spreading funding over increased areas of responsibility.
        Now is not the time to reduce our national commitment to State and
    local health departments. Building a strong public health
    infrastructure, particularly a trained public health workforce with
    sufficient epidemiologists and public health laboratory scientists,
    core public health professionals, will take a sustained commitment of
    resources over a long period of time, but will reap critical benefits
    in protected health.

    CSTE SUPPORTS $132 MILLION FOR THE PHHS BLOCK GRANT IN FISCAL YEAR 2006

        The Preventive Health and Health Services Block Grant, currently
    funded at $132 million, is proposed to be eliminated in the President's
    fiscal year 2006 budget. CSTE urges Congress not to cut this important
    prevention program for states, but maintain funding at the fiscal year
    2005 level. When this proposed cut is considered alongside the $130
    million cut in the state and local Bioterrorism grant program, the net
    result is to seriously undermine support for developing state public
    health capacity and activities, a strong Congressional goal leading up
    to and following the attacks of 9/11.
        The Block Grant was created to help states focus on achieving the
    health objectives identified in Healthy People 2010--a nationally
    conceived effort to set and achieve national health goals. To receive
    block grant funding, states must develop health plans, report to the
    federal government about their activities, and target public health
    interventions to populations in need. The flexibility of the grant
    allows each state to address their own unique challenges in exciting
    and innovative ways.
        Examples of this include a program in Idaho to prevent falls for
    older adults. Falls are the leading cause of injury death for Idaho
    adults age 65 and older, with hip fractures along costing the United
    States $20 billion annually. The Idaho program funds a curriculum and
    provides training to individuals who lead senior fall prevention
    exercise programs throughout the state. Another example is in Alabama
    where the Community Waterborne Disease Program, funded solely with PHHS
    Block Grant dollars protects 340,000 Alabamians who reside in rural
    areas against waterborne disease outbreaks from contaminated wells and
    septic tanks. Other Block Grant funds are used to combat newly emerging
    public health threats, such as West Nile virus, distribute smoke
    detectors, counter the growing epidemic of obesity and ensuing chronic
    diseases, improve cancer screening, conduct disease surveillance and
    infectious disease outbreaks, such as Hepatitis A and E.coli 0157:H7.
    While Block Grant funds sometimes complement existing categorical
    programs, they DO NOT DUPLICATE other CDC funded programs.

     CSTE SUPPORTS $250 MILLION FOR INFECTIOUS DISEASES CONTROL IN FISCAL
                                   YEAR 2006

        Infectious diseases are the leading cause of death worldwide, and
    the number of deaths from infectious diseases had been increasing in
    the recent past and remains substantial in the United States today. New
    challenges in the growth of resistance to commonly used antibiotics,
    emerging disease threats such as avian flu, SARS, the rapid spread of
    West Nile virus across the United States, and the rising number of food
    borne disease outbreaks, including increased monitoring of mad cow
    disease, make increased resources for infectious diseases control
    essential to the nation's health and well-being.
        CSTE's fiscal year 2006 recommendation for infectious diseases
    control is $25 million more than the fiscal year 2005 appropriation
    level of $225.5 million. CSTE urges that the additional $25 million in
    funding target the following critical areas:
      --Expand the Emerging Infections Program (EIP) from its current
            funding level of about $20 million to allow more than the
            current 11 States (CA, CO, CT, GA, MD, MA, NM, NY, OR, TN, TX)
            to join this program that provides a population-based network
            of surveillance for infectious diseases, applied epidemiologic
            and laboratory research, as well as capacity for flexible
            public health response.
      --Provide support for epidemiology fellowship programs to expand the
            number of trained public health epidemiologists, particularly
            at the State level, where shortages in these essential public
            health professionals are severe.
      --Expand the Epidemiology and Laboratory Capacity (ELC) cooperative
            agreement program which provides the 50 States, plus six large
            local health departments (Chicago, Houston, Los Angeles, New
            York City, Philadelphia, Washington, D.C.) and Puerto Rico,
            with support to strengthen the collaboration between
            epidemiologic and laboratory science at the State and local
            level to meet the demands placed upon the country by emerging
            and re-emerging infectious disease threats.
      --Ensure that funding for CDC's new initiative in global infectious
            diseases supports the International Emerging Infections
            Program, which is modeled on the U.S. EIP program.

     CSTE SUPPORTS $50 MILLION FOR CDC'S HEALTH TRACKING GRANT PROGRAM IN
                                FISCAL YEAR 2006

        Researchers have linked specific diseases with exposures to some
    environmental hazards, such as the link between exposure to asbestos
    and lung cancer. Other links remain unproven, such as the suspected
    link between exposure to disinfectant by-products and bladder cancer.
    As the Pew Environmental Health Commission's report, ``America's
    Environmental Health Gap: Why the Country Needs A Nationwide Health
    Tracking Network'' noted, there is currently no national surveillance
    system to investigate the possible links between these environmental
    exposures and a number of diseases and conditions. Most states have
    little environmental health capacity. The Environmental Public Health
    Tracking Program is designed to increase state and local environmental
    health capacity by providing resources to conduct surveillance of
    health effects, exposures and hazards and their possible linkages.

    Program Accomplishments
        Since fiscal year 2002, CDC has supported 20 state and local health
    departments to:
      --Build environmental health capacity
      --Increase collaboration between environmental and health agencies
      --Identify and evaluate existing data systems
      --Build partnerships with non-governmental organizations and
            communities
      --Develop model systems that link data
        Additional funding would be used to:
      --Fund additional state health departments to increase their
            environmental health capacity
      --Fund technical development activities to support a nationwide
            network
      --Expand training and education activities
      --Expand collaboration with national partners to coordinate
            technologic standards development efforts for the network
        Surveillance: Four Priorities--Behavioral Risk Factor Surveillance
    Survey (BRFSS).--Among the many important chronic disease programs
    within CDC's Center for Chronic Disease Prevention, Health Promotion,
    and Genomics which CSTE supports, a priority is the Behavioral Risk
    Factor Surveillance Survey (BRFSS). CSTE urges continued progress
    toward achieving a funding level of $18 million (+$10 million)--the
    base amount needed to fully implement the survey. CSTE is very pleased
    that Congress increased funding for the survey from $1.8 million where
    it had remained for many years, to $6.9 million in fiscal year 2003 and
    to $7.2 million in fiscal year 2004 and $7.6 million in fiscal year
    2005. The BRFSS is a primary source of information to guide
    intervention, policy decision, and budget direction at the local, state
    and federal level for a host of health problems, especially chronic
    diseases. It is the source of data for 24 of the 73 chronic disease
    indicators, six areas of the Healthy People 2010 leading health
    indicators and serves as the core source of surveillance for multiple
    public health programs across the CDC. The additional funding provided
    in fiscal year 2004 and fiscal year 2005 will significantly improve
    data collection infrastructure, timeliness, and analysis that will not
    only improve guidance for state-based public health activities, but
    allow state to state comparisons, state to national comparisons, and a
    more solid foundation for national resource and other decisions with
    regard to a range of public health activities.
        HIV/AIDS Surveillance.--Within a total recommendation of $1,049.2
    million (+$386.6 m) for CDC's HIV/AIDS prevention activities, CSTE
    urges an increase of $35 million in fiscal year 2006 for HIV/AIDS
    surveillance cooperative agreements with state and local health
    departments to strengthen HIV case reporting. Surveillance activities
    are critical to the goal of preventing new HIV infections which can
    save an estimated $195,000 in lifetime treatment costs per individual.
    Persistent, significant funding gaps between what state and local
    health departments have requested and what CDC can provide impede
    attainment of national prevention goals. CSTE recommends, at minimum,
    an additional $35 million for HIV/AIDS core surveillance, enhanced
    perinatal surveillance, incidence surveillance, behavioral surveillance
    and morbidity monitoring.
        National Violent Death Reporting System.--Within a total
    recommendation of $168 million (+$30 m) for CDC's National Center for
    Injury Prevention and Control, CSTE urges $10 million in funding for
    fiscal year 2006 (+$6.8 million) to continue building a fully
    implemented violent death reporting system in every state. Information
    from the reporting system can be used to target prevention and early
    intervention efforts to prevent a significant number of the 50,000
    annual deaths in the United States due to violence. Increased resources
    in fiscal year 2006 would be used to create uniform reporting systems
    in more states and build capacity to both collect and analyze data;
    ensure leadership and assistance; establish strong partnerships among
    federal, state, and non-governmental organizations; and research
    potential barriers to data collection. As of August, 2004, CDC is
    funding 17 states: AK, CA, CO, GA, KY, MA, MD, NC, NJ, NM, OK, OR, RI,
    SC, UT, VA, WI.
        State-Based Occupational Safety and Health Surveillance.--Within a
    total recommendation of $335 million (+$49 m) for CDC's NIOSH
    activities, CSTE urges that $10 million be provided in fiscal year 2006
    to fully fund this program to prevent workplace injuries, diseases and
    death.. Both the CDC and CSTE believe that programs should be
    established within State Health departments as one of the most
    effective ways to build a nationwide system to prevent major causes of
    injuries and illnesses that are caused by hazardous conditions at work.
    The CDC and CSTE have established 13 occupational health indicators
    that every State should use to measure the burden of workplace injuries
    and illnesses, and then determine where they need to act to reduce
    preventable disease and disability in the population. In fiscal year
    2005, NIOSH has funded the first 12 States to establish programs to use
    these indicators to count workplace injuries and illnesses, and make
    recommendations about how to prevent a few important health conditions
    (such as asthma, pesticide illness, silica lung diseases, and
    needlesticks). This program should be expanded to all 50 States to
    assure that every State has the capacity to track work-related health
    problems and take steps to prevent work-related injury, disease and
    death. Professional judgment assesses that $10 million is needed to
    expand this program to all 50 States.
                                     ______

    Prepared Statement of the Friends of the Health Resources and Services
                             Administration (HRSA)

        The Friends of HRSA is an advocacy coalition of more than 100
    national organizations, collectively representing millions of public
    health and health care professionals, academicians and consumers. Our
    member organizations strongly support programs that assure Americans'
    access to health services.
        HRSA programs assure that all Americans have access to our nation's
    best available health care services. Through its programs in thousands
    of communities across the country, HRSA provides a health safety net
    for medically underserved individuals and families, including 45
    million Americans who lack health insurance; 49 million Americans who
    live in neighborhoods where primary health care services are scarce;
    African American infants, whose infant mortality rate is more than
    double that of whites; and the estimated 850,000 to 950,000 people
    living with HIV/AIDS. Programs to support the underserved place HRSA on
    the front lines in erasing our nation's racial/ethnic and rural/urban
    disparities in health status. HRSA funding goes where the need exists,
    in communities all over America. The Friends support a growing trend in
    HRSA programs to increase flexibility of service delivery at the local
    level, necessary to tailor programs to the unique needs of America's
    many varied communities. The agency's overriding goal is to achieve 100
    percent access to health care, with zero disparities. In the best
    professional judgment of the members of the Friends of HRSA, to respond
    to this challenge, the agency will require a funding level of at least
    $7.5 billion for fiscal year 2006.
        Through its many programs and new initiatives, HRSA helps countless
    individuals live healthier, more productive lives. In the 21st century,
    rapid advances in research and technology promise unparalleled change
    in the nation's health care delivery system. HRSA is well positioned to
    meet these new challenges as it continues to provide first-rate health
    care to the nation's most vulnerable citizens. We are grateful to the
    Subcommittee for your consistent strong support for all of HRSA's
    programs, including the initiatives in terrorism preparedness and
    response in the past. Unfortunately, the president's budget overall
    recommends a massive $838 million or over 12 percent cut to the agency
    for fiscal year 2006. We urge the members of the Subcommittee to
    restore the cuts and fund the agency at a level that allows HRSA to
    effectively implement these important programs.
        Community-based health centers and National Health Service Corps-
    supported clinics form the backbone of the nation's safety net. More
    than 4,000 of these sites across the nation provide needed primary and
    preventive care to nearly 15 million poor and near-poor Americans. HRSA
    primary care centers include community health centers, migrant health
    centers, health care for the homeless programs, public housing primary
    care programs and school-based health centers. Health centers provide
    access to high-quality, family-oriented, culturally and linguistically
    competent primary care and preventive services, including mental and
    behavioral health, dental and support services. Nearly three-fourths of
    health center patients are uninsured or on Medicaid, approximately two-
    thirds are people of color, and more than 85 percent live below 200
    percent of the poverty level. Additional primary care is provided by
    2,700 clinicians in the National Health Service Corps. Corps members
    work in communities with a shortage of health professionals in exchange
    for scholarships and loan repayments. The Friends of HRSA are pleased
    that the president has requested a significant 17.5 percent increase
    for Community Health Centers for a total of $2.038 billion.
        The Friends are concerned about a number of programs slated for
    deep cuts or elimination under the Administration's fiscal year 2006
    budget proposal. An adequate, diverse, well-distributed and culturally
    competent health workforce is indispensable to our national readiness
    efforts. We are concerned with the president's proposed cut for
    hospital preparedness. In the post 9/11 era, all responders, providers
    and facilities must be ready to detect and respond to complex
    disasters, including terrorism, and HRSA must continue to support these
    vital programs.
        HRSA Health Professions Programs under Title VII and VIII address
    the need for an adequate national workforce in the face of projected
    nationwide shortages of nurses, pharmacists, and other professionals.
    Graduates of these programs are up to 10 times more likely to practice
    in underserved areas, and they are up to 5 times more likely to be
    minorities. These programs provide support to students, programs,
    departments, and institutions to improve the accessibility, quality,
    and racial and ethnic diversity of the health care workforce. In
    addition to providing unique and essential training and education
    opportunities, these programs help meet the health care delivery needs
    of the areas in this country with severe health professions shortages,
    at times serving as the only source of health care in many rural and
    disadvantaged communities. The Friends are greatly concerned about the
    elimination of most funding for the Title VII health professions
    training programs and flat funding for Title VIII nurse training.
        The Healthy Community Access Program is an example in which
    communities build partnerships among health care providers to deliver a
    broader range of health services to their neediest residents. Grantees
    are public or private entities that demonstrate a commitment to
    bridging service gaps and improving health outcomes for uninsured and
    underserved people. The Friends are very concerned that the
    Administration's budget proposal once again recommends eliminating this
    program of coordinated service delivery, an innovative program that
    does not duplicate other available programs.
        Another vital program administered by HRSA is newborn screening.
    Newborn screening is a public health activity used for early
    identification of infants affected by certain genetic, metabolic,
    hormonal or functional conditions for which there is effective
    treatment or intervention. Screening detects disorders in newborns
    that, left untreated, can cause death, disability, mental retardation
    and other serious illnesses. Parents are often unaware that while
    nearly all babies born in the United States undergo newborn screening
    tests for genetic birth defects, the number and quality of these tests
    vary from state to state. Screening programs coordinated through the
    HRSA Bureau of Maternal and Child Health will assure that every baby
    born in the US receive, at a minimum, a universal core group of
    screening tests regardless of the state in which he/she is born.
        Title 26 of the Children's Health Act of 2000 authorized funding
    for grants and programs to improve state-based newborn screening. This
    provision also called for an advisory committee to provide advice and
    recommendations to the Secretary for the development of grant
    administration policies and priorities, and to enhance the ability of
    the Secretary to reduce mortality or morbidity from heritable
    disorders. The Secretary appointed 15 members to this committee in
    February 2004. HRSA, together with this committee, recently published a
    report to be considered by the Secretary, which makes recommendations
    on the number and types of conditions that should be required by state
    programs. The Friends are very concerned that the Administration's
    budget did not include additional funding for such activity and that
    once again, the President's budget zeroed-out existing funding for the
    universal newborn hearing screening program. The newborn screening
    program is vital to ensuring that newborns are screened and treated for
    conditions that, if left alone, disability, mental retardation and even
    death.
        HRSA programs improve health care service for the more than 61
    million people who live in rural America. Although almost a quarter of
    the population lives in rural areas, only an eighth of our doctors work
    there. Because rural families earn less than urban families, many
    health problems associated with poverty are more serious, including
    high rates of chronic disease and infant mortality. While the recently
    passed Medicare prescription drug bill included several enhancements
    for Medicare reimbursement for rural hospitals, this does not justify
    the elimination of small, targeted programs designed to improve access
    to health care services in rural areas. The deep $115 million cut
    proposed for rural health programs has the potential to only exacerbate
    rural/urban health disparities seen today.
        In light of many states experiencing budget crises, HRSA's State
    Planning Grants Program provides one-year grants to States to develop
    plans for providing access to affordable health insurance coverage to
    all their citizens. Considering that 45 million Americans are
    uninsured, with many individuals simultaneously being dropped from
    Medicaid and SCHIP rolls, there is a need for states to explore
    alternative approaches that provide health insurance benefits to its
    residents that are affordable in nature. The potential for states to
    share best practices as a result of this program is enormous, and
    therefore the Friends of HRSA is gravely concerned with this program's
    proposed elimination in the president's budget request.
        Also, the proposed elimination of the Emergency Medical Services
    for Children Program is of concern considering many children who are
    eligible for Medicaid and SCHIP cannot enroll due to state enrollment
    limits and budgetary pressures. Therefore, these uninsured children
    will likely increasingly utilize emergency health services, as they are
    less likely to have a usual source of care. Not investing in improving
    the quality of emergency health services to children, especially at
    this time, may result in higher rates of death and disability among
    this population. Also, this program, as outlined in the midcourse
    review of the EMSC Five-Year Plan, 2001-2005, has been shown to make
    significant progress in meeting stated objectives to improve emergency
    health service delivery to children.
        The Friends of HRSA are also concerned with the proposed flat
    funding of programs that make a difference in thousands of communities
    across the United States, and ultimately affect the lives of millions.
    The Maternal and Child Health Block Grant is another source of flexible
    funding for states and territories to address their unique needs, and
    remains in great need of increased, not flat, funding. The Block Grant
    is one of several HRSA Maternal and Child Health programs. Each year,
    more than 26 million pregnant women, infants and children nationwide
    are served by a MCH program. Of the nearly 4 million mothers who give
    birth annually, almost half receive some prenatal or postnatal service
    from a MCH-funded program. MCH programs increase immunizations and
    newborn screening, reduce infant mortality and developmentally
    handicapping conditions, prevent childhood accidents and injuries, and
    reduce adolescent pregnancy. Although states in theory could use MCH
    block grant funds to continue the universal newborn hearing screening
    and Emergency Medical Services for Children programs, two programs that
    have been proposed for elimination, in reality this is not a viable
    alternative. With the proposed flat funding of the block grant, funding
    additional programs under its auspices would mean that programs
    currently funded would have to be cut.
        Title X of the Public Health Service Act was enacted to provide
    high-quality, subsidized contraceptive care to those who need but
    cannot afford such services, to improve women's health, reduce
    unintended pregnancies, and decrease infant mortality and morbidity.
    Title X programs provide comprehensive, voluntary and affordable family
    planning services to millions of low-income women and men--many of whom
    are uninsured--at more than 4,600 clinics nationwide. People who visit
    Title-X funded clinics receive a broad package of preventive health
    services, including breast and cervical cancer screening, blood
    pressure checks, anemia testing, and STD/HIV screening.
        The Ryan White CARE Act programs, administered by HRSA's HIV/AIDS
    Bureau, are the largest single source of federal discretionary funding
    for HIV/AIDS health care for low-income, uninsured and underinsured
    Americans. We are very concerned that most programs under the Act would
    be flat-funded should the figures requested by the Administration be
    implemented, which will not be enough to meet the growing need and
    demand for services. The CARE Act program is an important safety net
    program, providing an estimated 533,000 people access to services and
    treatments each year. In addition to primary health care, CARE Act
    programs support the dissemination of drug therapies, home-based care,
    early intervention services, treatment adherence, case management and
    support. The CARE Act also funds a dental reimbursement program and the
    AIDS Education and Training Centers that offers specialized clinical
    education on the latest in HIV/AIDS care. Only the State AIDS Drug
    Assistance Program (ADAP), which provides medications to over 120,000
    individuals those living with HIV/AIDS who would otherwise fall through
    the cracks, lacking private health insurance, but ineligible for
    Medicaid, receives an increase of $10 million over fiscal year 2005.
        Cross-cutting HRSA programs continually respond to new public
    health challenges. Tooth decay remains the single most chronic
    childhood disease in the nation. About 125 million Americans have no
    dental insurance; lack of access to dental care is especially severe
    among children of poor, rural and minority families. A quarter of the
    nation's school-age children have 80 percent of all dental disease,
    putting them at risk for a host of related illnesses. And as new drugs
    help people with HIV/AIDS live longer, healthier lives, their need for
    regular oral health care will continue to climb. HRSA can help both
    groups by increasing the number of dentists in community and school-
    based centers and by providing greater reimbursements to hospital
    dental clinics and dental schools for the growing costs of treating
    people living with HIV/AIDS.
        The members of the Friends of HRSA are grateful for this
    opportunity to present our views to the Subcommittee.
                                     ______

            Prepared Statement of the InterTribal Bison Cooperative

                          INTRODUCTION AND BACKGROUND

        My name is Ervin Carlson, a Tribal Council member of the Blackfeet
    Tribe of Montana and President of the InterTribal Bison Cooperative.
    Please accept my sincere appreciation for this opportunity to submit
    testimony to the honorable members of the Appropriations Sub-Committee
    on Labor, Health and Human Services and Education. The InterTribal
    Bison Cooperative (ITBC) is a Native American non-profit organization,
    headquartered in Rapid City, South Dakota, comprised of 54 federally
    recognized Indian Tribes located within 18 States across the United
    States.
        Buffalo thrived in abundance on the plains of the United States for
    many centuries before they were hunted to near extinction in the 1800s.
    During this period of history, buffalo were critical to survival of the
    American Indian. Buffalo provided food, shelter, clothing and essential
    tools for Indian people and insured continuance of their subsistence
    way of life. Naturally, Indian people developed a strong spiritual and
    cultural respect for buffalo that has not diminished with the passage
    of time.
        Numerous tribes that were committed to preserving the sacred
    relationship between Indian people and buffalo established the ITBC as
    an effort to restore buffalo to Indian lands. ITBC focused upon raising
    buffalo on Indian Reservation lands that did not sustain other economic
    or agricultural projects. Significant portions of Indian Reservations
    consist of poor quality lands for farming or raising livestock.
    However, these wholly unproductive Reservation lands were and still are
    suitable for buffalo. ITBC began actively restoring buffalo to Indian
    lands after receiving funding in 1992 as an initiative of the Bush
    Administration.
        Upon the successful restoration of buffalo to Indian lands,
    opportunities arose for Tribes to utilize buffalo for tribal economic
    development efforts. ITBC is now focused on efforts to assure that
    tribal buffalo projects are economically sustainable. Federal
    appropriations have allowed ITBC to successfully restore buffalo the
    tribal lands, thereby preserving the sacred relationship between Indian
    people and buffalo. The respect that Indian tribes have maintained for
    buffalo has fostered a serious commitment by ITBC member Tribes for
    successful buffalo herd development. The successful promotion of
    buffalo as a healthy food source will allow Tribes to utilize a
    culturally relevant resource as a means to achieve self-sufficiency.

            FUNDING REQUEST FOR PREVENTATIVE HEALTH CARE INITIATIVE

        The InterTribal Bison Cooperative respectfully requests an
    appropriation for fiscal year 2006 in the amount of $2,000,000 in the
    form of an earmark to the Department of Health and Human Service
    Department's budget. ITBC intends to utilize the funds to conduct a
    national demonstration project focused on the delivery of bison meat to
    Native Americans suffering from diet related diseases.
        The Native American population currently suffers from the highest
    rates of Type 2 diabetes. The Indian population further suffers from
    high rates of cardio vascular disease and various other diet related
    diseases. Studies indicate that Type 2 diabetes commonly emerges when a
    population undergoes radical diet changes. Native Americans have been
    forced to abandon traditional diets rich in wild game, buffalo and
    plants and now have diets similar in composition to average American
    diets. More studies are needed on the traditional diets of Native
    Americans versus their modern day diets in relation to diabetes rates.
    However, based upon the current data available, it is safe to assume
    that disease rates of Native Americans are directly impacted by a
    genetic inability to effectively metabolize modern foods. More
    specifically, it is well accepted that the changing diet of Indians is
    a major factor in the diabetes epidemic in Indian Country.
        Approximately 65-70 percent of Indians living on Indian
    Reservations receive foods provided by the USDA Food Distribution
    Program on Indian Reservation (FDPIR) or from the USDA Food Stamp
    Program. The FDPIR food package is composed of approximately 58 percent
    carbohydrates, 14 percent proteins and 28 percent fats. Studies have
    shown that the FDPIR food package has not been compatible with the
    genetic compositions of Native Americans and has been a major factor in
    the high incidence of diet-related disease among Native Americans.
    Indians utilizing Food Stamps generally select a grain based diet and
    poorer quality protein sources such as high fat meats based upon
    economic reasons and the unavailability of higher quality protein food
    sources.
        Buffalo meat is low in fat and cholesterol and is compatible to the
    genetics of Indian people. ITBC intends to develop a health care
    initiative that would educate Indian Reservation families of the
    benefits of incorporating buffalo meat into their diets. In conjunction
    with educating Reservation families on the benefits of buffalo meat,
    ITBC intends to develop methods to make buffalo meat accessible for
    Indian families and to promote incorporation of buffalo into their
    diets. ITBC intends to coordinate with Reservation health care
    providers in nutritional studies of Reservation populations that
    incorporate buffalo meat into diet packages.
        ITBC believes that incorporating buffalo meat will positively
    impact the diets of Indian people living on Reservations. A healthy
    diet for Indian people that results in a lower incidence of diabetes
    and other diet related illnesses will reduce Indian Reservation health
    care costs and result in a savings for taxpayers.

              FUNDING REQUEST FOR ITBC TRAINING AND LABOR PROGRAM

        The InterTribal Bison Cooperative respectfully requests an
    appropriation for fiscal year 2006 in the amount of $500,000. This
    amount is $400,000 above the fiscal year 2005 appropriation for ITBC
    and is critical to maintain last years funding level and to develop
    ITBC's training and labor program.
        In fiscal year 2005, the ITBC and its member Tribes were funded at
    $100,000, a decrease of $200,000 from the previous year. ITBC is now
    requesting $500,000 for fiscal year 2006 for job training as part of
    ITBC's labor initiative. To insure the success of ITBC's buffalo
    restoration efforts to Indian lands, training for the various jobs
    related to the buffalo projects is essential. Most member Tribes of
    ITBC have reservation unemployment rates of 72 percent. Jobs
    opportunities on most Indian Reservations are limited, low-paying, and
    often seasonal and temporary. The jobs created by buffalo restoration
    to Indian lands will positively impact Tribal unemployment rates and
    the overall Reservation poverty levels. Raising buffalo as an economic
    development effort requires skilled labor in permanent employment. ITBC
    has developed a job training program incorporating on-the-job training
    and work experience for youth that specifically addresses the unique
    needs of managing and maintaining buffalo. ITBC's training program
    further focuses on strengthening the economic development opportunities
    of buffalo restoration with training specific to meat processing,
    veterinary science, wildlife and biological services, infrastructure
    development, business and management training, and the overall
    development of a skilled workforce.
        Sufficient funding for job training is critical to the success of
    the buffalo restoration projects. The increase in funding will ensure
    that ITBC can provide job training, job growth training to ITBC member
    tribes. Without funding at the requested level, the buffalo restoration
    projects have less assurance of success.

                           ITBC GOALS AND INITIATIVES

        In addition to developing a preventative health care initiative,
    ITBC intends to continue with buffalo restoration efforts and the
    Tribal buffalo marketing initiative.
        In 1991, seven Indian Tribes had small buffalo herds, with a
    combined total of 1,500 animals. The herds were not utilized for
    economic development but were often maintained as wildlife only. During
    ITBC's relatively short 10-year tenure, it has been highly successful
    at developing existing buffalo herds and restoring buffalo to Indian
    lands that had no buffalo prior to 1991. Today, through the efforts of
    ITBC, over 35 Indian Tribes are engaged in raising over 15,000 buffalo.
    All buffalo operations are owned and managed by Tribes and many
    programs are close to achieving self-sufficiency and profit generation.
    ITBC's technical assistance is critical to ensure that the current
    Tribal buffalo projects gain self-sufficiency and become profit-
    generating. Further, ITBC's assistance is critical to those Tribes
    seeking to start a buffalo restoration effort.
        Through the efforts of ITBC, a new industry has developed on Indian
    reservations utilizing a culturally relevant resource. Hundreds of new
    jobs directly and indirectly revolving around the buffalo industry have
    been created. Tribal economies have benefited from the thousands of
    dollars generated and circulated on Indian Reservations.

                                   CONCLUSION

        ITBC has proven highly successful since its establishment to
    restore buffalo to Indian Reservation lands to revive and protect the
    sacred relationship between buffalo and Indian Tribes. Further, ITBC
    has successfully promoted the utilization of a culturally significant
    resource for viable economic development.
        ITBC has assisted Tribes with the creation of new jobs, on-the-job
    training and job growth in the buffalo industry resulting in the
    generation of new money for tribal economies. ITBC is also actively
    developing strategies for marketing Tribally owned buffalo. Finally,
    and most critically for Tribal populations, ITBC is developing a
    preventive health care initiative to utilize buffalo meat as a healthy
    addition to Tribal family diets to reduce the incidence of diet-related
    illnesses.
        ITBC strongly urges you to support its request for a $2,000,000
    earmark to the Department of Health and Human Service Department's
    budget to develop the critically needed preventative health care
    initiative utilizing Tribally produced buffalo.
                                     ______

                 Prepared Statement of the Lummi Indian Nation

                                   WHO WE ARE

        The Lummi Nation is a party to the Point Elliot Treaty of 1855.
    Under this Treaty we understand that the Lummi Nation has secured the
    protection of the United States of America and has reserved the right
    to govern our own lands, people and the people who enter these lands
    voluntarily. The Lummi Nation is a federally recognized Indian tribal
    government located in what is now called the State of Washington. The
    Lummi Nation includes a population of nearly 5,000 people. The Lummi
    Nation land base includes over 12,500 upland acres and 5,000 acres of
    tidelands. The Lummis are a fishing people with fishing rights in the
    San Juan Islands and much of Puget Sound and its associated waterways
    extending for hundreds of miles.

    Self-governing Status
        The Lummi Nation is one of the first self-governance Tribes.
    Although many thought the Lummi Nation was seeking to establish a new
    relationship with the Federal government, it was really seeking to re-
    establish the relationship that it started in 1855; to affirm the
    government-to-government relationship that began back then and reshape
    it into a relationship that fits today's realities, needs and goals.
    Each generation must continue the unbroken promise to take
    responsibility for the welfare of our people that began in the past and
    extends into the future.

    Health Disparities Index
        Over the past several years there has been growing concern over the
    disparities in Health care funding that is available to disadvantaged
    populations within the United States. Unfortunately this concern has
    not generated additional funding for health care services. Instead the
    information that there are substantial and verifiable disparities in
    the level of funding provided to minority population. New funding has
    been appropriated to study the problem and to make recommendations that
    will most likely include a recommendation for additional service
    funding.

    U.S. Civil Rights Commission Report
        The Civil Rights Report ``A Quiet Crisis'' was issued last year. In
    this report, the federal government provides a devastating indictment
    of the level of funding for Indian Country. This situation did not
    occur during the current administration, nor did it occur during the
    previous administration. This is not about politics. It is about human
    beings.

                       INDIAN HEALTH CARE IMPROVEMENT ACT

        The Lummi Nation wants the Congress and the Department to support
    that section of the proposed Indian Health Care Improvement Act which
    enables tribes to not only participate but to operate Medicaid Program
    services consistent with the need for health care service needs of
    their people. This proposal is budget neutral. These costs are already
    included in the current expenditure. This is simply re-routing a
    existing expenditures through the Tribal governments, which are closest
    to the people who are being served. This proposal enables Tribal
    governments to develop their own Medicaid Services plans instead of
    simply participating in the State's plan.

                   HEAD START BUREAU--NEW HEAD START FACILITY

        The Lummi Nation is proud to have operated a Head Start Program
    since 1969. Our Head State Program now serves one hundred and eighteen
    children (118) and their families. However, the Lummi Nation Head Start
    Program needs to serve over two hundred (200). The limitations of the
    existing facility have limited the expansion of the program and its
    badly needed services. The Lummi Nation has completed construction of a
    new school facility with Bureau of Indian Affairs funding. In the
    process of constructing this facility the Lummi Nation planned for the
    construction of a new Head Start Facility adjacent to the new School
    Facility. Water, sewer and electrical services have been stubbed out to
    the site, thereby reducing the cost of constructing the facility. The
    first phase of construction will cost approximately $500,000.

                    ADMINISTRATION FOR CHILDREN AND FAMILIES

    Tribal Social Services Demonstration Projects
        ACF staff have informed Tribal Leadership the Department was
    considering a demonstration project to provide Tribes with direct
    access to Title IV (b) and Title IV (e) Social Services and Foster Care
    Services. The Lummi Nation supports the idea of a demonstration project
    and would eagerly participate in such a project. The Lummi Nation would
    support legislation that enables tribal governments to work directly
    with DHHS to access funding for Title IV (b), (c), (d), and (e) while
    maintaining their service relationship with the State services for the
    benefit of all Indian children.

    Unemployment and Poverty
        The Lummi Nation approaches the problems of poverty and welfare
    through its own experience. The Lummi Nation economy is unique. It had
    remained a traditional fishing economy in the 21st century. The
    strength of the annual salmon runs had supported the Lummi Nation
    economy since time immemorial. However, these runs have finally
    succumbed to combination of farm fish competition, over-fishing and
    disappearing habitat.

    Increasing Welfare Case Load
        The experience of the Lummi Nation is that TANF caseloads are
    increasing not decreasing. Due to the failure of the last 5 years
    fishing seasons the Lummi Nation fishers are being added into the
    existing welfare base case loads for the TANF and BIA General
    Assistance Programs. Each Lummi fisher person supports an additional
    four to five families that worked on their boat and received a share of
    the total income. These fishing boats have reduced by 53 percent from
    700 to 373. What community in the United States could sustain this
    level of economic disaster? For the Lummi Nation this is the bankruptcy
    of nearly all its small businesses owners/operators within a short
    period of time.

    Funding for Tribes to Build Social Services/TANF Infrastructure
        The existing TANF funding for Tribes fails to recognize the long-
    term investment in the development of the State Welfare infrastructure.
    Therefore, Tribes are presented a less than level playing field when
    they seek to develop and implement welfare service programs that meet
    the needs of their people. The Lummi Nation urges the Committee to
    consider earmarking a portion of the funding provided to States for
    their administrative costs to support the development of Tribal TANF
    infrastructure. This funding should be provided directly to Tribes who
    have assumed the responsibility for operating TANF.

           SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

    Tribal Substance Abuse Block Grant
        The Lummi Nation has been able to have several meeting with the
    senior management of the Substance Abuse and Mental Health Services
    Administration over the past year. During one of these meeting we
    suggested that they re-program just one year's increase in the funding
    that is available to ``States under the Substance Abuse Block Grant
    funding. Currently only the Red Lake Ban of Chippewa is receiving an
    allocation directly from the Substance Abuse Block Grant administered
    by the Substance Abuse and Mental Health Services Administration. The
    Tribal specific Block Grant Program could be started using only the
    increases that are appropriated for the general population re-
    programmed as a Tribal only Substance Abuse Block Grant. Then Congress
    would subsequently appropriate enough funds for annual inflationary
    increases for both the State Block Grant and the Tribal Block Grant.

    Alcohol and Substance Abuse Program Infrastructure Funding
        SAMHSA has been able to support the development of State Alcohol
    and Substance abuse program infrastructure. While Tribal governments
    face the same data challenges that are posed by the operation of the
    Alcohol and Substance Abuse Treatment, Prevention and After-care
    activities. Apparently tribal governments can achieve what State
    governments who have access to tax bases of their own, cannot do
    without Federal assistance.

                              DEPARTMENT OF LABOR

    Jobs Now--Job Creation and Economic Development
        In response to the economic fishing disaster for the Lummi people,
    of past 5 years, the Lummi Nation has created the JOBS NOW Initiative
    and is in the process of developing a long-term economic stimulus plan.
    These initiatives utilize all of the Lummi Nation projects, services,
    and resources to address the internal, social and economic needs of
    Lummi Nation families. Through this initiative the Lummi Nation has
    been able to register its membership in a job skills bank and
    identified area of job training that are in demand by the local labor
    market and consistent with the employment preferences of the
    membership.

    Lummi Nation Families Ned 500 Jobs to Replace Lost Fishing Industry
            Jobs
        The goal of the Lummi Nation Salmon Recovery Initiative is to
    create 500 jobs that provide a family wage to confront the current and
    long-term effects of the fishing economic disaster that is facing Lummi
    Nation members. Therefore the Lummi Nation urges the Committee to
    support additional job training program funding earmarked to address
    the economic crisis that is facing the members of the Lummi Nation.

    Lummi Nation Dislocated Fishers Project
        The Lummi Nation is fully aware of how different, how culturally
    specific this economic dislocation is. The Lummi Nation expects the
    federal government including the Department of Labor to recognize the
    unique relationship that exits between the Lummi Nation and the United
    States of America through the Point Elliot Treaty of 1855.
        The Lummi Nation anticipated that it would be afforded the full
    discretion allowed under the law. Instead we believe that we have been
    held hostage to the past experiences of the Dislocated Worker Program.
    Past practices are not useful guides to new situations. We are
    disappointed with the reaction of the Department of Labor to the needs
    of our community members. The situation at Lummi Nation is a real
    economic dislocation, not just a profit dislocation. This is not a
    company failure. This is not simply a mater of mismanagement and plant
    failure. We are not working with workers but with small businessmen who
    were previously successfully self-employed. The service models that are
    imposed by the Department of Labor are based on the plant failure
    model.
        It is clear that the intent of the legislation is to assist workers
    to get jobs when the industry that supported them is no longer
    operable. Our situation is clearly within the intent of the authorizing
    legislation. The fishing industry to which our people have devoted
    their lives and invested their fortune has changed, due to no action or
    inaction on the part of the workers for whom assistance is sought.

    Negotiated Standard
        During negotiations with the Department of Labor the Lummi Nation
    sought and received a promise that funding would be available to meet
    the needs of all eligible members of the Lummi Nation. The Lummi Nation
    expects the Department to honor this standard and continue funding of
    this project until all eligible Lummi Nation members have been provided
    services such that they are able to secure and maintain comparable
    permanent employment.

    +$420,000.--Additional funding for Lummi Nation WIA Programs and
            Services
        The Lummi Nation allocation for funding under the WIA Comprehensive
    and Youth Programs is less than one third of what it needs to be. The
    Lummi Nation is requesting that the Committee review its allocations
    and increase the funding that is available to the Lummi Nation by three
    (3) times. The Lummi Nation receives $140,000 annually to meet the
    needs of 5,000 people, with multiple needs including basic reading and
    writing skills, physical therapy, other personal issues to address
    prior to job training and eventually employment. The Lummi Nation needs
    an allocation of $420,000.

                            DEPARTMENT OF EDUCATION

    Funding for Tribal Education Departments
        This is needed by all of Indian Country. Those tribes that do not
    operate their own schools need the infrastructure to support their
    youth in the public schools. Those Tribes that do operate schools need
    the Department format to insure that educational services are connected
    to the Tribal government.

    No Child Left behind
        The United States of America has left behind Indian children,.
    While we are supportive of many provision of the Act we are not aware
    of any benefits that it has brought to us. Indian children are still
    left behind by the lack of adequate school and preschool facilities,
    teachers and operating resources. While the 2006 Presidents budget
    Request does includes requests to maintain the 2004 funding level it is
    woefully inadequate. The leading cause of death in our community is
    abuse of alcohol and/or drugs. Children who live in such a community
    have significant social, developmental needs that must be addressed so
    that basic educational services can be of any value. The current
    funding level mean that Indian Children will continue to be left behind
    as the rest of America is catapulted into the 21st Century.

    Vocational Rehabilitation
        The Lummi Nation is a long-standing grantee of the Department's
    Indian Vocational Rehabilitation. We are grateful for the support of
    the Department for the development of the Lummi Nation Vocational
    Rehabilitation Program as well as the funding to provide mush needed
    services for our membership. The Department needs to insure that the
    full amount of this allocation is available for the benefit of Indian
    people.

    477 Program
        The Lummi Nation along with other who are participating in the 477
    Program are seeking to consolidate all employment and training
    programs, services functions and activities. The Education Department
    needs to fully participate in this program. The Lummi Nation urges the
    Committee to require the Department to meet with Tribal leadership and
    members of the Committee staff to identify the barriers to full
    participation and develop appropriate administrative and or legislative
    remedies.
                                     ______

       Prepared Statement of the National Association of County and City
                                Health Officials

                                    SUMMARY

        The proposed cuts in the fiscal year 2006 budget of the Centers for
    Disease Control and Prevention (CDC) fall disproportionately on local
    and state public health departments. The two largest proposed program
    cuts for CDC are a reduction of $130 million in funding for state and
    local bioterrorism preparedness and elimination of the $131 million
    Preventive Health and Health Services block grant program. Such funding
    cuts would seriously compromise the ability of the nation's
    governmental public health system to fulfill its mission of protecting
    and promoting health.
        Local public health departments work every day on the front lines
    to combat threats to the health of their communities. They can ill
    afford substantial reductions in federal support for their roles as
    first responders to bioterrorism and other public health emergencies.
    Moreover, local public health departments receive about 40 percent of
    the Preventive Health and Health Services block grant (PHHS) funds.
    These enable them to carry out programs ranging from prevention of
    heart attack and stroke to combating West Nile virus. In states where
    local health departments rely on these funds to run prevention programs
    for which no other sources of funding are available, activities to
    reduce the burdens of preventable disease will be reduced.
        At a time when the nation is engaged in urgent work to protect the
    homeland from terrorists, as well as to stop an epidemic of obesity, it
    is profoundly counterproductive and irrational to reduce support for
    local programs that are the first line of defense against the greatest
    threats to the health of communities. NACCHO urges Congress to continue
    funding these two CDC programs at levels no less than that of the
    current fiscal year. Those levels are $932 million for state and local
    bioterrorism preparedness and $131 million for the Preventive Health
    and Health Services block grant.

    STRENGTHENING THE GOVERNMENTAL PUBLIC HEALTH SYSTEM TO IMPROVE HOMELAND
                      SECURITY REQUIRES SUSTAINED FUNDING

        Congress recognized in 1997 an unmet need to strengthen the
    nation's capacity to respond to an act of bioterrorism and initiated
    funding for bioterrorism preparedness in fiscal year 1999. The initial
    funding of about $121 million (which included $51 million solely for
    stockpiling medications) assisted CDC and state and local health
    departments to begin examining what plans and resources were necessary.
    After 9/11 and the anthrax outbreaks in the fall of 2001, Congress
    increased bioterrorism funding markedly and included $940 million for
    building state and local capacities, of which about $870 million was
    actually made available to states and localities. The Department of
    Health and Human Services got these funds out to states and three large
    cities via cooperative agreements very promptly, far ahead of other
    homeland security funds for states and localities.
        Substantial bioterrorism preparedness funds for improving all
    aspects of preparedness have actually been in the hands of state health
    departments since August 2002, less than three years. Local public
    health departments, many of which have been funded for much less time,
    are justifiably proud of the progress they have made.
        Extensive response plans, developed in collaboration with local
    emergency management systems, have been made. Numerous ``tabletop'' and
    real field exercises have tested local capabilities. Mass vaccination
    clinics have taken place, some in conjunction with the actual
    requirement to provide smallpox vaccine to selected first responders,
    others as a real response to this year's flu vaccine shortage.
    Communications systems and equipment that enable rapid electronic
    information exchange among health departments and by health departments
    to their communities are operational. Improved systems for disease
    detection are in place.
        Local health departments have engaged hospitals, physicians, and
    other individuals and organizations in the private sector in developing
    their roles in responding to a serious disease outbreak. Complex
    logistical arrangements needed to distribute medications or equipment
    from the Strategic National Stockpile to stricken populations have been
    developed.
        In some locations, genuine public health crises, such as suspected
    SARS cases or flu vaccine shortages, have demanded a response. In the
    act of the responding, local health departments and their community
    partners continually identify new challenges and new ways to improve
    their ability to respond. Improving a locality's ability to detect a
    disease outbreak promptly and to contain it swiftly is a continuous
    process. Interrupting that process through funding cuts would take the
    nation's bioterrorism preparedness backwards, not forward. New
    capacities that are now in place cannot be sustained without sustained
    funding.
        The Administration has proposed to fund more medicines and supplies
    for the Strategic National Stockpile and to purchase portable medical
    treatment units, instead of sustaining funding for state and local
    capacities. Yet the acquisition of vaccines or equipment is useless
    unless there are trained people and established systems in place to get
    the vaccines or treatment to stricken populations. According to a
    recent report by the Government Accountability Office (``Bioterrorism:
    Information on Jurisdictions' Expenditure and Reported Obligation of
    Program Funds,'' February 2005), state and local governments are taking
    action responsibly to prepare for bioterrorism and there are not large
    surpluses of unspent funds. It is wholly irrational to suggest that
    more vaccines and supplies can improve national preparedness, if
    funding to sustain health departments' capacity to use those vaccines
    and supplies is simultaneously cut back.
        The nation has a long way to go before every citizen enjoys the
    best possible protection by disease detection and response systems that
    work as quickly as humanly possible. Providing this protection is the
    job of the governmental public health system. No other entity can do
    it. NACCHO urges Congress not to cut back funds available to local
    public health departments, the nation's first responders to
    bioterrorism.

               THE PHHS BLOCK GRANT IS A LINCHPIN FOR PREVENTION

        Local public health departments receive approximately 40 percent of
    the Preventive Health and Health Services block grants nationally. The
    proportion varies among states from less than 5 percent to almost 100
    percent. The block grant funds fulfill three critical purposes. First,
    they enable states to address critical unmet public health needs. The
    coexistence of other federal categorical public health funds does not
    mean that available categorical funds are sufficient or available to
    address all problems. They are not. Improving chronic disease
    prevention through screening programs and programs that promote healthy
    nutrition and physical activity are prime examples of activities to
    which many jurisdictions devote PHHS funds. Forty percent of fiscal
    year 2004 block grant funds were spent on chronic disease prevention,
    including prevention of obesity, stroke, heart disease, cancer,
    diabetes, and dental caries.
        Second, PHHS funds provide some flexible funding to address
    unexpected problems or problems that are unique to a particular
    geographic area. West Nile virus, a fully preventable disease spread to
    humans by mosquitoes, is one good example. Third, PHHS fund provide
    leverage for more funds and in-kind resources from non-federal sources.
    In one southern state, local health departments collectively used $2.77
    million in block grant funds to establish new prevention programs and
    generate $5 million in additional resources for those programs.
        States are fully accountable to the Department of Health and Human
    Services for their expenditures of block grant funds and report how
    much money they spend by specific program area. In those states where
    local health departments receive a significant amount of PHHS funds
    from the state, local prevention efforts will diminish. Local and state
    health departments are key leaders and providers of population-based
    prevention programs. They work to keep prevention in the public eye and
    they build on programs that have been proven effective in reducing
    disease and preventing premature death. As health care costs escalate,
    reducing the nation's commitment to prevention by eliminating the PHHS
    block grant and weakening state and local public health departments is
    unwise and uneconomic.
        The National Association of County and City Health Officials
    (NACCHO) is the organization representing the almost 3,000 local public
    health departments in the United States.
                                     ______

     Prepared Statement of the National Association of Foster Grandparent
                               Program Directors

                                  INTRODUCTION

        I am honored to testify in support of fiscal year 2006 funding for
    the Foster Grandparent Program (FGP), the oldest and largest of the
    three programs known collectively as the National Senior Volunteer
    Corps, which are authorized by Title II of the Domestic Volunteer
    Service Act (DVSA) of 1973, as amended and administered by the
    Corporation for National and Community Service (CNS).
        Good morning Mr. Chairman. My name is Brenda Lax and I have been
    the Foster Grandparent Program Director with the City of Kansas City,
    Missouri for the past 17 years. I am here in my capacity as President
    of the National Association of Foster Grandparent Program Directors
    (NAFGPD). NAFGPD is a membership-supported professional organization
    whose roster includes the majority of more than 350 directors who
    administer Foster Grandparent Programs nationwide, as well as local
    sponsoring agencies and others who value and support the work of FGP.
    This year we will celebrate our 40th Anniversary of engaging low-income
    seniors in service to children with special needs with a reception on
    September 21, 2005 here in Washington, DC. On behalf of NAFGPD members
    across the country, I would like to extend an invitation to you and
    your staff to join us for this special occasion.
        Mr. Chairman, I would like to begin by thanking you and the
    distinguished members of the Subcommittee for your steadfast support of
    the Foster Grandparent Program. No matter what the circumstances, this
    Subcommittee has always been there to protect the integrity and mission
    of our programs. Our volunteers and the children they serve across the
    country are the beneficiaries of your commitment to FGP, and for that
    we thank you. I also want to acknowledge your outstanding staff for
    their tireless work and very difficult job they have to ``make the
    numbers fit.''--an increasingly difficult task in this budget
    environment.
        Last year I had the great privilege of testifying before the House
    Subcommittee about the fiscal year 2005 budget request for FGP. While
    it was a great honor to be there, I was compelled to deliver some very
    disappointing news--a cut of some $3.5 million was proposed for our
    programs across the country. Well, Mr. Chairman under your leadership
    the Subcommittee not only rejected this misguided cut, but provided an
    increase of nearly $2 million over the fiscal year 2004 enacted level.
    NAFGPD was very glad to see this ill-conceived cut rejected, and we
    believe your action sent a message about our programs--they are alive
    and well and quite worthy of scarce federal resources.
        Thanks to your action in the fiscal year 2005 appropriations
    process, Mr. Chairman, the fiscal year 2006 budget request for FGP does
    not suggest another significant cut to our programs. Instead, the
    fiscal year 2006 budget provides an increase of $634,000 (.5 percent)
    for headquarters-based administrative functions such as training and
    technical assistance. While NAFGPD was pleased to see our programs not
    slated for a cut, we remain concerned that the Corporation's request
    does not provide any new funding where it is needed most--in the field.
    All of us recognize the spending constraints placed on the President
    and, most importantly on you and the Appropriations Committee, Mr.
    Chairman. However, in a time of such scarce federal resources, NAFGPD
    believes strongly that any new funding should flow to our programs in
    the field where it is most urgently needed, not CNCS headquarters.
        NAFGPD respectfully requests the subcommittee to provide $116.440
    million for the Foster Grandparent Program in fiscal year 2006, an
    increase of $5.016 million over the fiscal year 2005 level. This
    critical funding will ensure the continued viability of the Foster
    Grandparent Program, and allow for important expansion of this unique
    program. Specifically, this proposal would fund a 3 percent cost of
    living increase for every Foster Grandparent Program and expansion
    grants to existing programs that would add 372 new low-income senior
    volunteers to serve children.

                                FGP: AN OVERVIEW

        Established in 1965, the Foster Grandparent Program was the first
    federally funded, organized program to engage older volunteers in
    significant service to others. From the 20 original programs based
    totally in institutions for children with severe mental and physical
    disabilities, FGP now comprises nearly 350 programs in every state and
    the District of Columbia, Puerto Rico, and the Virgin Islands. All of
    these programs are now primarily based in community volunteer sites--
    where most special needs children can be found today--and are
    administered locally through a non-profit organization or agency and
    Advisory Council comprised of community citizens dedicated to FGP and
    its mission. FGP represents the best in the federal partnership with
    local communities, with federal dollars flowing directly to local
    sponsoring agencies, which in turn determine how the funds are used.
    There are currently 38,700 Foster Grandparent volunteers who give over
    36 million hours annually to more than 277,000 children.
        The Foster Grandparent Program is unique for several reasons. We
    are one of only two volunteer programs in existence that enable seniors
    living on very limited incomes to serve their communities as volunteers
    by providing a small non-taxable stipend and other support which allow
    volunteers to serve at little or no cost to themselves. Our volunteers
    provide intensive, consistent service--15 to 40 hours every week,
    usually 4 hours every day. FGP provides intensive pre-service
    orientation and at least 48 hours of ongoing training every year to
    keep volunteers current and informed on how to work with children who
    have special needs. And our volunteers provide one-to-one service to
    their assigned children, exactly what is required to help prepare our
    nation's neediest children to become self-sufficient adults.

                              FGP: THE VOLUNTEERS

        The Foster Grandparent Program is a versatile, dynamic, and
    uniquely multi-purpose program. First, we give Americans 60 years of
    age or older who are living on incomes at or less than 125 percent of
    the poverty level the opportunity to serve 15 to 40 hours every week
    and use the talents, skills and wisdom they have accumulated over a
    lifetime to give back to the communities which nurtured them throughout
    their lives. Seniors in general are not valued or respected in today's
    society, and low-income seniors are particularly devalued because of
    their economic status. They are rarely asked by their communities to
    contribute through volunteering, because they are not traditionally
    those who participate in community activities.
        FGP actively seeks out these low-income seniors. We dare to ask
    them to serve, to give something back. And we help them to develop the
    additional skills they may need to function effectively in settings
    unfamiliar to them, like public schools, hospitals, childcare centers,
    and juvenile detention facilities. We also provide them with ongoing
    training and support throughout their tenure as Foster Grandparents.
    Through their service, our older volunteers say they feel and stay
    healthier, that they feel needed and productive. Most importantly, they
    leave to the next generation a legacy of skills, perspective and
    knowledge that has been learned the hard way--through experience.
        Within budgetary constraints, FGP is engaging older people who are
    not usually asked to serve and those usually considered as needing
    services rather than being able to serve: 86 percent are 65 or older
    and 45 percent come from various ethnic groups.

                               FGP: THE CHILDREN

        Through our volunteers, the Foster Grandparent Program also
    provides person-to-person service to children and youth under the age
    of 21 who have special or exceptional needs, many of whom face serious,
    often life-threatening challenges. With the changing dynamics in family
    life today, many children with disabilities and special needs lack a
    consistent, stable adult role model in their lives. The Foster
    Grandparent is very often the only person in a child's life who is
    there every day, who accepts the child, encourages him no matter how
    many mistakes the child makes, and focuses on the child's successes.
        Special needs of children served by Foster Grandparents include
    AIDS or addiction to crack or other drugs; abuse or neglect; physical,
    mental, or learning disabilities; speech, or other sensory
    disabilities; incarceration and terminal illness. Of the children
    served, 7 percent are abused or neglected, 26 percent have learning
    disabilities, and 11 percent have developmental delays. FGP focuses its
    resources in areas where they will have the most impact: early
    intervention services and literacy activities. Nationally, 85 percent
    of the children served by Foster Grandparents are under the age of 12,
    with 39 percent of these children age 5 or under. Foster Grandparents
    work intensively with these very young children to address their
    problems at as early an age as possible, before they enter school.
    Nearly one-half of FGP volunteers serve nearly 12 million hours
    annually addressing literacy and emergent-literacy problems with
    special needs children.
        Activities of the FGP volunteers with their assigned children
    include teaching parenting skills to teen parents; providing physical
    and emotional support to babies abandoned in hospitals; helping
    children with developmental, speech, or physical disabilities develop
    self-help skills; reinforcing reading and mathematics skills; and
    giving guidance and serving as mentors to incarcerated or other youth.

                            FGP: THE VOLUNTEER SITES

        The Foster Grandparent Program provides agencies and organizations
    providing services to special-needs children with a consistent,
    reliable, invaluable extra pair of hands 15 to 40 hours every week to
    assist in providing these services. Seventy-one percent of FGP
    volunteers serve in public and private schools as well as sites that
    provide early childhood pre-literacy services to very young children,
    including Head Start.

                          FGP: COST-EFFECTIVE SERVICE

        The Foster Grandparent Program serves local communities in a high
    quality, efficient and cost-effective manner, saving local communities
    money by helping our older volunteers stay independent and healthy and
    out of expensive in-home or institutional care. Using the Independent
    Sector's 2003 valuation for one hour of volunteer service ($17.19/
    hour), the value of the service given by Foster Grandparents annually
    is over $618 million, and represents a 5-fold return on the federal
    dollars invested in FGP. The annual federal cost for one Foster
    Grandparent is $3,800--less than $4.00 per hour.
        The value local communities place on FGP and its multifaceted
    services is evidenced by the large amount of cash and in-kind donations
    contributed by communities to support FGP. For example, FGP's fiscal
    year 2001 federal allocation was matched with $40 million in non-
    federal donations from states and local communities in which Foster
    Grandparents volunteer. This represents a non-federal match of 42
    percent, or $.42 for every $1.00 in federal funds invested--well over
    the 10 percent local match required by law.

                    NAFGPD'S FISCAL YEAR 2006 BUDGET REQUEST

        Given the dramatically expanding number of low-income seniors
    eligible to serve and the staggering number of troubled and challenged
    children in America today, we respectfully request that the
    Subcommittee provide $116.440 million for the Foster Grandparent
    Program in fiscal year 2006, an increase of $5.016 million over fiscal
    year 2005. This critical funding will ensure the continued viability of
    the Foster Grandparent program, and allow for an expansion of this
    important program.
        The requested increase would be allocated for the following
    purposes, in order of priority:
        1st.--Award an administrative cost increase of 3 percent to each
    existing Foster Grandparent Program in order to maintain quality,
    enable recruitment and sustain the important work already being done by
    programs.
        2nd.--In accordance with the Domestic Volunteer Service Act (DVSA),
    designate one-third of the increase over the fiscal year 2005 level to
    fund Program of National Significance (PNS) expansion grants to allow
    existing FGP programs to expand the number of volunteers serving in
    areas of critical need as identified by Congress in the DVSA.
        This funding proposal will generate opportunities for approximately
    372 new low-income senior volunteers contributing in excess of 400,000
    hours of service annually to more than 2,000 additional children.
        The message is clear: (1) the population of low-income seniors
    available to volunteer 15 to 40 hours every week is increasing; (2)
    communities need and want more Foster Grandparent volunteers and more
    Foster Grandparent Programs. FGP respectfully requests increased
    funding that will address our most pressing need: a 3 percent
    administrative cost increase that will enable the program to expand its
    reach across the nation. The Subcommittee's continued investment in FGP
    now will pay off in savings realized later, as more seniors stay
    healthy and independent through volunteer service, as communities save
    tax dollars, and as children with special needs are helped to become
    contributing members of society.
        Mr. Chairman, in closing I would like to again thank you for the
    subcommittee's support and leadership for FGP over the years. NAFGPD
    takes great comfort in knowing you and your colleagues in Congress
    appreciate what our low-income senior volunteers accomplish every day
    in communities across the country.
                                     ______

             Prepared Statement of the National League for Nursing

        The National League for Nursing (NLN)--representing more than 1,200
    nursing schools and health care agencies, some 18,000 individual
    members composed of nurses, educators, administrators, public members,
    and 18 constituent leagues--appreciates the Subcommittee's past support
    for nursing education and your continued recognition of the important
    role nurses play in the delivery of health care services. We are
    concerned, however, that the advancements made by Congress to help
    alleviate the nursing shortage will be lost during the fiscal year 2006
    appropriations process unless additional resources are expended. NLN
    urges your continued support for Title VIII--Nursing Workforce
    Development Programs by ensuring that these programs are funded at a
    minimum level of $210 million for fiscal year 2006. To put this funding
    request into perspective, in 1974, during the last serious nursing
    shortage, Congress appropriated $153 million for nurse education
    programs. In today's dollars that would equate to $592 million,
    approximately four times what the federal government is spending now.
        Today's nursing shortage is very real and very different from any
    experienced in the past. The current shortage is evidenced by an aging
    workforce and an inadequate number of people entering the profession.
    Schools of nursing are suffering from a continuing and growing shortage
    of faculty, which prevents these institutions from admitting many
    qualified students who are applying to their programs. A recent NLN
    survey of nursing programs at all levels shows that an estimated
    125,000 qualified applicants were turned away from nursing programs for
    the academic year 2003-2004 because of the severe faculty shortage. The
    supply of appropriately prepared nurses and nursing faculty is
    inadequate to meet the needs of a diverse, aging population, and this
    shortfall will grow more serious over the next 5 years.
        Congress did an admirable job of passing the Nurse Reinvestment Act
    in 2002. The new monies used to fund loans and scholarships are
    appreciated. However, it has become abundantly clear that significantly
    more funding is required to even minimally meet the existing need.
        NLN's Faculty Survey conducted in 2002 concludes that not enough
    qualified nurse educators exist to teach the number of nurses needed to
    ameliorate the nursing shortage. Subsequent information indicates that
    this situation is getting more serious and is not expected to improve
    in the near future, since an inadequate number of nurse educators are
    currently in the education pipeline.
        The NLN Survey found three trends influencing the future of nursing
    education over the next decade:
      --The aging of the nurse faculty population.--An average of 1.3 full-
            time faculty members per program left their positions in
            nursing education in 2002. About half the Survey respondents
            had at least one unfilled budgeted full-time faculty position
            and some have as many as 15 such positions. 36.5 percent of
            faculty who left their positions in the preceding year did so
            because of retirement; 8.6 percent of faculty were 61 years of
            age or older; and 75 percent of the current faculty population
            is expected to retire by 2019.
          Approximately 1,800 full-time faculty members leave their
            positions each year. About 10,000 master's level nurses
            graduate per year, 15 percent of whom would have to go into
            teaching just to maintain the status quo. Since this is highly
            unlikely, the gap between unfilled positions and the candidate
            pool will widen significantly.
      --The increasing number of part-time faculty.--The number of part-
            time faculty ha increased notably since 1996--nearly 17 percent
            in baccalaureate programs and 14 percent in associate degree
            programs. Part-time faculty now provides approximately 23
            percent of the estimated number of faculty FTEs.
          Part time employees are often not an integral part of the design,
            implementation, and evaluation of the overall nursing education
            program. Many may hold other positions that often limit their
            availability to students. Further, many part-time faculty have
            not been prepared for the faculty role.
      --The large number of nursing faculty who are not prepared at the
            doctoral level.--Approximately half the full-time faculty in
            baccalaureate and higher degree programs hold a doctoral
            degree. In associate degree programs, doctorally prepared
            faculty account for only 6.6 percent of the total faculty and
            the number is slightly more than 5 percent in diploma programs.
            Only 350 to 400 nursing students receive doctoral degrees each
            year and the pool of doctorally prepared candidates for full-
            time nursing professorships is very limited.
          Educators without doctoral degrees may lack credibility within a
            university setting and have limited opportunities to assume
            leadership positions. Institutions with low numbers of
            doctorally prepared educators may be less likely to get funds
            to support research or educational innovations.
        As important as educational incentives are for future practicing
    nurses, the scholarships for doctoral students who will instruct the
    next generation of nurses are even more critical. Please do not allow
    us to lose ground in the fight against the nursing shortage. Fund Title
    VIII--Nursing Workforce Development Programs at a level commensurate
    with the severity of the health care crisis facing the nation today.
        Your support will help ensure that nurses exist in the future who
    are prepared and qualified to take care of you, your family, and all
    those in this country who will need our care. If you have any questions
    about NLN's position or we can be of further assistance to you, please
    feel free to contact Kathleen Ream, NLN Manager of Government Affairs,
    at 703-241-3974.
                                     ______

          Prepared Statement of the National Mental Health Association

        Thank you for this opportunity to submit testimony to the
    Subcommittee and to address the important issue of mental health. The
    National Mental Health Association (NMHA), the country's oldest and
    largest advocacy organization addressing all aspects of mental health
    and mental illness, represents over 340 affiliates throughout the
    country. NMHA is uniquely positioned to speak to the entire mental
    health and substance abuse portfolio including prevention, early
    intervention, treatment, and research.
        NMHA would like to thank Chairman Regula and Reps. Obey and Kennedy
    for your leadership and for your strong support in winning increases
    last year for mental health programs. However, we are deeply troubled
    by the Administration's current proposal to cut mental health services
    at the Center for Mental Health Services (CMHS) by a dangerous 7
    percent (from $901 to $837 million) and to increase funding for the
    National Institutes of Health (NIH) by less than 1 percent. We hope to
    highlight the tremendous need for mental health services in communities
    throughout the country and why it is imperative that we make an
    investment not cuts in mental health.

                 CALL TO MAKE MENTAL HEALTH A NATIONAL PRIORITY

        NMHA strongly urges you to make mental health a national priority.
    In creating the Commission on Mental Health, President Bush
    emphatically declared that ``Our country must make a commitment:
    Americans with mental illness deserve our understanding, and they
    deserve excellent care. I look forward to . . . fixing the [mental
    health] system, so that Americans do not fall through the cracks.''
        These are not cracks; these are, at this time, unbridgeable chasms.
    As we know and as corroborated in a December 2004 New York Times
    editorial, the robust community-based mental health system that
    national leaders envisioned would replace the country's reliance on
    warehoused institutional care never materialized. As a result, an
    astounding 80 percent of children entering the juvenile justice system
    have mental disorders, and prisons and jails have become de facto
    mental hospitals, but without the treatment that would allow
    individuals with a mental illness to control their symptoms and
    organize their lives.
        The President's New Freedom Commission on Mental Health, the first
    such commission in over 25 years, recommended a fundamental
    transformation of the Nation's approach to mental health care. This
    transformation must ensure that mental health services and supports
    actively facilitate recovery, and build resilience to face life's
    challenges--with consumers active participants in designing and
    developing their plans of care. The Commission also found that our
    nation's failure to make mental health a priority is a national
    tragedy. A measure of the scope of that tragedy is the
    disproportionately high number of individuals with mental illness in
    the corrections system as well as over 30,000 lives lost annually to
    suicide--a loss, the Commission states, that is largely preventable.

              UNTENABLE FISCAL YEAR 2006 MENTAL HEALTH BUDGET CUTS

        Although mental illness (the chronic disease of the young) ranks
    first in the United States in terms of causing disability, the proposed
    fiscal year 2006 budget for the Center for Mental Health Services at
    SAMHSA would shrink funding for the federal government's lead mental
    health agency to virtually the level of support provided the agency for
    fiscal year 2002. Cutting a mental heath budget to fiscal year 2002
    levels at a time that more than 67 percent of adults and nearly 80
    percent of children who need mental health services do not receive
    treatment is hardly a formula for making mental health a national
    priority.
        NMHA strongly urges the Subcommittee to reverse the proposed 7
    percent cut or loss of nearly $70 million to mental health services at
    the Center for Mental Health Services (CMHS).
        In particular, we urge you to reverse the following proposals in
    the Administration's budget for the Substance Abuse and Mental Health
    Services Administration:
      --The proposed cut in funding for a successful youth-violence
            prevention program by nearly a third, from $94 to $67 million;
      --The proposed cut in funding for jail diversion program by nearly 50
            percent, from $7 to $4 million;
      --The proposed cut in funding of an additional $40 million in CMHS'
            important Programs of Regional and National Significance
            account--in essence slashing funding from an account aimed at
            much needed priority programming; and
      --The proposed cut in funding for substance abuse prevention by 7
            percent, from $198 to $184 million.
        In addition, we urge you to build on the Administration's proposal
    to:
      --Level fund critical youth suicide-prevention efforts, the
            children's systems-of-care, the homelessness (PATH), PAIMI and
            elderly programs, the mental health and substance abuse block
            grants, as well as the Consumer TA Centers; and
      --Provide an increase of only 0.4 percent, on average, for research
            activities at the National Institutes of Mental Health, Drug
            Abuse, and Alcohol Abuse and Alcoholism.
        Lastly, we support the Administration's $6 million increase request
    for the State Infrastructure Grants, which will likely fund 11 grants
    with the proposed new total of $26 million, to assist States with
    planning and implementing the Commission's call for transformation of
    state mental health services across multiple service systems.

           YOUTH VIOLENCE PREVENTION: A WHOLLY UNWARRANTED BUDGET CUT

        Recent tragic events illustrate what we believe are critical
    failures in priority-setting in the SAMHSA budget. This month's
    horrible shootings at Minnesota's Red Lake High School, the most
    violent school slaying since Columbine, is a reminder that youth
    violence is still prevalent and underscores the need for every school
    house to be prepared to deal with traumatic, tragic events. Surely this
    incident is emblematic of the shortsightedness of the Administration's
    proposed devastating cut of nearly 33 percent or $27 million to youth
    violence prevention--the Safe Schools/Healthy Students (SS/HS)
    program--at CMHS.
        As CMHS' major school violence prevention program, the SS/HS
    initiative addresses school violence prevention through a wide range of
    early childhood development, early intervention and prevention, suicide
    prevention, and mental health treatment services. The primary objective
    of this grant program is to promote healthy development, foster
    resilience in the face of adversity, and prevent violence. The
    President's Commission report highlighted the need for the mental
    health system to coordinate better with other federal agencies. This
    landmark program, administered jointly with the Department of Education
    (Safe and Drug Free Schools Office) and the Department of Justice
    (Office of Juvenile Justice and Delinquency Prevention), does just
    that.
        The Red Lake School shooting and other such shootings underscore
    the tremendous mental health needs of young people that too often go
    unmet. One in ten children suffers from a mental disorder severe enough
    to cause some level of impairment. Even more children experience
    psychiatric trauma, or emotional harm, which is essentially a normal
    response to an extreme event that may or may not happen with some
    regularity.
        This Subcommittee should make investments not only in the area of
    youth violence prevention, but also invest in Jail Diversion programs
    designed to keep young people at home and in their communities as they
    get care. This is not the time to cut funding for programs that help to
    protect our nation's youth.

                    LACK OF COMMUNITY MENTAL HEALTH SERVICES

        While we call on the Subcommittee to reverse the alarming cuts
    proposed in the SAMHSA budget, we urge that the Subcommittee also
    provide needed increases in funding. To illustrate the magnitude of
    needs that plead for attention, we urge that you take steps to address
    the shocking findings highlighted by Sen. Susan Collins (R-ME) whose
    hearing last year spotlighted the devastating reality that, every day,
    about 2,000 children and adolescents are warehoused in juvenile
    detention centers around the country simply because community mental
    health services are unavailable. An estimated $100 million of
    taxpayers' money is spent on the detention of these youth awaiting
    community mental health services. Shouldn't that $100 million and other
    precious resources be invested in the community rather than in the
    corrections system to provide cost-effective, quality mental health
    services? Consider the outrage that would be heard if 2,000 young
    people with ANY other illness not only went without treatment, but were
    involuntarily institutionalized as well.
        NMHA agrees with Senator Collins that ``another consequence of our
    tattered `safety net' for children with mental illness [is] the
    inappropriate use of juvenile detention centers as `holding areas' for
    young people who are waiting for mental health services. Like custody
    relinquishment [of children with mental disorders], these inappropriate
    detentions are a regrettable symptom of a much larger problem, the lack
    of available, affordable, and appropriate mental health services and
    support systems.''
        With this tragic situation in mind, we urge you to consider, for
    example, a greater investment in the Children's Mental Health Services
    program that would allow CMHS to expand beyond the 92 grants in 46
    States that have provided services to approximately 54,343 children
    from 1993-2004. This program, which scored highly in the OMB PART
    review/evaluation, has only served children in 274 or 9 percent of the
    3,142 counties in the United States.

        NEEDS ARE INCREASING, AND APPROACHING A MENTAL HEALTH STATE OF
                                   EMERGENCY

        The need for mental health services is ever-escalating for both
    young people and adults, and gaining ever-wider recognition. To
    illustrate, a February 2005 study found that U.S. hospital emergency
    departments greatly under-diagnose psychiatric disorders. Investigators
    from Louisiana State University examined records of more than 33,000
    patients and discovered an overall psychiatric disorder rate among
    patients of 5.27 percent--far below the national rate of 20 percent to
    28 percent. The researchers believe this points to large numbers of
    missed diagnoses. Last July a county in Nevada declared a ``State of
    Emergency'' after many individuals with mental illness overcrowded the
    state's hospitals. In Nebraska, the state last February reported its
    mental health system to be in crisis. And with the fifth-highest
    suicide rate in the nation, West Virginia's Gazette-Mail concluded
    earlier this year that the state is in the midst of a ``mental health
    crisis.''
        Broad societal mental health needs too often go unrecognized. As
    the nation grapples with an obesity epidemic, for example, there has
    been insufficient recognition of the link to mental health. Yet mental
    health issues are often closely intertwined with other chronic illness.
    In the case of obesity, for example, we can expect individuals who
    suffer from obesity to be at risk for heart disease. Two decades of
    NIMH research have shown that people with heart disease are more likely
    to suffer from depression than otherwise healthy people, and
    conversely, that people with depression are at greater risk for
    developing heart disease. With sharp cutbacks in the already modest
    (PRNS) funding available to the Center for Mental Health Services to
    address priority needs, any opportunity that might exist to address
    such co-morbidities appears futile. Yet such a focus could pave the way
    for the one in three people who have survived a heart attack and
    experience major depression in a given year to improve their overall
    health and lessen the fiscal burden on the nation's health care system.

                               RETURNING SOLDIERS

        It has been reported that through the end of September 2004, nearly
    900 troops had been evacuated from Iraq by the Army for psychiatric
    reasons, included attempts or threatened attempts at suicide. And a
    study of members of combat infantry units deployed to Iraq in 2003
    published in the New England Journal of Medicine (July 1, 2004),
    researchers found evidence of major depression, anxiety, or PTSD after
    combat duty in approximately one of every six of these troops. Dr.
    Stephen C. Joseph, an assistant secretary of defense for health affairs
    from 1994 to 1997, declared that ``the mental health consequences are
    going to be the medical story of [the Iraqi] war.'' We should not
    assume, however, that those bearing the psychic scars of this war will
    necessarily seek treatment from the Defense Department or the
    Department of Veterans Affairs. The study in New England Journal was
    particularly troubling in that regard in finding that most veterans who
    appeared to have combat-related mental health problems avoided seeking
    the treatment available in the military, due principally to stigma.
    That finding suggests that for many veterans war-related mental health
    problems may go unaddressed for a period of time. In many instances, an
    already overburdened public mental health system may be called on to
    meet their needs.
        At a minimum, this problem calls for a robust, multi-pronged
    campaign to renew and more fiercely combat the enormous stigma in key
    sectors of American society, such as among service-members. Where
    stigma and misperceptions regarding mental health problems fuel
    resistance to early intervention, one can foresee that these problems
    will simply persist and worsen. Yet with a sharply diminished budget,
    it is highly unlikely that SAMHSA could even consider a new anti-stigma
    effort.

                                    SUICIDE

        Yet another very troubling dimension of the SAMHSA budget is its
    ``status quo'' approach to public health crisis. Both the Institute of
    Medicine and the President's New Freedom Commission on Mental Health
    have highlighted that mental illness plays a major role in the over
    650,000 attempted suicides in America every year--30,000 suicides are
    completed. Almost twice as many individuals die from suicide than
    homicide yet hundreds of millions are spent on law enforcement and
    corrections facilities to prevent and protect Americans from homicides
    while suicide prevention funding under the proposed CMHS budget would
    be held to a mere $16.5 million. We urge the Subcommittee to heed this
    disparity and bring funding for suicide prevention efforts more closely
    in line with the scope of this public health crisis.
        The tragedy that befell Sen. Gordon Smith and his family when his
    son took his life did shine a spotlight on this unspeakable crisis.
    Last year, Congress enacted the Garrett Lee Smith Memorial Act to: (a)
    support the planning, implementation, and evaluation of organized
    activities involving statewide youth suicide intervention and
    prevention strategies; (b) authorize grants to institutions of higher
    education to reduce student mental and behavioral health problems; and
    (c) authorize funding for the national suicide prevention resource
    center. The program will provide early intervention and assessment
    services, including screening programs, to youth who are at risk for
    mental or emotional disorders that may lead to a suicide attempt, and
    that are integrated with school systems, educational institutions,
    juvenile justice systems, substance abuse programs, mental health
    programs, foster care systems, and other child and youth support
    organizations.
        Suicide is a problem of enormous scope and demands a response
    commensurate with its enormity. The truly tragic aspect to suicide is
    how largely preventable this crisis is. It is not just young people at
    risk of suicide deaths, older Americans are also at great risk. We urge
    the Subcommittee to increase both youth-suicide prevention funding and
    support for the Elderly program at CMHS to deal with suicide and other
    issues endemic to an aging population.

                                    CLOSING

        Shrinking CMHS program funding to fiscal year 2002 dollar levels is
    a very troubling response to a landmark Presidential commission's call
    to make mental health a national priority. But a budget decline of this
    magnitude would have concrete implications in communities across this
    country. It would, for example, mean closing the door to states and
    communities that badly need help to improve mental health service-
    delivery. It would mean no help to anguished school systems that are
    struggling to achieve the twin goals of school-safety and healthy-
    students in the face of the threat of more Columbines and Red Lakes. It
    would mean despair for young people languishing in juvenile detention
    facilities across the country while they wait for community mental
    health treatment and families forced to relinquish custody of their
    children to secure desperately needed mental health services.
        Without a seismic shift in the level of priority the Federal
    government gives to mental health, and a corresponding investment in
    research, supports and services, we can expect to see a
    disproportionate numbers of individuals with mental illness who attempt
    and complete suicide or languish in corrections facilities.
        By making mental health a more robust funding priority, this
    Subcommittee could dramatically change the lives of millions of
    Americans, improving not only their well-being but our nation's
    productivity. And by investing in early intervention services and in an
    array of other mental health services and supports, precious resources
    at the state and federal level would be saved by stemming the flow of
    resources being spent in corrections or other systems that deliver
    mental health services that are not as cost-effective and at a lower
    quality than providing those services in the community.
                                     ______

         Prepared Statement of the National Nursing Centers Consortium

        The NNCC (National Nursing Centers Consortium) appreciates the
    opportunity to submit written comments for the record regarding funding
    for nursing workforce and research programs in fiscal year 2006. This
    testimony does not include a monetary request. Instead, the NNCC
    requests that this subcommittee support the creation of a new grant
    program under the jurisdiction of the Health Resources and Services
    Administration's (HRSA's) Bureau of Health Professions (BHPr) that
    would enable the Centers for Medicare and Medicaid Services (CMS) to
    issue nurse-managed health centers (NMHCs) prospective payment
    reimbursement for their Medicare and Medicaid patients.

                                NNCC BACKGROUND

        The NNCC is the first nation wide association of nurse-managed
    health centers (NMHCs) in the United States. The organization currently
    represents over 100 NMHCs and individual members in 35 states. These
    centers are typically community-based non-profit organizations or are
    affiliated with university-based schools of nursing. The fact that many
    NNCC member centers are affiliated with schools of nursing allows them
    to act as teaching centers for new nurses entering the workforce. Along
    with fulfilling this important role with regard to nursing education,
    these centers also provide a host of primary care, health promotion and
    disease prevention services to medically underserved patients living in
    both urban and rural communities. NNCC member centers are run by nurse
    practitioners in partnership with the communities they serve. Many
    NMHCs have established community advisory boards that give the
    community a role in determining the future of the center and the
    services provided. Along with nurse-practitioners, these services may
    also be provided clinical nurse specialists, registered nurses, health
    educators, community outreach workers, health care students and
    collaborating physicians.
        The vision of the NNCC is to improve the health of communities
    through neighborhood-based health care services that are accessible,
    acceptable, and affordable. The mission is to strengthen the capacity,
    growth, and development of nurse-managed health centers to provide
    quality health care services to vulnerable populations and to eliminate
    health disparities in underserved communities.

           THE FINANCIAL CRISIS FACED BY NURSE-MANAGED HEALTH CENTERS

        Many NMHCs were initially established with the help of Nurse
    Practice and Retention grants from the BHPr. However, of the 70
    grantees that received Division of Nursing (DON), grants to establish
    nurse-managed health centers between 1993-2001, 27 or 39 percent have
    been forced to close. There are two main reasons why such a high
    percentage of DON funded NMHCs are no longer in operation. The first
    reason is that DON has shifted its funding priorities to nurses working
    in acute care settings, and is no longer funding NMHCs. The second
    reason is that even though a recent study conducted by the NNCC and
    sponsored CMS found that NMHCs are safety-net providers, they do not
    have access to the prospective payment system (PPS), which is offered
    to other safety-net providers such as Community Health Centers (CHCs)
    and Federally Qualified Health Centers (FQHCs).
        Under PPS, CHCs/FQHCs are able to offset the cost of caring for the
    uninsured because they receive a higher level of reimbursement for
    their Medicare and Medicaid patients. Even though NMHCs also see a high
    percentage of uninsured patients they cannot offset these costs through
    PPS. Without PPS, NMHCs are forced to depend on low capitation payments
    from managed care organizations (MCOs) and unreliable private grants.
    These payments and grants are not sufficient to cover the costs of
    operating NMHCs.
        For example, the average cost of caring for a Medicaid recipient at
    a NMHC is about $540 per year. However, Medicaid MCOs pay an average
    annual capitation payment of about $144 for each Medicaid patient. This
    means that capitation payments only cover about 26 percent of the costs
    associated with caring for Medicaid patients. NMHCs are forced to seek
    outside funding to recover the other 74 percent of these costs.
    Assuming the NMHC is able to cover these costs, the center must then
    take into account the costs associated with caring for their uninsured
    clients that are and not eligible for capitation payments. About 46
    percent of the clients receiving care at NNCC member centers around the
    nation are uninsured.
        In contrast, CHCs and FQHCs with access to PPS are able to recover
    about 89 percent of the costs associated with their Medicaid clients.
    This increased revenue allows these centers to direct a higher
    percentage of their resources to covering the cost of caring for their
    uninsured patients. In addition, CHCs receive an average payment of
    $250 for each uninsured patient. PPS helps to ensure that CHCs/FQHCs
    remain financially viable. If NMHCs do not also gain access to PPS
    reimbursement many more of these centers will be forced to close
    leaving thousands of medically underserved and uninsured clients
    without access to critical primary care services. Congress itself has
    recognized the tremendous financial challenges faced by NMHCs, and has
    published language, ``encouraging HRSA to provide alternative means to
    secure cost-based (or PPS) reimbursement for NMHCs'' (Senate Report
    108-345 (2005) p.37).
        Earlier this year the Senate Appropriations Committee praised NMHCs
    for the important work they are doing to reinforce America's health
    care safety-net. The committee stated, ``Nurse-Managed Health Centers
    (NMHCs) serve a dual function in strengthening the health care safety-
    net by providing health care to populations in underserved areas and by
    providing the clinical experiences to nursing students that are
    mandatory for professional development.'' (Senate Report 108-345 (2005)
    p.37). If Congress truly values NMHCs this subcommittee should move to
    ensure that they have access to PPS reimbursement.
        NNCC requests that this subcommittee support the creation of a new
    grant program under which HRSA's BPHr would be allowed to distribute
    grants through which CMS could issue NMHCs PPS reimbursement. The most
    likely place for BPHr to find the authority to issue such grants would
    be under Title VIII of the Public Health Service Act (PHSA). Placing
    the new grant program under Title VIII of the PHSA would allow NMHCs to
    retain their emphasis on education and nursing workforce development.
    The NNCC also requests that any NMHCs, which previously received start
    up funding through DON, be automatically granted access to the newly
    created PPS. As mentioned above, there are still about 48 NMHCs in
    operation around the country which were established with the help of
    DON grants. However, shifting funding priorities at DON have left these
    centers in need of a stable source of funding. Granting them automatic
    access to PPS would make them financially viable and allow them to
    provide a full range of primary care, health promotion and disease
    prevention services to their patients. These centers record close to
    600,000 client encounters each year. Lastly, CHCs receive approximately
    $250 every year for each of their uninsured patients. BHPr should be
    given the discretion to provide similar grant funding to NMHCs that
    provide care to a high percentage of uninsured clients.

                                   CONCLUSION

        We thank you for this opportunity to discuss the financial crisis
    faced by NMHCs and the significance of maintaining their financial
    sustainability. The NNCC is ready to assist policy makers in granting
    NMHCs PPS reimbursement, and has already drafted a model bill that
    would accomplish this goal. If the above steps are taken the NNCC
    believes the future of these important safety-net providers will be
    secure for years to come.
                                     ______

      Prepared Statement of the National Organizations Responding to AIDS
                                (NORA) Coalition

              RECOGNIZING THE CHALLENGES AND LOOKING TO THE FUTURE

        The year 2005 brought with it a new Congress and a new
    Administration, yet for people living with, and at risk for, HIV and
    the organizations and agencies that serve them, things have remained
    much the same. For the fourth year in a row federal funding for the
    domestic HIV/AIDS portfolio remains level, and for the past two years
    funding has been reduced through funding rescissions. For the fifth
    consecutive year, the Centers for Disease Control and Prevention (CDC)
    maintains that there are 850,000-950,000 people living with HIV in the
    United States, despite a minimum of 40,000 new infections each year.\1\
    And once again we find ourselves challenged to make a noticeable
    difference in the course of the HIV epidemic.
    ---------------------------------------------------------------------------
        \1\ Centers for Disease control and Prevention, ``Basic
    Statistics,'' 2003. <>
    ---------------------------------------------------------------------------
        Since 2000, the CDC has estimated that there were 850,000-950,000
    people living with HIV in the United States. Since that time, the CDC
    has reported that there are approximately 40,000 new HIV infections,
    and 15,000 deaths from AIDS related causes, in the United States each
    year.\2\ (This is a minimum number; recent data suggests that we may be
    actually seeing 43,000-44,000 additional new infections each year.)
    Thus, by simply doing the math it would seem that today, in 2005, there
    are roughly 125,000 more people living with HIV in this country then
    there were just five years ago--for a total of 975,000-1,075,000 HIV
    positive Americans. In other words, 1 million people.\3\
    ---------------------------------------------------------------------------
        \2\ Fleming, P., et al., ``HIV Prevalence in the U.S. 2000,'' 9th
    Conference on Retroviruses and Opportunistic Infections, February 2002.
        \3\ Ovadiya, Iris, and Tytel, Jessica, AIDS Action.
    ---------------------------------------------------------------------------
        Twenty-four years after the start of the HIV epidemic one million
    people are living in the United States with HIV--and that number
    continues to grow each and every day. Despite all the progress that has
    been made, from the development of new treatments and therapies to
    increased availability of testing and counseling services, the epidemic
    here at home is still far from over.
        The U.S. domestic response has historically been a patchwork of
    services, ranging from the work of community-based organizations to
    that of agencies of the federal government, each of which continues to
    play a critical role in addressing the epidemic. Since the beginning
    the thread that has bound all of these pieces together has been the
    financial support of Congress and the White House. Unfortunately,
    recent fiscal constraints have caused that thread to fray--to the point
    where some of the pieces are threatening to come undone. It is
    increasingly clear that unless we reengage ourselves in the real work
    of responding to this epidemic we will no longer be able to maintain
    the public health systems that have until now have been the true
    successes in addressing HIV in the United States.
        Of special note, of the 1 million people who are currently living
    with HIV in the United States, CDC and the Health Resources and
    Services Administration (HRSA) estimate that roughly one half are
    accessing regular medical care.\4\ On one level that is a very
    important accomplishment. 500,000 people are receiving the live-saving
    treatment and medical support that they need because our government
    made an investment and a commitment to help through the establishment
    of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act and
    through the commitment of additional resources to existing programs.
    However, the fact remains that the other half--another 500,000--are not
    in care, either because they are unaware of their HIV status or because
    of financial and/or other barriers that are keeping them from getting
    the care and treatment that they need. This grim statistic has remained
    unchanged for the past five years. The challenge before us now is to
    find a way to tip the balance.
    ---------------------------------------------------------------------------
        \4\ Fleming, P., et al., ``HIV Prevalence in the U.S. 2000,'' 9th
    Conference on Retroviruses and Opportunistic Infections, February 2002.
    ---------------------------------------------------------------------------
        If we are going to provide care and support services for those
    500,000 Americans currently not in care we must first face up to the
    reality of the challenge that lies before us. Most of the programs
    within the domestic federal HIV portfolio have been level-funded and/or
    cut for the past four fiscal years. Many are now facing their lowest
    funding levels in recent memory--despite the fact that they are seeing
    an increasing demand for services. We are now finding ourselves
    straining to meet the needs of the 500,000 we already serve, all the
    while aware of the need to reach an additional 500,000 whose needs we
    have not even begun to assess or address. Despite all of our best
    efforts we are still not reaching the people who need us most. Without
    access to testing and counseling, and subsequently care and treatment,
    these people remain unaware of the realities of their HIV infection,
    and thus unable to maintain their own health and prevent further
    transmission of the virus. This is simply unacceptable.
        Both CDC and HRSA have recently identified the half a million HIV
    positive people not in care as a top priority for their HIV programs.
    Beginning with the 2000 reauthorization of the Ryan White CARE Act,
    HRSA has focused attention on what it has termed ``unmet need,''
    individuals who are HIV positive and aware of their status, but not in
    care. CARE Act grantees have received instructions from HRSA to
    prioritize this population in the delivery of services in an attempt to
    successfully connect these individuals to care. However, no additional
    resources have been allocated to grantees for this task, and many
    report that they are already overburdened by their current client load.
    For example, in the Washington, D.C. metro area newly diagnosed HIV
    positive clients are being placed on 3 month long waiting lists for
    doctor's appointments.
        In 2003, CDC launched Advancing HIV Prevention (AHP), a new
    initiative ``aimed at reducing barriers to early diagnosis of HIV
    infection and, if positive, increasing access to quality medical care,
    treatment, and ongoing prevention services.'' \5\ One of the primary
    goals of this national initiative is to increase access to HIV
    counseling, testing, and referral to care. Since the first funds were
    awarded in 2003, AHP has shown success in linking people to testing
    through the use of new rapid test technologies; however, it remains to
    be seen whether or not the CDC can successfully link these people to
    care--and whether or not HRSA's already overburdened care system can
    maintain them in services.
    ---------------------------------------------------------------------------
        \5\ Centers for Disease Control and Prevention, ``Advancing HIV
    Prevention: New Strategies for a Changing Epidemic,'' September 2003.
    <>
    ---------------------------------------------------------------------------
        Last year NORA chose to focus on building upon our past successes.
    This year we must look to what we still have left to do. The AHP and
    unmet need initiatives are working, but we can not expect them to be
    the definitive solution. The HIV epidemic in this country continues to
    evolve, and we continue to face unanticipated policy and program
    challenges. In the past year alone we have seen the initial phases of
    implementation of the Medicare Modernization Act, the expansion of
    rapid testing technologies, and emerging concerns about the Food and
    Drug Administrations (FDA) drug approval process. At the same time the
    Department of Health and Human Services has committed itself to the
    goal of reducing by half annual HIV infections in this country by 2010,
    after realizing that the 2005 goal was out of reach. The federal
    government must commit to fund, manage, and monitor the domestic
    response, or else we will find ourselves falling even farther behind in
    our response to the epidemic.
        The challenge before us today is significant, but it is not
    insurmountable. If we commit to funding that truly meets the needs of
    people living with, and at risk for, HIV infection then we can change
    the course of the epidemic.
        We know how to provide care.
        We know what it takes to link people to medical treatment.
        We know how to support its communities living with HIV.
        Now is the time to turn knowledge into action.
        The chart that follows is NORA's funding recommendations for fiscal
    year 2006.

                                           NORA FISCAL YEAR 2006 APPROPRIATIONS REQUESTS FOR FEDERAL HIV/AIDS PROGRAMS
    --------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                     President's                         Fiscal year 2006
                Program               Fiscal yeary 2006 need   Fiscal year 2005    fiscal year 2006     Change from            NORA           Change from
                                                                 appropriation         request        fiscal year 2005   recommendations    fiscal year 2005
    --------------------------------------------------------------------------------------------------------------------------------------------------------
     DEPARTMENT OF HEALTH AND HUMAN
                SERVICES

    Minority HIV/ AIDS Initiative    $855 million...........  $399 million \1\..  $399 million.....  .................  $610 million.....  +$411 million
     (To be added across multiple
     HHS programs and included in
     fiscal year 2002 program
     totals as indicated).
    ACF: Runaway and Homeless Youth  .......................  104 million.......  114 million......  +$10 million.....  140 million......  +36 million
     Act Programs.
    Agency for Healthcare Research   .......................  319 million.......  319 million......  .................  440 million......  +121 million
     and Quality.
    CDC: Total--HIV, STD, TB line..  2.33 billion...........  961.2 million.....  957.3 million....  -4 million.......  2.33 billion.....  +1.27 billion
    CDC: HIV Prevention and          .......................  662.6 million.....  686.6 million....  -4 million.......  1.5 billion......  +813.4 million
     Surveillance.
    CDC: STD Prevention............  .......................  159.7 million.....  159.7 million....  .................  351 million......  +191.3 million
    CDC: TB Prevention.............  .......................  138.9 million.....  138.9 million....  .................  287.3 million....  +148.4 million
    CDC: Viral Hepatitis             .......................  17.36 million.....  17.36 million....  .................  100.24 million...  +82.88 million
     (Infectious Disease Control
     line).
    CDC: DASH (Chronic Disease       .......................  56.75 million.....  56.76 million....  +0.1 million.....  88.25 million....  +31.49 million
     Prevention and Health
     Promotion line).
    FDA............................  .......................  1.45 billion......  1.5 billion......  +50 million......  1.57 billion.....  +116 million
    HRSA: Ryan White CARE Act Total  3.2 billion............  2.048 billion.....  2.058 billion....  +10 million......  2.56 billion.....  +513 million
    Title I........................  .......................  610 million.......  610 million......  .................  725 million......  +115 million
    Title II: Care.................  .......................  334 million.......  334 million......  .................  384 million......  +50 million
    Title II: ADAP.................  1.5 billion (non-add)..  787 million.......  797 million......  +10 million......  1.09 billion.....  +303 million
    Title III......................  .......................  196 million.......  196 million......  .................  236.6 million....  +41 million
    Title IV.......................  .......................  72.53 million.....  72.53 million....  .................  113.25 million...  +40.72 million
    Part F: AETCs..................  .......................  35 million........  35 million.......  .................  45 million.......  +10 million
    Part F: Dental Reimbursement...  .......................  13.3 million......  13.3 million.....  .................  19 million.......  +5.7 million
    HRSA: Consolidated Health        .......................  1.733 billion.....  2.038 billion....  +304.2 million...  2.038 billion....  +304.2 million
     Centers.
    HRSA: Title V..................  .......................  724 million.......  724 million......  .................  755 million......  +31 million
    HRSA: Title X..................  .......................  286 million.......  286 million......  .................  350 million......  +66 million
    Indian Health Service: HIV/AIDS  .......................  2.68 million......  2.79 million.....  +0.1 million.....  10 million.......  +7.32 million
     Program.
    NIH Office of AIDS Research....  3.327 billion..........  2.92 billion......  2.93 billion.....  +12 million......  3.1 billion......  +200 million
    Office of the Secretary: Office  5 million..............  ..................  .................  .................  2 million........  +2 million
     of HIV/AIDS Policy.
    SAMHSA: Center for Substance     .......................  1.78 billion......  1.78 billion.....  .................  1.85 billion.....  +71 million
     Abuse Treatment Block Grant
     \2\.
    SAMHSA: Center for Substance     .......................  422.4 million.....  447.1 million....  +24.7 million....  472 million......  +50 million
     Abuse Treatment--other.
    SAMHSA: Center for Substance     .......................  198.7 million.....  184.3 million....  -14.4 million....  210 million......  +11 million
     Abuse Prevention \3\.
    SAMHSA: Mental Health Block      .......................  432.8 million.....  432.8 million....  .................  471.5 million....  +38.9 million
     Grant \4\.
    SAMHSA: Center for Mental        .......................  176.7 million.....  144.1 million....  -32.6 million....  191.8 million....  +15.1 million
     Health Services--other \4\.
    SAMHSA: GBHI...................  .......................  40.1 million......  34.4 million.....  -5.7 million.....  42.5 million.....  +1.7 million
    SAMHSA: PATH...................  .......................  54.8 million......  54.8 million.....  .................  59.8 million.....  +5 million

     DEPARTMENT OF EDUCATION (DOE)

    Protection and Advocacy for      .......................  16.6 million......  16.6 million.....  .................  22 million.......  +5.4 million
     Human Rights.

    DEPARTMENT OF HOUSING AND URBAN
           DEVELOPMENT (HUD)

    HOPWA..........................  2.8 billion............  282 million.......  268 million......  -14 million......  385 million......  +103 million
    McKinney-Vento Homelessness      .......................  1.241 billion.....  1.44 billion.....  +199 million.....  1.572 billion....  +331 million
     Assistance Grant Program.

        GLOBAL HIV/AIDS PROGRAMS

    President's Emergency Plan for
     AIDS Relief (PEPFAR)

    HIV/AIDS Programs..............  6.7 billion............  2.9 billion.......  3.16 billion.....  +265 million.....  4.61 billion.....  +1.7 billion

    Global Fund to Fight AIDS,
     Tuberculosis and Malaria (non-
     add)

    Global Fund....................  1.5 billion............  435 million.......  300 million......  -135 million.....  1.5 billion......  +1.06 billion
    --------------------------------------------------------------------------------------------------------------------------------------------------------
    \1\ NOTE.--All fiscal year 2004 amounts include the .80 percent rescission.
    \2\ The numbers in this chart reflect the entire budget of SAMHSA for Substance Abuse Treatment; HIV/AIDS programs are included in this total.
    \3\ The numbers in this chart reflect the entire budget of SAMHSA for Substance Abuse Prevention; HIV/AIDS programs are included in this total.
    \4\ The numbers in this chart reflect the entire budget of SAMHSA for Mental Health Services; HIV/AIDS programs are included in this total.

         Prepared Statement of the North American Brain Tumor Coalition

        I am Gary L. Kornfeld, a nine-year survivor of a grade 3
    oligoastrocytoma and Chair of the North American Brain Tumor Coalition
    (NABTC). On behalf of the Coalition, I am pleased to offer these
    comments regarding brain tumor research for the record of the Labor,
    Health and Human Services, and Education Appropriations Subcommittee.
    The NABTC, a network of 12 brain tumor organizations, is dedicated to
    improving treatments for brain tumors and ensuring individuals with
    brain tumors access to high quality care. The volunteers who comprise
    the NABTC are survivors, family members, friends, and caregivers, and
    we know firsthand the devastating effects that brain tumors can have.
    We are working hard to reduce the suffering from brain tumors and
    improve the outlook for all who receive this diagnosis.
        Each year, approximately 190,000 people in the United States and
    10,000 in Canada will be diagnosed with a primary or metastatic brain
    tumor. Approximately 40,000 individuals in the United States will be
    diagnosed with primary brain tumors; of this total, more than 18,000
    will be diagnosed with malignant brain tumors. Brain tumors are a
    leading cause of death from childhood cancer, accounting for almost a
    quarter of cancer deaths in children up to 19 years of age. Brain
    tumors are the second leading cause of cancer death in young adults
    ages 20-39.
        These numbers, as frightening as they are, do not convey the
    complete story. The treatment of brain tumors is very difficult, and
    factors that contribute to these treatment challenges are the location
    of these tumors and the fact that there are more than 120 different
    kinds of tumors. Standard therapies for brain tumors include surgery,
    radiation therapy, and chemotherapy, used either individually or in
    combination.

                          RECENT ADVANCES IN TREATMENT

        There have been recent advances in the treatment of glioblastoma
    multiforme (GBM), or grade IV malignant glioma, which usually causes
    death in a year. Researchers have found that concurrent administration
    of a chemotherapy drug, temozolomide, and radiation therapy results in
    a clinically meaningful survival benefit of two and one-half months for
    newly diagnosed glioblastoma patients.
        These findings were published in the New England Journal of
    Medicine on March 10, 2005.\1\ Temozolomide with radiation can be a
    very significant development for patients with GBM, and the brain tumor
    community applauds this development. However, much more must be done to
    extend and improve the lives of those affected by brain tumors.
    Progress against brain tumors still comes much too slowly.
    ---------------------------------------------------------------------------
        \1\ Stupp, et al., ``Radiotherapy Plus Concomitant and Adjuvant
    Temozolomide for Glioblastoma,'' New England Journal of Medicine, March
    10, 2005.
    ---------------------------------------------------------------------------
        The NABTC believes treatment strides will come through an enhanced
    investment in brain tumor research and improved dissemination of
    information about the best available care for brain tumors. Researchers
    in the Glioma Outcomes Project recently reported troubling gaps in care
    of individuals with brain tumors, suggesting that more work needs to be
    done to guarantee that the best possible therapies are available to all
    with brain tumors.\2\
    ---------------------------------------------------------------------------
        \2\ Chang, et al., ``Patterns of Care for Adults With Newly
    Diagnosed Malignant Glioma,'' Journal of the American Medical
    Association, February 2, 2005.
    ---------------------------------------------------------------------------
                 ENHANCE THE INVESTMENT IN BRAIN TUMOR RESEARCH

        In 2000, the National Cancer Institute (NCI) and National Institute
    of Neurological Disorders and Stroke (NINDS) published the report of a
    brain tumor research advisory panel, called the Brain Tumor Progress
    Review Group. This report included an aggressive and thoughtful plan
    for moving brain tumor research and treatments forward. In 2000, the
    NABTC endorsed the Progress Review Group plan and urged implementation
    of its key research recommendations. In 2005--half a decade after the
    report's publication--the NABTC finds that the report still describes a
    valid and vital plan for brain tumor research. While the continuing
    relevance of the report is in part a testament to the vision of the
    Progress Review Group, it is primarily a testament to the troubling
    lack of progress in brain tumor research and treatment and the failure
    to implement the report's recommendations.
        To advance brain tumor research, the NABTC recommends that:
      --NCI and NINDS implement the recommendations of the Brain Tumor
            Progress Review Group. To ensure that we do not look back from
            2010 and observe limited progress on the Progress Review Group
            plan, the NABTC requests that NCI and NINDS submit to Congress
            a brain tumor research plan, including timelines and a budget
            for implementation of the PRG report.
      --The Directors of NCI and NINDS appoint leaders of their extramural
            brain tumor programs without delay. Strong scientific
            management is necessary to ensure that the nation's financial
            investment in brain tumor research is utilized as effectively
            as possible. Extramural research coordinators should be
            appointed at each institute to ensure that there is proper
            leadership on brain tumor research issues.
      --Congress provide adequate funding for existing brain tumor research
            efforts. There are several structures or systems for clinical
            research on brain tumors, including the brain tumor consortia
            and the brain tumor specialized programs of research
            significance (SPOREs), but these programs are not adequately
            funded to allow investigation of all promising brain tumor
            treatments and to ensure correlative studies as part of trials.
      --NINDS and NCI convene a special workshop on brain tumor research.
            Brain tumor research is an area where cross-disciplinary
            research approaches are absolutely critical, and a workshop on
            a cutting-edge brain tumor research topic would likely
            stimulate innovative research efforts. A workshop is an
            activity that could be undertaken by NINDS in collaboration
            with NCI.
        For individuals with brain tumors and their families, friends, and
    caregivers, the NABTC urges a greater sense of urgency among the
    leaders of NCI and NINDS regarding brain tumor research.

               ELIMINATE THE TWO-YEAR WAITING PERIOD FOR MEDICARE

        Although we realize Medicare is not in the jurisdiction of this
    Subcommittee, we nevertheless would like to direct your attention to
    important legislation, introduced by Senator Jeff Bingman (D-NM) and
    Representative Gene Green (D-TX), that would eliminate the two-year
    waiting period for Medicare benefits for those who have established
    eligibility for Social Security Disability benefits. For many
    individuals with brain tumors, the current 24-month waiting period can
    result in delays in access to care that extends or improves life.
        Thank you again for the opportunity to offer this brief statement
    on brain tumor research and care.
                                     ______

               Prepared Statement of the Oncology Nursing Society

        The Oncology Nursing Society (ONS) appreciates the opportunity to
    submit written comments for the record regarding funding for cancer and
    nursing related programs in fiscal year 2006. ONS, the largest
    professional oncology group in the United States composed of more than
    31,000 nurses and other health professionals, exists to promote
    excellence in oncology nursing and the provision of quality care to
    those individuals affected by cancer. As part of its mission, the
    Society honors and maintains nursing's historical and essential
    commitment to advocacy for the public good.
        This year more than 1.37 million Americans will be diagnosed with
    cancer and more than 570,000 will lose their battle with this terrible
    disease. Despite these grim statistics, significant gains in the War
    Against Cancer have been made through our nation's investment in cancer
    research and its application. Research holds the key to improved cancer
    prevention, early detection, diagnosis, and treatment, but such
    breakthroughs are meaningless unless we can deliver them to all
    Americans in need. Recent studies have reported 126,000 registered
    nurse vacancies in hospitals and 13,900 registered nurse vacancies in
    nursing homes. These statistics create a sizeable barrier to ensuring
    that all people benefit from breakthroughs in cancer research.
        To ensure that all people with cancer have access to the
    comprehensive, quality care they need and deserve, ONS advocates on-
    going and significant federal funding for cancer research and
    application, as well as funding for programs that help ensure an
    adequate oncology nursing workforce to care for people with cancer. The
    Society stands ready to work with policymakers at the local, state, and
    federal levels to advance policies and programs that will reduce and
    prevent suffering from cancer and sustain and strengthen the nation's
    nursing workforce.

        SECURING AND MAINTAINING AN ADEQUATE ONCOLOGY NURSING WORKFORCE

        Over the last 10 years, the setting in which treatment for cancer
    is provided has changed dramatically. An estimated 80 percent of all
    Americans receive cancer care in community settings including cancer
    centers, physicians' offices, and hospital outpatient departments.
    Treatment regimens are as complex, if not more so, than regimens given
    in the inpatient setting a few years ago. Oncology nurses are on the
    front lines in the provision of quality cancer care for individuals
    with cancer--administering chemotherapy, managing patient therapies and
    side-effects, working with insurance companies to ensure that patients
    receive the appropriate treatment, providing counseling to patients and
    family members, and engaging in myriad other activities on behalf of
    people with cancer and their families.
        Overall, age is the number one risk factor for developing cancer.
    Approximately 77 percent of all cancers are diagnosed at age 55 and
    older. Currently, Medicare beneficiaries account for more than 50
    percent of all cancer diagnoses and 64 percent of cancer deaths. Over
    the next 10 to 15 years the number of Medicare beneficiaries with
    cancer is estimated to double while more than 1.1 million registered
    nursing vacancies will need to be filled by 2012 to meet growing
    patient demand and replace retiring nurses. With an increasing number
    of people with cancer needing high quality health care, coupled with an
    inadequate nursing workforce, our nation could quickly face a cancer
    care crisis of serious proportion with limited access to quality cancer
    care, particularly in traditionally underserved areas. A study in the
    New England Journal of Medicine found that nursing shortages in
    hospitals are associated with a higher risk of complications--such as
    urinary tract infections and pneumonia, longer hospital stays, and even
    patient death. Without an adequate supply of nurses, there will not be
    enough qualified oncology nurses to provide the quality cancer care to
    a growing population of people in need and patient health and well
    being could suffer.
        Further, of additional concern is that our nation also will have a
    shortage of nurses available and able to conduct cancer research and
    clinical trials. With a shortage of nurses in cancer research, the War
    against Cancer will take longer because of unfulfilled staffing needs
    coupled with the reality that in some practices and cancer centers
    resources could be funneled away from cancer research to pay for the
    hiring and retention of oncology nurses to provide direct patient care.
    Without a sufficient supply of trained, educated, and experienced
    oncology nurses, our nation will falter in its delivery--or
    application--of the benefits from our federal investment in research.
        ONS has joined with others in the nursing community in advocating
    $210 million as the fiscal year 2006 funding level necessary to support
    implementation of the Nurse Reinvestment Act and the range of nursing
    workforce programs housed at the U.S. Health Resources and Services
    Administration (HRSA). Enacted in 2002, the Nurse Reinvestment Act
    included new and expanded initiatives, including loan forgiveness,
    scholarships, career ladder opportunities, and public service
    announcements to advance nursing as a career. Despite the enactment of
    this critical measure, HRSA fails to have the resources necessary to
    meet the current and growing demands for our nation's nursing
    workforce. For example, in fiscal year 2004 HRSA received 4,873
    applications for the Nurse Education Loan Repayment Program, but only
    had funding to award 857--a rate of 17.6 percent. Also in fiscal year
    2004, the agency received 8,806 applications for the Nursing
    Scholarship Program, but only could fund 126--a rate of 1.4 percent.
    Further exacerbating the current situation is that nursing programs
    turned away more than 125,000 qualified students last year, in part due
    to a shortage of faculty. If funded sufficiently, the components and
    programs of the Nurse Reinvestment Act would help address the multiple
    factors contributing to the nationwide nursing shortage, including the
    shortage of faculty, decline in nursing student enrollments, and poor
    public perception of nursing as a viable and worthwhile profession.
        ONS strongly urges Congress to provide HRSA with a minimum of $210
    million in fiscal year 2006 to ensure that the agency has the resources
    necessary to fund a higher rate of Nurse Education Loan Repayment and
    Nursing Scholarship applications as well as implement other essential
    endeavors to sustain and boost our nation's nursing workforce. Nurses--
    along with patients, family members, hospitals, and others--have joined
    together in calling upon Congress to provide this essential level of
    funding. One Voice Against Cancer (OVAC)--a collaboration of more than
    45 national nonprofit organizations representing millions of
    Americans--has added a request of $210 million for the Nurse
    Reinvestment Act funding to its fiscal year 2006 appropriations
    advocacy agenda. ONS and its allies have serious concerns that without
    full funding, the ``Nurse Reinvestment Act'' will prove an empty
    promise; the current and expected nursing shortage will worsen and
    people will not have access to the quality cancer care they need and
    deserve.

     BOOST OUR NATION'S INVESTMENT IN CANCER PREVENTION, EARLY DETECTION,
                                 AND AWARENESS

        Approximately two-thirds of cancer cases are preventable through
    lifestyle and behavioral factors and improved practice of cancer
    screening. Although the potential for reducing the human, economic, and
    social costs of cancer by focusing on prevention and early detection
    efforts remains great, our nation does not invest sufficiently in these
    strategies. While as a nation we spend almost a trillion dollars a year
    on our health care system, we only allocate about one percent of that
    amount for population-based prevention. By the year 2020, cancer and
    other chronic disease expenditures will reach one trillion dollars or
    80 percent of health care costs. The nation must make significant and
    unprecedented federal investments today to address the burden of cancer
    and other chronic diseases, and to reduce the demand on the healthcare
    system and diminish suffering in our nation both for today and
    tomorrow.
        As the nation's leading prevention agency, the Centers for Disease
    Control and Prevention (CDC) plays an important role in translating and
    delivering at the community level what is learned from research--
    especially ensuring that those populations disproportionately affected
    by cancer receive the benefits of our nation's investment in medical
    research. Therefore, ONS joins with our partners in the cancer
    community--including OVAC--in calling on Congress to provide additional
    resources for physical activity, nutrition, and tobacco control
    programs and other cancer-related screening, prevention, and public
    health education efforts supported through the CDC to support and
    expand much-needed and proven effective cancer prevention, early
    detection, and risk reduction efforts. Specifically, ONS advocates the
    appropriation of $404 million in fiscal year 2006 for the Centers for
    Disease Control and Prevention's (CDC) comprehensive cancer, ovarian
    cancer, breast and cervical cancer early detection, cancer registries,
    prostate cancer, colorectal cancer, and skin cancer programs. ONS also
    urges an increase funding for the CDC's physical activity, nutrition,
    and tobacco-control programs to help reduce risk factors for developing
    cancer and other chronic diseases, diminish suffering from cancer, and
    decrease the demand on the healthcare system.
      --$250 million for the National Breast and Cervical Cancer Early
            Detection Program;
      --$65 million for the National Cancer Registries Program:
      --$25 million for the Colorectal Cancer Prevention and Control
            Initiative;
      --$25 million for the Comprehensive Cancer Control Initiative;
      --$20 million for the Prostate Cancer Control Initiative;
      --$5 million for the National Skin Cancer Prevention Education
            Program;
      --$9 million for the Ovarian Cancer Control Initiative;
      --$5 million for the Geraldine Ferraro Blood Cancer Program;
      --$145 million for the National Tobacco Control Program; and
      --$70 million for the Nutrition, Physical Activity, and Obesity
            Program.

                SUSTAIN AND SEIZE CANCER RESEARCH OPPORTUNITIES

        Our nation has benefited immensely from past federal investment in
    biomedical research at the National Institutes of Health (NIH). ONS has
    joins with the entire cancer community in advocating $30.1 billion for
    the NIH in fiscal year 2006. This will allow NIH to sustain and build
    on its research progress resulting from the recent NIH budget doubling
    effort while avoiding the severe disruption to that progress that would
    result from a minimal increase.
        Cancer research is producing extraordinary breakthroughs--leading
    to new therapies that translate into longer survival and improved
    quality of life for cancer patients. We have seen extraordinary
    advances in cancer research resulting from our national investment that
    have produced effective prevention, early detection and treatment
    methods for many cancers. To that end, ONS calls upon Congress to
    allocate $5.21 billion to the National Cancer Institute (NCI) in fiscal
    year 2006 to continue our battle against cancer.
        The National Institute of Nursing Research (NINR) supports basic
    and clinical research to establish a scientific basis for the care of
    individuals across the life span--from management of patients during
    illness and recovery to the reduction of risks for disease and
    disability and the promotion of healthy lifestyles. These efforts are
    crucial in translating scientific advances into cost-effective health
    care that does not compromise quality of care for patients.
    Additionally, NINR fosters collaborations with many other disciplines
    in areas of mutual interest such as long-term care for older people,
    the special needs of women across the life span, bioethical issues
    associated with genetic testing and counseling, and the impact of
    environmental influences on risk factors for chronic illnesses such as
    cancer. ONS joins with the nursing community in advocating an
    allocation of $160 million for NINR in fiscal year 2006.

                                   CONCLUSION

        ONS stands ready to work with policymakers to advance policies and
    support programs that will reduce and prevent suffering from cancer
    this year and sustain and strengthen our nation's nursing workforce.
    Moreover, ONS maintains a strong commitment to working with Members of
    Congress, other nursing societies, patient organizations, and other
    stakeholders to ensure that the oncology nurses of today continue to
    practice tomorrow and that we recruit and retain new oncology nurses to
    meet the unfortunate growing demand that we will face as the baby boom
    generation ages. We thank you for this opportunity to discuss the
    funding levels necessary to ensure that our nation has a sufficient
    nursing workforce to care for the patients of today and tomorrow and
    that our nation continues to make gains in our fight against cancer.
                                     ______

               Prepared Statement of the Procter & Gamble Company

        Procter & Gamble appreciates the opportunity to provide testimony
    in support of funding for the Interagency Coordinating Committee on the
    Validation of Alternative Methods (ICCVAM) and pain and distress
    research under the jurisdiction of the Labor, Health and Human
    Services, Education and Related Agencies Subcommittee in fiscal year
    2006.
        As a leader in the development of alternatives to animal testing,
    P&G is committed to eliminating animal testing for products intended
    for human use. We are working on a global basis with governments and
    academia to eliminate regulations that require unnecessary animal
    testing and to promote the acceptance of alternatives. To date, P&G has
    devoted significant resources to this effort and helped to develop more
    than 50 proven alternative methods. Despite these advances, it is
    acknowledged that state-of-the-art science cannot replace animal
    research at present and far more research is needed, by governments,
    academia and the private sector, for the development, promotion and
    validation of alternative test methods.

      INTERAGENCY COORDINATING COMMITTEE ON THE VALIDATION OF ALTERNATIVE
                                METHODS (ICCVAM)

        We were very pleased that Congress enacted Public Law 106-545 by
    unanimous voice vote in both chambers in 2000. This legislation,
    introduced by Senator Mike DeWine (R-OH) and Representatives Ken
    Calvert (R-CA) and Tom Lantos (D-CA), strengthened and made permanent
    the Interagency Coordinating Committee on the Validation of Alternative
    Methods (ICCVAM). The statute has already begun to enhance the federal
    government's capacity to evaluate and adopt chemical testing methods
    that are often faster, cheaper, and more scientifically sophisticated
    than current methods, as well as more responsive to the public's
    concerns about the welfare of animals used in toxicity testing. Public
    Law 106-545 has streamlined the process by which these better methods
    are validated and assessed, and has eased institutional barriers within
    federal agencies that discourage their use.
        ICCVAM performs an invaluable ``win-win'' function for regulatory
    agencies and stakeholders in industry, public health, and animal
    protection by assessing the suitability of new toxicological test
    methods that have interagency application. These new (and newly
    revised) methods include alternative methods that can limit animal use
    or suffering in testing. After appropriate independent peer review of a
    new test method, ICCVAM provides its assessment of the new test to the
    federal agencies that regulate the particular endpoint that the test
    measures. In turn, the federal agencies maintain their authority to
    incorporate the validated test method as appropriate for the agencies'
    regulatory mandates. This streamlined approach to assess the validation
    status of new test methods has reduced the regulatory burden of
    individual agencies, provided ``one-stop shopping'' for industry,
    animal protection, and public health advocates to consider test
    methods, and set uniform criteria for what constitutes a validated test
    method.
        ICCVAM arose from an initial mandate in the NIH Revitalization Act
    of 1993 for the National Institute of Environmental Health Sciences
    (NIEHS) to ``(a) establish criteria for the validation and regulatory
    acceptance of alternative testing methods, and (b) recommend a process
    through which scientifically validated alternative methods can be
    accepted for regulatory use.'' In 1994, NIEHS established an ad hoc
    ICCVAM to write a report that would recommend criteria and processes
    for validation and regulatory acceptance of toxicological testing
    methods that would be useful to federal agencies and the scientific
    community. Through a series of public meetings, interested stakeholders
    and agency representatives from 14 regulatory and research agencies
    developed NIH Publication No. 97-3981, Validation and Regulatory
    Acceptance of Toxicological Test Methods. This report has become the
    ``sound science'' guide for consideration of new test methods by the
    federal agencies and interested stakeholders. After publication of the
    report, the ad hoc ICCVAM moved to standing status under the NIEHS'
    National Toxicology Program Interagency Center for the Evaluation of
    Alternative Toxicological Methods (NICEATM). Representatives from
    federal regulatory and research agencies have continued to meet, with
    advice from NICEATM's Scientific Advisory Committee and independent
    peer review committees, to assess the validation of new toxicological
    test methods.
        Since its inception, ICCVAM has conducted rigorous evaluations of
    several test methods and has concluded that these methods are
    scientifically valid, i.e., have been adequately validated, and are
    acceptable for specific purposes. These methods include Corrositex,
    Epiderm, Episkin, and Transcutaneous Epithelial Resistance assays for
    assessing skin corrosivity; the 3T3 NRU Phototoxicity assay for
    assessing phototoxicity; the Local Lymph Node Assay for assessing skin
    sensitization; and the Up and Down Method and various cytotoxicity
    assays for assessing acute systemic toxicity. In turn, the appropriate
    regulatory agencies have incorporated these methods into their
    regulatory practices.
        The open public comment process, input by interested stakeholders,
    and the continued commitment by various federal agencies have all
    enhanced the ICCVAM process. Now, under Public Law 106-545, ICCVAM is
    poised to go beyond its largely passive role of assessing the
    validation status of test methods that have been developed and
    validated by industry and others. ICCVAM should adopt a more proactive
    role in developing and validating promising tests methods in
    partnership with outside stakeholders, to ensure that a steady stream
    of new test methods are available for review and adoption by the
    federal government. Such a proactive stance and partnership with
    stakeholders will enable the federal government to better harness the
    potential of emerging technologies to meet the challenge of efficiently
    testing large numbers of chemicals with minimal cost in terms of money
    and animal lives. With a more proactive approach, ICCVAM could, for
    example, explore the potential of investigator-initiated and small
    business grant programs to further its mission.
        Adequate funding should be provided for ICCVAM to put the resources
    in place to ensure the federal government and industry have the best
    available tools with which to assess the toxic properties of chemicals
    in commerce. To accomplish this, we respectfully request an earmark of
    $3.6 million for fiscal year 2006 and the following Committee Report
    language:

        ``In order for the Interagency Coordinating Committee for the
    Validation of Alternative Methods (ICCVAM) to carry out its
    responsibilities under the ICCVAM Authorization Act of 2000, the
    Committee strongly urges NIEHS to strengthen the resources provided to
    ICCVAM for methods validation reviews in fiscal year 2006. ICCVAM and
    NIEHS activities must include up-front validation study design,
    execution, and review to ensure that new and revised test methods, non-
    animal test methods, and alternative test methods (such as QSARs,
    mechanistic screens, high throughput assays, and toxicogenomics) are
    deemed scientifically valid before they are recommended or adopted for
    use by federal agencies or used in implementing the National Toxicology
    Program's Road Map and Vision for NTP's toxicology program in the 21st
    century.''

                           PAIN AND DISTRESS RESEARCH

        An estimated 40 percent of the National Institutes of Health (NIH)
    budget--or currently more than $11 billion--is devoted to some aspect
    of animal research. At this time, no funding is set aside specifically
    for research into alternatives that reduce the amount of pain and
    distress to which research animals are subjected, nor methods that
    replace or reduce the use of vertebrate animals in research. NIH may
    receive $28.8 billion in fiscal year 2006 if Congress fulfills the
    President's budget request. Out of this funding, we seek $2.5 million
    (0.009 percent) for research and development focused on identifying and
    alleviating animal pain and distress. In addition to our request for a
    specific funding amount, we also urge the Committee to specify in
    report language that this research should be conducted in conjunction
    with, or ``piggy-backed'' onto, ongoing research that already causes
    pain and distress. Infliction of pain and distress on additional
    animals is unnecessary, given the volume of existing research (we
    estimate a minimum of 20-25 percent of all animal research) that is
    believed to involve moderate to significant pain and/or distress.
        The large extent to which animals are used in federally-funded
    research underscores the importance of earmarking funds for pain and
    distress research. NIH has a statutory mandate to conduct or support
    research into alternative methods that produce less pain and distress
    in animals. This was specified in the NIH Revitalization Act of 1993
    regarding a plan for the use of animals in research. Earmarked funding
    will assist NIH in meeting this mandate. Additionally, researchers
    themselves often comment publicly at scientific meetings about the
    urgent need for funding in order to properly understand and mitigate
    pain and distress in research animals and to follow Animal Welfare Act
    and Public Health Service policy requirements to minimize pain and
    distress.
        It is well known that uncontrolled, undetected, and unalleviated
    pain and distress has adverse effects on animal welfare, which leads to
    adverse effects on the quality of science. Ultimately, the lack of
    information on pain and distress leads to misinterpretation of research
    results that could result in harmful effects in human beings when pre-
    clinical animal research results are applied to humans in clinical
    trials.
        A 2001 survey conducted by an independent polling firm indicates
    that concern about animal pain and distress strongly influences public
    opinion about animal research in general. Seventy-five percent of the
    American public opposes research that causes severe animal pain and/or
    distress, even when it is health-related. Despite this public concern,
    NIH has failed to sponsor research and development aimed at determining
    how to minimize animal suffering and distress in the laboratory.
        During the past several years, our organization has been reviewing
    institutional policies and practices with respect to pain and distress
    in animal research. We have found that research institutions have
    inconsistent policies due to the lack of information on this subject,
    and that standards vary greatly from one institution to another. The
    federal standard for determining laboratory animal pain specifies that,
    if a procedure causes pain or distress to humans, it should be assumed
    to cause pain and distress to animals. Furthermore, while human
    experience can and should provide a useful guide in some cases, there
    are others in which humans are never subjected to the conditions facing
    laboratory animals. Information on pain and distress that animals
    themselves actually experience is important.
        Our nation takes pride in leading the world in biomedical research,
    yet we lag behind many other countries in our efforts to minimize pain
    and distress in animal subjects. For example, the United Kingdom,
    Sweden, Switzerland, Germany, the Netherlands and the European Union
    all have committed funds specifically for the ``three R's'' (replacing
    the use of animals, reducing their use, and refining research
    techniques to minimize animal suffering).
        We urge the Committee to make this small investment of $2.5 million
    to promote animal welfare and enhance the integrity of scientific
    research. We also respectfully request this accompanying committee
    report language:

        ``The Committee provides $2.5 million to support research and
    development focused on improving methods for recognizing, assessing,
    and alleviating pain and distress in research animals. No pain and
    distress should be inflicted solely for the purpose of this initiative,
    since the investigations can and should be conducted in conjunction
    with ongoing research that is believed to involve pain and distress
    under Government Principle IV of Public Health Service Policy, which
    assumes that procedures that cause pain and distress in humans may
    cause pain and distress in animals.''

        Again, we appreciate the opportunity to share our views regarding
    priorities for the Labor, Health and Human Services, Education and
    Related Agencies Appropriation Act of fiscal year 2006. We hope the
    Committee will be able to accommodate these modest requests that will
    benefit animals, enhance effectiveness of toxicological testing, and
    improve the quality of research. Thank you for your consideration.
                                     ______

      Prepared Statement of the Society for Animal Protective Legislation

        On behalf of the Society for Animal Protective Legislation (SAPL)
    and Doris Day Animal League I would like to discuss several important
    issues within the jurisdiction of this committee. In addition, SAPL
    endorses the funding request by the Doris Day Animal League for fiscal
    year 2006 to operate the National Institute of Environmental Health
    Sciences' (NIEHS) National Toxicology Program Interagency Center for
    the Evaluation of Alternative Toxicological Test Methods (NICEATM) for
    Interagency Coordinating Committee for the Validation of Alternative
    Methods (ICCVAM) activities for fiscal year 2006.

    CRIMINAL ANIMAL CRUELTY CHARGES FILED AGAINST NIH'S ALAMOGORDO PRIMATE
                                    FACILITY

        For years, the NIH funded the New Mexico-based Coulston Foundation
    primate testing lab with millions of taxpayer-funded dollars despite
    the lab's continued violations of the Animal Welfare Act. Compliance
    with federal animal welfare laws is a requirement for receipt of
    federal funds. The Coulston situation resulted in unprecedented
    regulatory action by the U.S. Department of Agriculture, international
    media interest, and intense Congressional scrutiny. The NIH's actions
    at Coulston prompted the House Committee on Energy and Commerce to
    launch a broad investigation of the mismanagement of billions of
    dollars in taxpayer-funded grants by NIH.
        Under the intense pressure from Congress, the NIH eventually
    stopped funding the Coulston lab. The agency assumed ownership of the
    facility located on Holloman Air Force Base, renamed it the Alamogordo
    Primate Facility (APF), and in June 2001 awarded Charles River
    Laboratories with a 10-year, $42 million contract to operate the lab,
    which houses approximately 265 government-owned chimpanzees. The NIH is
    legally responsible for the ``day-to-day management'' of the APF
    including its ``associated animal activities.'' The APF is an
    intramural NIH lab and is listed under the agency's Animal Welfare
    Assurance.
        One would think that after the years of Coulston abuses--and the
    accompanying NIH malfeasance that prompted a Congressional
    investigation--the agency would be that much more careful to ensure
    that the lab it now directly owns and manages would comply with the
    most basic precepts of animal welfare and simple human decency.
        One would be wrong.
        In September 2004, New Mexico District Attorney Scot Key filed
    multiple counts of criminal animal cruelty, accusing the NIH's
    handpicked contractor, Charles River Laboratories, and APF Director,
    veterinarian Rick Lee, of institutional negligence in the deaths of two
    chimpanzees and the near-death of a third. The D.A.'s independent
    criminal investigation found that it was ``standard practice'' for
    Charles River to leave critically ill chimpanzees in the ``care'' of
    security guards after trained animal care staff repeatedly walked off,
    clocking out at the end of the workday around 4:00 p.m.
        Because the APF is a federal research facility, it is required to
    comply with the Animal Welfare Act, but the USDA has no jurisdiction to
    enforce it. In 2001, the New Mexico legislature, prompted by the
    continuing abuses at Coulston and the federal government's inability to
    stop them, amended the state's animal cruelty statute to remove the
    blanket exemption for research facilities.
        In September 2003, the NIH was informed that the D.A. had initiated
    a criminal investigation against Charles River; that APF Director Lee
    had illegally threatened employees with lie detector tests in an
    attempt to find out who had leaked information about the treatment of
    the chimpanzees; and that the allegations were worse than anything ever
    documented at the Coulston lab. On October 1, 2003, an ad hoc NIH
    consultant, veterinarian Thomas Butler, conducted a one-day site visit
    along with the NIH official, Dr. Raymond O'Neill, in charge of
    overseeing the contract with Charles River. Butler's ``site visit''
    report--compiled in less than one day by an ad hoc NIH consultant with
    no law enforcement authority--was neither thorough nor an
    investigation. Indeed, it completely failed to address the heart of the
    criminal charges: Charles River's abandonment of the three
    chimpanzees--including Rex, who was unconscious and vomiting--to
    security guards. In stark contrast to the NIH consultant's report,
    multiple eyewitnesses named in the D.A.'s months-long independent
    criminal investigation corroborated the criminal charges.
        On March 23, 2005, New Mexico judge Jerry Ritter accepted Charles
    River's argument that it was engaged in the practice of veterinary
    medicine, and dismissed the charges; he issued no written opinion
    regarding the other legal technicalities. By making this argument,
    Charles River and the NIH have conceded that for them, the ``practice
    of veterinary medicine'' constitutes intentional and repeated
    abandonment of critically ill or injured chimpanzees to once-per-hour
    observation by untrained security guards.
        Charles River never denied the facts alleged by the D.A. in the
    criminal charges, and the judge's decision did not deny the merits of
    the case. For now, Charles River and the NIH are accountable to
    absolutely no legitimate law enforcement authority. Neither the D.A.,
    the USDA, nor the New Mexico Veterinary Board have any jurisdiction
    over the APF. The only ``oversight'' is provided by the NIH--the very
    definition of a conflict of interest--whose malfeasance at this very
    same facility when it was operated by the Coulston Foundation prompted
    a Congressional investigation of the entire agency.
        After the years of abuse at Coulston, the situation at this
    government-owned facility descended into alleged criminal animal
    cruelty while the agency was paying Charles River millions of tax
    dollars annually, including $175,000 in maximum bonus incentives.
    Charles River and the NIH have never denied the cold, cruel facts
    alleged by the D.A. in criminal charges resulting from a months-long
    independent criminal investigation conducted by a 24-year police
    veteran.
        Charles River and the NIH cannot be allowed to evade their
    culpability by hiding behind legal technicalities, half-truths and the
    typical NIH whitewash. This small-town District Attorney was attempting
    to uphold the law and do the job that a $28 billion federal agency has
    refused to do. We urge Congress to step into this gaping void of
    oversight and hold accountable the perpetrators of this unconscionable
    cruelty and their violation of the most basic standards of simple human
    decency. Congress should continue to actively investigate NIH's
    mismanagement of the APM and hold public hearings into the situation.

     NIH FAILS TO ADDRESS THIS SUBCOMMITTEES CONCERN ON ILLEGALLY ACQUIRED
                                 DOGS AND CATS

        Approximately 90,000 dogs and cats are used for experimentation in
    the United States each year. The vast majority of these animals are
    obtained from breeders who raise the animals under controlled
    conditions and have extensive information on their genetic background
    and health and vaccination status. In addition, some dogs and cats are
    being bred for experimentation at research facilities like the
    University of Texas, and in some cases, inexpensive random type animals
    are purchased directly from animal pounds.
        Despite extensive documentation strongly discouraging the practice,
    some research facilities are foot-dragging by continuing to buy dogs
    and cats from random source dealers. These dealers, with a Class B
    license designation by the U.S. Department of Agriculture (USDA), are
    notorious for selling animals to laboratories that have been acquired
    illegally and for their widespread failure to comply with other minimum
    requirements under the Animal Welfare Act.
        The saga of C.C. Baird is a prime example of the problem. Baird was
    a licensed dealer who sold random source dogs and cats for
    experimentation for about 15 years. More than a year and a half ago,
    126 animals were seized by federal authorities because their health was
    in jeopardy. And shortly thereafter USDA finally filed charges against
    him for hundreds of violations of the Animal Welfare Act stating, ``The
    violations alleged in this complaint are of the utmost seriousness, and
    include severe mistreatment and neglect of a multitude of animals in
    respondents' custody, falsification of health certificates for dogs and
    cats that respondents sold to research facilities, multitudinous
    record-keeping deficiencies and instances of noncompliance with the
    barest standards of care, husbandry and housing for dogs and cats.''
    The charges against Baird included failure to provide adequate
    veterinary care and illegal acquisition of animals.
      --Dog Dealer's Day of Reckoning: http://www.awionline.org/pubs/
            Quarterly/03-52-4/524p1011.htm
      --A Glimpse Behind the Kennel Door: http://www.awionline.org/pubs/
            Quarterly/04-53-3/533p16.htm
      --Random Source Dealer Surrenders: http://www.awionline.org/pubs/
            Quarterly/05-54-1/541p2.htm
        Despite all of this, several registered research facilities
    including the University of Missouri continued to purchase animals from
    him. Unless NIH gives proper direction, some institutions will continue
    to place a higher priority on a cheap, ready supply of dogs than
    ensuring that animals are legally acquired and properly cared for.
    Thankfully, Baird has finally been put out of business. In fact, less
    than 20 Class B dealers remain, but the problems will persist until
    their number is reduced to zero.
        NIH has told this Subcommittee that it is ``committed to ensuring
    the appropriate care and use of animals in research.'' However, NIH has
    left the decision of whether or not to buy dogs and cats from random
    source dealers ``to the local level on the basis of scientific need.''
    NIH defends the use of Class B dealers arguing that these dealers are
    needed to obtain ``animals that may not be available from other
    sources, such as genetically diverse, older, or larger animals.'' In
    fact, in the rare circumstance that a researcher asserts the need for
    such animals, they can be obtained directly from pounds as noted
    previously.
        The distinction between non-purpose-bred animals from pounds versus
    Class B dealers must be made. By using Class B dealers (middlemen)
    instead of pounds, researchers are contributing to the problem. In
    their search to fill researchers' demands for ``genetically diverse,
    older or larger animals,'' random source dealers and their suppliers
    may be stealing pets from backyards and farms or they are acquiring
    animals through fraud by collecting animals offered ``free to a good
    home.''
        All animals used in research should be obtained from legitimate
    sources.
        Taxpayer dollars, in the form of NIH extramural grants, must not
    continue to fund purchase of dogs and cats from dealers whose modus
    operandi are pet theft, acquisition of pets by fraud, payments made
    under the table and other illegal activities. Proper oversight of NIH's
    dispersal of extramural grants is urgently needed. We respectfully
    request that this Subcommittee include the following language in the
    HHS appropriations bill: ``None of these funds shall be used for
    research which utilizes dogs and/or cats obtained from random source
    dealers.''
                                     ______

               Prepared Statement of the Tri-Council for Nursing

        The Tri-Council for Nursing is an alliance of four national nursing
    organizations--the American Association of Colleges of Nursing (AACN),
    the American Nurses Association (ANA), the American Organization of
    Nurse Executives (AONE), and the National League for Nursing (NLN).
    Focused on leadership and excellence in nursing, the Tri-Council
    represents the breadth of the nursing profession including practicing
    nurses, nurse executives, nurse educators, and nurse researchers.
        The Nursing Workforce Development Programs under Title VIII of the
    Public Health Service Act strive to meet the health needs of the nation
    by assuring an adequate supply and distribution of qualified nursing
    personnel. These Programs increase access to quality care through
    improved composition, diversity, and retention of the nursing
    workforce; improved quality of nursing education and practice; and the
    identification of and use of data, and program performance measures and
    outcomes to make informed decisions on nursing workforce issues. The
    Tri-Council for Nursing urges Congress to ensure that adequate funding
    is available to address the critical nursing shortage through the
    Nursing Workforce Development Programs authorized by Title VIII of the
    Public Health Service Act.
        This testimony highlights the fundamental importance of the Nursing
    Workforce Development Programs as they relate to an adequately prepared
    nursing workforce. As an example, we would like to bring the public
    health role of nurses and the vital services they are providing to this
    nation today to the forefront of your attention.
        Nurses are a critical, but often unrecognized, component of the
    federal medical response to major emergencies and disasters, both
    natural and manmade. In the case of a major emergency, nurses have and
    will continue to be called upon to assist with chemoprophylaxis (oral
    or injectable medications/vaccinations) of hundreds of thousands or
    millions of Americans. The Office of Public Health Preparedness at the
    Health Resources and Services Administration (HRSA) estimates that a
    population of 100,000 people attacked by biological weapons would
    require 200 personnel working 100 hours just to deliver
    chemoprophylaxis. This effort would require approximately 16,171
    trained persons for a city the size of New York. Nurses will also be
    called upon to assist with the planned use of ``special needs
    shelters'' during disasters. People in special needs shelters may
    include an insulin-dependent diabetic who requires frequent monitoring,
    epileptic persons with a history of unstable seizure activity, and
    persons with disabilities requiring assistance with activities of daily
    living.
        Today's nursing shortage is very real and very different from any
    experienced in the past. It is evidenced by acute shortages of
    registered nurses (RNs) who are adequately prepared to meet patient
    care needs in a changing health care environment across the country.
    Although applications and enrollments for nursing programs have
    increased due to the major marketing efforts of corporations and health
    care providers, a serious nursing faculty shortage prevents the
    expansion of nursing programs to educate the number of nurses needed
    now and in the future. Studies have shown that unless dramatic steps
    are taken, the supply of appropriately prepared nurses will fall far
    short of what is needed to meet the needs of a diverse population and
    that this shortfall will grow more serious over the next 20 years.
    Since RNs represent the largest portion of our health care workforce,
    the shortage threatens the very essence of our health care system.
        In February 2004, the Bureau of Labor Statistics reported that
    registered nursing would have the greatest job growth of all
    professions in the United States in the years spanning 2002 to 2012.
    During this ten-year period, health care facilities will need to fill
    more than 1.1 million RN job openings. HRSA projects that, absent
    aggressive intervention, the RN workforce will fall 29 percent below
    requirements by the year 2020.
        The increasing health care demands of an aging population and
    changes in the country's nursing work-force have combined to create a
    shortage unlike any other. A fundamental shift has occurred in the RN
    workforce over the last two decades. As occupational opportunities for
    young women have expanded, and the changing health care environment has
    increased stresses on nursing, the number of young people entering the
    profession has declined resulting in a steady and dramatic increase in
    the average age of the nurse. Today, the average working RN is more
    than 43 years old.

               NURSES--INCREASING ACCESS TO QUALITY PATIENT CARE

        Studies have shown that insufficient numbers of nurses contribute
    to medical errors, poor patient outcomes, and increased mortality
    rates. A study published in the May 30, 2002, New England Journal of
    Medicine reported that higher levels of nursing care correlate with
    better patient care. Another study published in the October 23, 2002,
    Journal of the American Medical Association found that among the
    surgical patients studied, a pronounced correlation existed between
    nursing shortages and both patient mortality and failure to rescue.
        By the year 2025, 68.3 percent of the current nursing workforce
    will be among the first of 78 million baby boomers reaching retirement
    age and enrolling in the Medicare program. By 2030, 20 percent of the
    population--70 million--will be older Americans, more than twice their
    number in 1999. The emerging complex health and social conditions of an
    aging population demonstrate the need for more and experienced nurses
    to care for this special population. Funding to support additional
    research and education in this area is needed.
        Nurses can increase the public's access to quality primary health
    care through advanced practice registered nurses (APRNs), RNs who have
    attained advanced expertise in the clinical management of health
    conditions. Typically, an APRN holds a master's degree with advanced
    didactic and clinical preparation beyond that of the RN. Practice areas
    include, but are not limited to, anesthesiology, family medicine,
    gerontology, pediatrics, mental health, and midwifery. APRNs include:
        Nurse Practitioners (NPs) who diagnose and treat common illnesses
    and injuries; provide immunizations; manage high blood pressure,
    diabetes, and other chronic problems; order and interpret lab tests;
    and counsel patients on adopting healthy lifestyles. Research confirms
    that NPs improve the public's access to high quality care at a cost
    savings to the system while a landmark study published in 2000 in the
    Journal of the American Medical Association indicates that NP quality
    of care is equal to that of physicians.
        Clinical Nurse Specialists (CNSs) who provide care in a range of
    specialty areas, such as oncology, neonatal, and obstetric/
    gynecological nursing, pediatrics, and psychiatric/mental health while
    working in hospitals and other clinical sites. CNSs develop quality
    assurance procedures and serve as educators and consultants. An
    estimated 69,000 CNSs are currently in practice.
        Certified Nurse-Midwives (CNMs) who provide prenatal and
    gynecological care to normal healthy women; deliver babies in
    hospitals, private homes, and birthing centers; and continue with
    follow-up postpartum care. Of all visits to CNMs, 90 percent are for
    primary, preventive care that includes gynecologic care such as annual
    exams and reproductive health visits.
        Certified Registered Nurse Anesthetists (CRNAs) who administer more
    than 65 percent of all anesthetics given to patients each year, and are
    the sole anesthesia providers in approximately two-thirds of all rural
    hospitals.
        As more acute public health needs exist in our communities, nurses,
    through their professional qualifications and sheer numbers, are at the
    very core of the nation's public health infrastructure.
        ``Nurse managed centers'' (NMCs) play an important role in the
    health services delivery system and offer a unique approach to primary
    care that emphasizes health promotion and disease prevention,
    particularly in underserved communities. They often serve at-risk
    persons who might not otherwise receive health care. About half of all
    their patients are uninsured and many are unable to turn elsewhere for
    medical care. In the Philadelphia region, for example, nurses at nurse-
    managed health centers see their patients almost twice as often as
    other providers see theirs; their patients are hospitalized 30 percent
    less and use the emergency department 15 percent less often than those
    patients of other health care providers. Unfortunately, NMCs often
    struggle or fail to remain financially viable; the centers themselves
    need a safety net to survive financially.
        The Nursing Workforce Development Programs of Title VIII provide
    the ability to maintain and expand the availability of a qualified
    nursing workforce and facilitate the integration of underrepresented
    populations into nursing.
        Section 811.--The Advanced Education Nursing Program--funds
    traineeships for individuals preparing to be nurse practitioners, nurse
    midwives, nurse administrators, and public health nurses. In addition,
    grants are awarded to nursing schools to support education and training
    of APRNs.
        Section 821.--The Nursing Workforce Diversity Program--funds grants
    to increase nursing education opportunities for individuals who are
    from disadvantaged backgrounds by providing student stipends, pre-entry
    preparation, and retention activities. These opportunities ensure a
    culturally diverse workforce to provide health care for a culturally
    diverse patient population.
        Section 831.--The Nurse Education, Practice and Retention Program--
    provides grant support for academic and continuing education projects
    designed to strengthen the nursing workforce. Several of this program's
    priorities apply to quality patient care including developing cultural
    competencies among nurses and providing direct support to establishing
    or expanding NMCs in non-institutional settings to improve access to
    primary health care in medically underserved communities. It also
    serves to provide grants to eligible entities to improve retention of
    nurses and enhanced patient care.
        Section 846.--The Loan Repayment and Scholarship Programs--is
    divided into two primary components. The Nursing Education Loan
    Repayment Program assists individual registered nurses by repaying up
    to 85 percent of their qualified educational loans over three years in
    return for their commitment to work at health facilities with a
    critical shortage of nurses. Similarly, the Nurse Scholarship Program
    provides financial aid to individual nursing students in return for
    working a minimum of two years in a health care facility with a
    critical nursing shortage.
        Section 855.--The Comprehensive Geriatric Education Grant Program--
    focuses on training, curriculum development, faculty development, and
    continuing education for nursing personnel caring for the elderly.

                          NURSES--EDUCATING THE FUTURE

        At nursing schools across the nation, a surge of qualified
    applicants, who could ease the worsening shortage of nurses, is being
    turned away because schools of nursing are suffering from a continuing
    and growing shortage of faculty. This situation is not expected to
    improve in the near term, since an adequate number of nurse educators
    are currently not in the education pipeline.
        The nursing faculty shortfall is driven by health care jobs that
    offer better pay than faculty positions and by fewer nurses pursuing
    the doctorate required for full-time teaching positions. Just as with
    the nursing workforce, the faculty is graying and a wave of retirements
    is expected about the same time when more care will be needed for aging
    baby boomers. An insufficient faculty was the top reason cited by
    nursing schools for not accepting all qualified applicants into entry-
    level programs for the 2004-2005 academic year. Just as important as
    educational incentives are for future practicing nurses, the
    scholarships for doctoral students who will instruct the next
    generation of nurses are even more critical.
        Title VIII funding bolsters existing programs to increase the
    number of qualified nurse faculty.
        Section 846A.--The Nurse Faculty Loan Program--supports the
    establishment and operation of a loan fund within participating schools
    of nursing to assist RNs to complete their education to become nursing
    faculty. The Program provides a cancellation provision in which 85
    percent of the loan may be cancelled over four years in return for
    serving full time as faculty in a school of nursing.
        Section 811.--The Advanced Education Nursing Program--provides
    trainee support for individuals preparing to be nurse educators. These
    funds support master's and doctoral programs, combined RN/master's
    degree programs, and post-nursing master's certificate programs.

                                    SUMMARY

        While the Tri-Council for Nursing is encouraged by a recent
    resurgence of interest in the nursing profession, we are concerned that
    the funding levels for the Title VIII--Nursing Workforce Development
    Programs are insufficient to assist qualified students to enter,
    advance, and remain within the nursing profession. The nursing shortage
    will continue to worsen if significant investments are not made in
    these Title VIII programs. Recent efforts have shown that aggressive
    and innovative strategies can help avert the impending nursing
    shortage--if they are adequately funded. The contributions of nurses in
    our health care system are complex and multifaceted, and are directly
    impacted by the level of federal funding that supports nursing
    programs.
                                     ______

           Prepared Statement of Patient Services Incorporated (PSI)

        PATIENT SERVICES INCORPORATED MEDICAL INSURANCE AND CO-PAYMENT
               ASSISTANCE CASE MANAGEMENT PROGRAM FOR HEPATITIS C

        PSI believes that its 16 years of proven patient assistance and
    results can and will translate into providing successful solutions to
    two major challenges in healthcare policy that the United States is
    currently facing:
      --Providing standard comprehensive health insurance coverage for the
            uninsured and the underinsured in this country.
      --Developing a public-private partnership to solving this problem in
            light of the tightening budget constraints at the federal and
            state government levels.
        With our goals and vision in mind, PSI would use the federal
    resources to further develop and augment the Medical Insurance and Co-
    payment Assistance Case Management Program for Hepatitis C to save
    federal and state government resources in this era of fiscal austerity.
    PSI intends to do this by:
      --Assisting Medicaid eligible patients affected with the Hepatitis C
            virus (HCV) by transitioning these patients into the private
            insurance market. According to our research, 10 percent to 15
            percent of the Hepatitis C patient population on Medicaid who
            are responding positively to the Pegylated Alpha Interferon/
            Ribavirin Combination treatment regimen can return to work. A
            positive response to the regimen can be defined as having such
            a low amount of the virus in your cell system that the viral
            load is undetectable. This portion of the population can re-
            enter the workforce, thus returning to the status of taxpayer
            and transition off the Medicaid roles.
      --PSI will use a portion of the federal funds to purchase health
            insurance premiums through State High-Risk policies, Guaranteed
            Issue policies, and/or Open Enrollment policies for these
            patients thus freeing up Medicaid dollars. These patients will
            then be eligible to re-enter the workforce, and ultimately be
            covered by an employer funded benefits package.
      --Assisting the segment of the Hepatitis C patient population not
            eligible for Medicaid, such as those patients enrolled in the
            Medicare program, state assistance programs, as well as those
            patients underinsured or uninsured.
        --PSI can assist patients on Medicare by satisfying the co-payment
                for the expensive, but life-altering treatment regiments.
        --PSI can assist those patients receiving treatments through state
                assistance programs by transitioning them into the private
                insurance market.
        --PSI can assist those patients who are uninsured and underinsured
                by transitioning them into the private insurance market.
        Over the last 9 years, PSI has proven that as an organization it
    can be an effective steward of taxpayer's dollars. For a $1 million
    investment by the federal government, PSI believes it can assist 1,200
    to 1,500 patients. This investment could have the potential once fully
    implemented to save the federal and state governments $10 million a
    year.

    Is your project a labor, health and human services, or education
            request?
        Health and Human Services

    Within the Labor, Health and Human Services, Education Appropriations
            Bill, the specific account within which funding is sought
        Centers for Medicare and Medicaid Services (CMS): Research,
    Demonstration and Evaluation Program.

    Amount Requested
        $1,000,000 for fiscal year 2006; $1,000,000 for fiscal year 2007;
    $1,000,000 for fiscal year 2008.
    How, specifically the federal funds will be spent, if obtained?
        PSI asks Congress to establish a demonstration project through the
    Department of Health and Human Services, Centers for Medicare and
    Medicaid Services, which will assist Medicare and Medicaid eligible
    individuals, who are infected with the Hepatitis C virus (HCV) and
    desiring assistance, to identify and subsidize individual health
    insurance policies. By providing premium and co-payment assistance, PSI
    will save federal Medicare and Medicaid dollars.
        PSI will begin the Medical Insurance and Co-payment Assistance
    Management Program for Hepatitis C by the Summer of 2005.
    Federal funding history of the organization
        This is the first year that Patient Services Incorporated has made
    a federal funding request.
    List the amount state, local and private funds being used to support
            the project. Indicate the proposed federal share of the project
        PSI is in the final stages of development of a co-payment
    assistance program with private sector industry. The industry support
    will provide PSI with funds to develop a disease management program for
    patients infected with Hepatitis C. This program would provide PSI with
    key funds to launch this pilot program, which would provide pharmacy
    co-payment assistance for the treatment regiment of Hepatitis C.
        The private funds provided to PSI will initially assist 100
    patients nationwide. PSI will also continue to reach out to other
    manufacturers of Hepatitis C treatments for further development of this
    program. The infusion of federal resources will assist in developing
    the PSI Medical Insurance and Co-payment Assistance Case Management
    Program for Hepatitis C into a more comprehensive program.
        Proposed federal share: $1 million per year, for 3 years.
    Report language requested
        Recommend Report Language Centers for Medicare and Medicaid
    Services, Program Management of the Medicare and Medicaid Research,
    Demonstration and Evaluation program.
        The committee has included $1,000,000 for a demonstration project/
    pilot program with Patient Services Incorporated of Midlothian,
    Virginia to save federal health care costs by subsidizing private
    health insurance coverage for individuals suffering from the Hepatitis
    C virus (HCV). The committee requests a report on the results of this
    unique and potentially cost-saving program.
    Members of Congress are you working with on this request
        Senator John Warner (R-VA) and Senator George Allen (R-VA).
    Please share any additional information you deem important
        Currently there is authorization for programs such as PSI's
    proposal under the following bills:
        (1) Centers for Medicare and Medicaid Research, Demonstration and
    Evaluation Program is an existing, statutory program.
        (2) The Medicare Modernization Act authorizes demonstration
    projects for innovative programs to reduce federal health care costs,
    and for chronic care improvement pilot projects.
        Pertinent background information and justification for this
    appropriations request:
    Patient Services Incorporated Demonstration Project/Pilot Program:
            Covering the Uninsured with Chronic and Catastrophic Illness
        PSI is a national, non-profit organization committed to supporting
    people with specific chronic illnesses and conditions by locating and
    securing solutions with health insurance by paying health insurance
    premiums and pharmacy co-payments in order to help improve their
    quality of life. PSI's vision for the future is to become the premier
    national non-profit organization in developing strategies and programs
    through collaboration with federal and state governments, corporations
    and individuals to address gaps in public and private health care
    coverage.
        PSI asks Congress to establish a demonstration project through the
    Department of Health and Human Services, Centers for Medicare and
    Medicaid Services, which will assist Medicare and Medicaid eligible
    individuals, who are infected with the Hepatitis C virus (HCV) and
    desiring assistance, to identify and subsidize individual health
    insurance policies. By providing premium and co-payment assistance, PSI
    will save federal Medicare and Medicaid dollars.
    Background on PSI
        Founded in 1989, PSI has spent the last fifteen years working with
    patients from the chronic disease community. PSI currently assists
    patients nationwide with the expensive costs of seventeen chronic
    illnesses and acute conditions. A few examples are those with
    Hemophilia, Alpha 1, Rheumatoid Arthritis, Crohn's Disease, Immune
    Deficiencies, Psoriasis and Multiple Sclerosis. PSI saves families from
    becoming financially devastated when a member is diagnosed with an
    expensive chronic illness. The PSI model provides the means for
    patients to become insured and have choices of treatments and
    providers.
        Private contributors, foundations, and corporate sponsors donate
    resources to PSI. PSI uses these resources to help families avoid
    turning to government sponsored social service programs. Families are
    offered assistance based upon the severity of their medical and
    financial needs, which is determined through an application process, a
    procedure that is unique to PSI. PSI has developed a sliding scale
    formula specifically designed to capture the working middle class
    person, providing the family with a safety net from financial ruin and
    assuring a successful return to work outcome. PSI does this by working
    with patients to gain access to insurance through State High Risk
    Insurance Pools, Open Enrollment, and Guaranteed Issue health insurance
    policies. PSI also assists patients in maintaining COBRA policies for
    those who qualify. PSI is committed to working with the chronically ill
    to ensure that they have the resources to meet their specific and
    costly health care needs.
        PSI is in the unique position of tackling head-on the acute problem
    of locating and ultimately paying for health insurance for the
    uninsured population in the United States. Currently the United States
    Census Bureau reports that there are over 44 million Americans who have
    no health insurance for a time period of one year or more. However,
    over 80 million Americans are without health insurance for some period
    of time during any given year. PSI can assist individuals in both
    categories. Since 1996, PSI also has successfully worked with State
    Health Department Title V programs, such as, Children With Special
    Health Care Needs and Childrens Rehabilitative Services (Medicaid). The
    PSI model has saved the Commonwealth of Virginia over $12 million since
    1996 and the state of Kentucky over $5 million in program costs since
    2000.
        In 2002, the U.S. Department of Health and Human Services' Office
    of the Inspector General issued a positive opinion endorsing the PSI
    model of premium assistance and sanctioning the co-payment assistance
    for Medicare patients. The Centers for Medicare and Medicaid Services
    acknowledged in its recent 641 Replacement Drug Demonstration Project
    that charitable organizations, like PSI, can assist patients with the
    out of pocket expenses associated with certain replacement drugs.
        It is no secret the chronic illnesses are both financially and
    emotionally draining for patients and families to cope with. Treating
    chronic conditions also accounts for the largest percentage of spending
    within the Medicare budget. The costliest five percent of Medicare
    beneficiaries account for about half of all Medicare spending each
    year. PSI has developed programs to help many of the families afflicted
    by these costly diseases; their Medical Insurance and Co-payment
    Assistance Case Management Program for Hepatitis C holds a great deal
    of promise for individuals and families who are affected by this virus
    and the accompanying complications.
    Hepatitis C
        The Hepatitis C virus (HCV) is a disease of the liver that has
    potentially fatal outcomes. In the majority of Hepatitis C cases,
    infection becomes chronic and slowly damages the liver over many years.
    During this time, the liver damage can lead to cirrhosis (scarring) of
    the liver, end-stage liver disease, and liver cancer. In the United
    States, Hepatitis C affects close to 4 million people, making the
    disease more prevalent than HIV/AIDS infection. The costs for providing
    care for patients with HCV-associated liver disease in the United
    States are estimated to range from $758 million to several billion
    dollars annually. Hepatitis C infections are expected to increase to
    10.8 million Americans in the next decade, leading to a major drain on
    government health resources and increased health costs.
        Hepatitis C can be treated; early diagnosis and treatment are
    crucial to being able to control the progression of the disease and
    reduce the chances of further liver damage. There are instances where
    the treatment has taken a protracted time to show any positive results
    in lowering the viral load of patients, and in certain cases the
    treatment may not change the progression of the disorder. Currently,
    the National Institutes of Health (NIH) recommends that Hepatitis C
    patients receive pegylated alpha interferon treatment in combination
    with the antiviral drug, Ribavirin. Three different agents are used in
    this treatment approach:
      --Alpha Interferons.--A protein made naturally by your body to boost
            your immune system and to regulate other cell functions. All of
            the currently approved treatments for chronic Hepatitis C
            include some form of natural or synthetic alpha interferon.
      --Pegylated Alpha Interferon.--Made by attaching a large water-
            soluble molecule call polyethylene glycol (PEG) to the alpha
            interferon molecule. These modified alpha interferons stay in
            the body longer and studies show they are more effective in
            producing a sustained viral response in patients with chronic
            Hepatitis C.
      --Ribavirin.--An antiviral drug that is used with manufactured forms
            of alpha interferon for the treatment of chronic Hepatitis C.
            Ribravirin by itself has not been shown to be effective against
            the Hepatitis C virus, but in combination with forms of alpha
            interferon is a much more successful treatment than alpha
            interferon alone.
        The Pegylated Alpha Interferon/Ribavirin Combination treatment
    regimen is expensive; according to the 2003 Red Book Update, the costs
    range from $24,000 to $48,000 for the drug alone. These costs do not
    include fees for administering the drugs, laboratory visits, and
    medical tests associated with HCV. Hepatitis C is an expensive chronic
    illness; PSI is able to work with the federal government to assist this
    community to ensure that it receives quality care in an economically
    efficient way.
                                     ______

               Prepared Statement of the Society for Neuroscience

                                  INTRODUCTION

        Mr. Chairman and members of the subcommittee, I am Dr. Carol Barnes
    of the University of Arizona and President of the Society for
    Neuroscience (SfN). I am here today in my capacity as the President of
    SfN to urge your support of biomedical research. SfN represents the
    entire range of scientific research endeavors aimed at understanding
    the nervous system and translating this knowledge to the treatment and
    prevention of nervous system disorders. It fosters the broad
    interdisciplinarity of the field, which uses multiple perspectives to
    study the nervous system of organisms ranging from invertebrates to
    humans across various stages of development, maturation, and aging.

                     WHAT IS THE SOCIETY FOR NEUROSCIENCE?

        The Society for Neuroscience is a nonprofit membership organization
    of basic scientists and physicians who study the brain and nervous
    system. Neuroscience includes the study of brain development, sensation
    and perception, learning and memory, movement, sleep, stress, aging,
    and neurological and psychiatric disorders. It also includes the
    molecules, cells, and genes responsible for nervous system functioning
    and human behavior.
        The 36,000 members of SfN include basic researchers studying the
    many neuroscience disciplines and clinicians specializing in neurology,
    neurosurgery, psychiatry, ophthalmology, and related fields. In 1970,
    neuroscience barely existed as a separate discipline. Today, there are
    more than 300 training programs in neuroscience alone. The field of
    neuroscience has made startling discoveries that have transformed our
    understanding of the healthy brain and helped to deliver treatments of
    disorders affecting millions.

             NATIONAL INSTITUTES OF HEALTH'S NEUROSCIENCE BLUEPRINT

        The NIH Neuroscience Blueprint is a framework to enhance
    cooperation among 15 NIH Institutes and Centers that support research
    on the nervous system. Over the past 10 years, driven by the science,
    the NIH neuroscience Institutes and Centers have increasingly joined
    forces through initiatives and working groups focused on specific
    disorders. The Blueprint builds on this foundation, making
    collaboration an everyday part of how the NIH does business in
    neuroscience. By pooling resources and expertise, the Blueprint can
    take advantage of economies of scale, confront challenges too large for
    any single institute, and develop research tools and infrastructure
    that will serve the entire neuroscience community.
        Last year, the Blueprint participants developed a set of
    initiatives focused on tools, resources, and training with immediate
    impact because they would build on existing programs. These initiatives
    include an inventory of neuroscience tools funded by the NIH and other
    government agencies, enhancement of training in the neurobiology of
    disease for basic neuroscientists, and expansion of ongoing gene
    expression database efforts, such as the Gene Expression Nervous System
    Atlas (GENSAT).
        Advances in the neurosciences and the emergence of powerful new
    technologies offer many opportunities for Blueprint activities that
    will enhance the effectiveness and efficiency of neuroscience research.
    Blueprint initiatives for fiscal year 2006 will include systematic
    development of genetically engineered mouse strains of critical
    importance to research on the nervous system and its diseases and
    training in critical cross cutting areas such as neuroimaging and
    computational biology.
        Several of the most common causes of death and disability, as well
    as hundreds of rare disorders, affect the brain, spinal cord, or nerve
    cells in the eye, ear, or elsewhere in the body. The vast array of
    nervous system disorders encompasses mental illness, neurological
    disease, drug and alcohol abuse, chronic pain conditions, developmental
    disorders, and dementias of aging. Numerous problems of hearing,
    vision, and other senses also include a brain component, and are
    serious health issues.
        In fiscal year 2006, NIH intends to allocate $26 million, with $14
    million contributed by collaborating institutes and centers, for
    Blueprint initiatives as follows:
      --Neuromouse Project.--developing genetically engineered mouse
            strains specifically for nervous system disease research;
      --Cross-Institute Neuroscience Training Programs.--training in
            critical cross-cutting areas such as neuroimaging and
            computational biology;
      --Neuroscience Core Grants.--supporting specialized,
            interdisciplinary ``core'' centers that might focus on areas
            such as animal models, cell culture, computer modeling, DNA
            sequencing, drug screening, gene vectors, imaging, microarrays,
            molecular biology, or proteomics and their applications to
            neuroscience research;
      --Translation of Discoveries.--accelerating the translation of basic
            neuroscience discoveries into better ways to treat and prevent
            nervous system diseases; and
      --Analytical Methods and Conceptual Models.--spurring the development
            of new analytical methods and conceptual models to study
            disease and allow for increased coordination among public
            education and outreach campaigns involving the brain and
            nervous system.

                                ACCOMPLISHMENTS

        The Society for Neuroscience would like to thank you for your past
    support. In the last 10 years, funding from the NIH and the Department
    of Veterans Affairs has helped scientists make great progress in
    helping people in many areas, including:
        1. Bipolar disorder.--Also known as manic depression, bipolar
    disorder is a serious brain disease that causes extreme mood swings,
    from intense feelings of euphoria (mania) to deep depression. Past
    funding from NIH and the Department of Veterans Affairs has helped
    scientists make great progress in understanding bipolar disorders and,
    thus, in diagnosing and treating the illness. Using the latest brain
    imaging technologies, scientists have also discovered that brain
    function and structure in people with bipolar disorder differs markedly
    from that in people without the illness. Researchers have found a
    significant decrease in the size of the amygdala, a part of the brain
    that governs emotions, in people with bipolar disorder. Other studies
    have found a decrease in the density of gray matter in the brains of
    people with bipolar disorder. These and other exciting new findings are
    helping to pave the way for the design of new drugs that directly
    target specific genes or areas of the brain.
        2. Alzheimer's Disease & Normal Aging.--Alzheimer's disease, one of
    the most frightening memory-robbing disorders, hampers the lives of
    some 4 to 5 million older Americans, costing the United States at least
    $100 billion in medical care and lost productivity each year.
    Fortunately, NIH-funded research has helped to generate new treatments
    that can aid memory loss. These medications slow memory deterioration
    in some patients and allow others to resume normal lives. Additional
    gains can and must be made in the field of memory research in order to
    benefit a wider range of people, and to reduce the financial burden of
    care. Recent studies on animal models suggest that the outlook could
    improve with treatments that target brain mechanisms to enhance memory.
    Additionally, research into Alzheimer's disease and its effects on
    memory have also led to important advances in how memory can be
    optimized in normal aging. This would clearly benefit the remaining
    millions of Americans who are looking toward successful aging.
        3. Depression & Heart Disease.--Depression is a biologically based
    brain disorder that affects about 10 percent of Americans over the age
    of 18. Depressed people feel intensely sad and worthless and have a
    diminished sense of emotional well-being. Among other diseases such as
    alcoholism and stroke, people with depression have an increased risk
    for heart disease, particularly coronary artery disease. In otherwise
    healthy people, depression doubles the risk for coronary artery
    disease. Furthermore, for those with coronary artery disease, there is
    evidence that depression influences outcomes, particularly mortality,
    following a heart attack. Additionally, for those undergoing coronary
    artery bypass grafting, there is increasing evidence that depression is
    associated with poorer outcomes. Studies from Johns Hopkins University
    reveal that patients with severe depression are up to five times more
    likely to have poorer outcomes such as the return of chest pain, heart
    attacks, or death. Despite much progress in understanding the biology
    of depression in the past decade, much remains to be done. The
    mechanisms of the interaction between depression and outcomes with
    cardiac disease are not clear. Nor is it known if treatment of
    depression, even mild depression, would lead to more favorable outcomes
    for those with cardiac problems. NIH-funded research might help us
    answer these complicated questions in order to save lives and money.

                          THE AMERICAN BRAIN COALITION

        Last year, the Society for Neuroscience, along with the American
    Academy of Neurology, started the American Brain Coalition (ABC). ABC
    is a nonprofit organization that brings together patients with
    disabling brain disorders, the families of those that suffer, and the
    professionals that research and treat diseases of the brain. The
    mission of the ABC is to reduce the burden of brain disorders, and
    advance the understanding of the brain.
        Because the brain is the center of human existence and the most
    complex living structure known, ABC advocates for collaboration among
    researchers and doctors who treat disorders of the brain. As seen with
    depression and heart disease, the brain plays a vital role in
    conditions once believed to be unrelated to the brain. It is only
    through more research that we will begin to further understand,
    prevent, and treat neurological and psychiatric diseases.

                        FISCAL YEAR 2006 BUDGET REQUEST

        The Society for Neuroscience supports the Ad Hoc Group for Medical
    Research Funding request of a 6 percent increase for NIH in fiscal year
    2006. This will help NIH to carry out its Blueprint initiatives and
    help people affected by neurological disorders lead healthier,
    productive lives. Furthermore it will help sustain the infrastructure
    for innovative discoveries necessary to compete as a worldwide leader
    in biomedical research.
        The request is based on the following information:
      --$1 billion is needed to cover biomedical research inflation, which
            is projected to be 3.5 percent;
      --$560 million is needed to replace the evaluation set-aside (an
            amount taken from each institute), which this year amounted to
            2.4 percent (it used to be 1 percent); and
      --The total number of research project grants (RPGs) is declining by
            402 from what it was in fiscal year 2005.
        Mr. Chairman, thank you for the opportunity to testify before this
    committee.
                                     ______

         Prepared Statement of The Humane Society of the United States

        On behalf of The Humane Society of the United States (HSUS) and our
    more than 8.6 million supporters nationwide, we appreciate the
    opportunity to provide testimony on our top funding priorities for the
    Labor, Health and Human Services, Education and Related Agencies
    Subcommittee in fiscal year 2006.

      INTERAGENCY COORDINATING COMMITTEE ON THE VALIDATION OF ALTERNATIVE
                                METHODS (ICCVAM)

        We were very pleased that Congress enacted Public Law 106-545 by
    unanimous voice vote in both chambers in 2000. This legislation,
    introduced by Senator Mike DeWine (R-OH) and Representatives Ken
    Calvert (R-CA) and Tom Lantos (D-CA), strengthened and made permanent
    the Interagency Coordinating Committee on the Validation of Alternative
    Methods (ICCVAM). The statute has already begun to enhance the federal
    government's capacity to evaluate and adopt chemical testing methods
    that are often faster, cheaper, and more scientifically sophisticated
    than current methods, as well as more responsive to the public's
    concerns about the welfare of animals used in toxicity testing. Public
    Law 106-545 has streamlined the process by which these better methods
    are validated and assessed, and has eased institutional barriers within
    federal agencies that discourage their use.
        ICCVAM performs an invaluable ``win-win'' function for regulatory
    agencies and stakeholders in industry, public health, and animal
    protection by assessing the suitability of new toxicological test
    methods that have interagency application. These new (and newly
    revised) methods include alternative methods that can limit animal use
    or suffering in testing. After appropriate independent peer review of a
    new test method, ICCVAM provides its assessment of the new test to the
    federal agencies that regulate the particular endpoint that the test
    measures. In turn, the federal agencies maintain their authority to
    incorporate the validated test method as appropriate for the agencies'
    regulatory mandates. This streamlined approach to assess the validation
    status of new test methods has reduced the regulatory burden of
    individual agencies, provided ``one-stop shopping'' for industry,
    animal protection, and public health advocates to consider test
    methods, and set uniform criteria for what constitutes a validated test
    method.
        ICCVAM arose from an initial mandate in the NIH Revitalization Act
    of 1993 for the National Institute of Environmental Health Sciences
    (NIEHS) to ``(a) establish criteria for the validation and regulatory
    acceptance of alternative testing methods, and (b) recommend a process
    through which scientifically validated alternative methods can be
    accepted for regulatory use.'' In 1994, NIEHS established an ad hoc
    ICCVAM to write a report that would recommend criteria and processes
    for validation and regulatory acceptance of toxicological testing
    methods that would be useful to federal agencies and the scientific
    community. Through a series of public meetings, interested stakeholders
    and agency representatives from 14 regulatory and research agencies
    developed NIH Publication No. 97-3981, Validation and Regulatory
    Acceptance of Toxicological Test Methods. This report has become the
    ``sound science'' guide for consideration of new test methods by the
    federal agencies and interested stakeholders. After publication of the
    report, the ad hoc ICCVAM moved to standing status under the NIEHS'
    National Toxicology Program Interagency Center for the Evaluation of
    Alternative Toxicological Methods (NICEATM). Representatives from
    federal regulatory and research agencies have continued to meet, with
    advice from NICEATM's Scientific Advisory Committee and independent
    peer review committees, to assess the validation of new toxicological
    test methods.
        Since its inception, ICCVAM has conducted rigorous evaluations of
    several test methods and has concluded that these methods are
    scientifically valid, i.e., have been adequately validated, and are
    acceptable for specific purposes. These methods include Corrositex,
    Epiderm, Episkin, and Transcutaneous Epithelial Resistance assays for
    assessing skin corrosivity; the 3T3 NRU Phototoxicity assay for
    assessing phototoxicity; the Local Lymph Node Assay for assessing skin
    sensitization; and the Up and Down Method and various cytotoxicity
    assays for assessing acute systemic toxicity. In turn, the appropriate
    regulatory agencies have incorporated these methods into their
    regulatory practices.
        The open public comment process, input by interested stakeholders,
    and the continued commitment by various federal agencies have all
    enhanced the ICCVAM process. Now, under Public Law 106-545, ICCVAM is
    poised to go beyond its largely passive role of assessing the
    validation status of test methods that have been developed and
    validated by industry and others. ICCVAM should adopt a more proactive
    role in developing and validating promising tests methods in
    partnership with outside stakeholders, to ensure that a steady stream
    of new test methods are available for review and adoption by the
    federal government. Such a proactive stance and partnership with
    stakeholders will enable the federal government to better harness the
    potential of emerging technologies to meet the challenge of efficiently
    testing large numbers of chemicals with minimal cost in terms of money
    and animal lives. With a more proactive approach, ICCVAM could, for
    example, explore the potential of investigator-initiated and small
    business grant programs to further its mission.
        Adequate funding should be provided for ICCVAM to put the resources
    in place to ensure the federal government and industry have the best
    available tools with which to assess the toxic properties of chemicals
    in commerce. To accomplish this, we respectfully request an earmark of
    $3.6 million for fiscal year 2006 and the following Committee Report
    language:

        ``In order for the Interagency Coordinating Committee for the
    Validation of Alternative Methods (ICCVAM) to carry out its
    responsibilities under the ICCVAM Authorization Act of 2000, the
    Committee strongly urges NIEHS to strengthen the resources provided to
    ICCVAM for methods validation reviews in fiscal year 2006. ICCVAM and
    NIEHS activities must include up-front validation study design,
    execution, and review to ensure that new and revised test methods, non-
    animal test methods, and alternative test methods (such as QSARs,
    mechanistic screens, high throughput assays, and toxicogenomics) are
    deemed scientifically valid before they are recommended or adopted for
    use by federal agencies or used in implementing the National Toxicology
    Program's Road Map and Vision for NTP's toxicology program in the 21st
    century.''

                           PAIN AND DISTRESS RESEARCH

        An estimated 40 percent of the National Institutes of Health (NIH)
    budget--or currently more than $11 billion--is devoted to some aspect
    of animal research. At this time, no funding is set aside specifically
    for research into alternatives that reduce the amount of pain and
    distress to which research animals are subjected, nor methods that
    replace or reduce the use of vertebrate animals in research. NIH may
    receive $28.8 billion in fiscal year 2006 if Congress fulfills the
    President's budget request. Out of this funding, we seek $2.5 million
    (0.009 percent) for research and development focused on identifying and
    alleviating animal pain and distress. In addition to our request for a
    specific funding amount, we also urge the Committee to specify in
    report language that this research should be conducted in conjunction
    with, or ``piggy-backed'' onto, ongoing research that already causes
    pain and distress. Infliction of pain and distress on additional
    animals is unnecessary, given the volume of existing research (we
    estimate a minimum of 20-25 percent of all animal research) that is
    believed to involve moderate to significant pain and/or distress.
        The large extent to which animals are used in federally-funded
    research underscores the importance of earmarking funds for pain and
    distress research. NIH has a statutory mandate to conduct or support
    research into alternative methods that produce less pain and distress
    in animals. This was specified in the NIH Revitalization Act of 1993
    regarding a plan for the use of animals in research. Earmarked funding
    will assist NIH in meeting this mandate. Additionally, researchers
    themselves often comment publicly at scientific meetings about the
    urgent need for funding in order to properly understand and mitigate
    pain and distress in research animals and to follow Animal Welfare Act
    and Public Health Service policy requirements to minimize pain and
    distress.
        It is well known that uncontrolled, undetected, and unalleviated
    pain and distress has adverse effects on animal welfare, which leads to
    adverse effects on the quality of science. Ultimately, the lack of
    information on pain and distress leads to misinterpretation of research
    results that could result in harmful effects in human beings when pre-
    clinical animal research results are applied to humans in clinical
    trials.
        A 2001 survey conducted by an independent polling firm indicates
    that concern about animal pain and distress strongly influences public
    opinion about animal research in general. Seventy-five percent of the
    American public opposes research that causes severe animal pain and/or
    distress, even when it is health-related. Despite this public concern,
    NIH has failed to sponsor research and development aimed at determining
    how to minimize animal suffering and distress in the laboratory.
        During the past several years, our organization has been reviewing
    institutional policies and practices with respect to pain and distress
    in animal research. We have found that research institutions have
    inconsistent policies due to the lack of information on this subject,
    and that standards vary greatly from one institution to another. The
    federal standard for determining laboratory animal pain specifies that,
    if a procedure causes pain or distress to humans, it should be assumed
    to cause pain and distress to animals. Furthermore, while human
    experience can and should provide a useful guide in some cases, there
    are others in which humans are never subjected to the conditions facing
    laboratory animals. Information on pain and distress that animals
    themselves actually experience is important.
        Our nation takes pride in leading the world in biomedical research,
    yet we lag behind many other countries in our efforts to minimize pain
    and distress in animal subjects. For example, the United Kingdom,
    Sweden, Switzerland, Germany, the Netherlands and the European Union
    all have committed funds specifically for the ``three R's'' (replacing
    the use of animals, reducing their use, and refining research
    techniques to minimize animal suffering).
        We urge the Committee to make this small investment of $2.5 million
    to promote animal welfare and enhance the integrity of scientific
    research. We also respectfully request this accompanying committee
    report language:

        ``The Committee provides $2.5 million to support research and
    development focused on improving methods for recognizing, assessing,
    and alleviating pain and distress in research animals. No pain and
    distress should be inflicted solely for the purpose of this initiative,
    since the investigations can and should be conducted in conjunction
    with ongoing research that is believed to involve pain and distress
    under Government Principle IV of Public Health Service Policy, which
    assumes that procedures that cause pain and distress in humans may
    cause pain and distress in animals.''

        Again, we appreciate the opportunity to share our views and top
    priorities for the Labor, Health and Human Services, Education and
    Related Agencies Appropriation Act of fiscal year 2006. We hope the
    Committee will be able to accommodate these modest requests that will
    benefit animals, enhance effectiveness of toxicological testing, and
    improve the quality of research. Thank you for your consideration.
                                     ______

               Prepared Statement of Voices for National Service

        Mr. Chairman and Members of the Subcommittee, Voices for National
    Service, formerly known as the Save AmeriCorps Coalition, is a
    coalition of community-based organizations, faith-based groups, state
    commissions, private sector partners, institutions of higher education,
    and others interested in promoting national service through AmeriCorps
    and other vehicles. We look forward to working with you to strengthen
    AmeriCorps and national service as you oversee the entire budget of the
    Corporation for National and Community Service for the first time.
        In light of AmeriCorps 10th Anniversary, it is appropriate to
    review some of the goals Congress set for AmeriCorps in 1993: ``to meet
    the unmet human, educational, environmental and public safety needs of
    the United States; to renew the ethic of civic responsibility and the
    spirit of community throughout the United States; to expand educational
    opportunity by rewarding individuals who participate in national
    service with an increased ability to pursue higher education or job
    training; to encourage citizens of the United States, regardless of
    age, income, or disability, to engage in full-time or part-time
    national service; and, to provide tangible benefits to the communities
    in which national service is performed.''
        We believe that those who do service through AmeriCorps, as part of
    school or community-based service-learning, or senior volunteer
    programs, through their churches synagogues and mosques, and community-
    based organizations are part of one of the great currents of American
    history: working with one's neighbor to build a better community and a
    better nation. President Bush captured this theme when, in his State of
    the Union Address in 2002, he said:

        ``My call tonight is for every American to commit at least 2
    years--4,000 hours--over the rest of your lifetime to the service of
    your neighbors and your nation. . . . Our country [also] needs citizens
    working to rebuild our communities. We need mentors to love children,
    especially children whose parents are in prison. And we need more
    talented teachers in troubled schools.''

          GOVERNMENT SPONSORED SERVICE IS DEEPLY ROOTED IN OUR HISTORY

        It was almost a century ago that philosopher William James spoke of
    service as ``the moral equivalent of war'' and said if there ``were a
    conscription of the whole youthful population to form for a certain
    number of years a part of the army enlisted against Nature, the
    injustice would tend to be evened out . . . .''
        Since that speech in 1906, Presidents from Franklin D. Roosevelt to
    George W. Bush have proposed that Americans serve both here and abroad
    to improve conditions for those who need support. They recognized that
    serving made better citizens and better Americans, that government--in
    conjunction with community-based institutions--has a role to play in
    solving our most intractable problems and that service must be real,
    not make-work.
        In 1933, President Roosevelt spoke to Civilian Conservation Corps
    (CCC) members in Warm Springs, Georgia and told them that ``You are
    rendering a real service, not only to this community but to this part
    of the State and the whole State. It is permanent work, it is work that
    is going to be useful for a good many generations to come. That is why,
    one reason why, the people of this country as a whole believe in the
    Civilian Conservation Corps . . . .''
        It is difficult to believe that nearly half a century has passed
    since President Kennedy challenged a new generation by saying ``And so,
    my fellow Americans: ask not what your country can do for you--ask what
    you can do for your country.'' Kennedy's Peace Corps proposal included
    many of the principles embodied in AmeriCorps:

        ``In establishing our Peace Corps we intend to make full use of the
    resources and talents of private institutions and groups. Universities,
    voluntary agencies, labor unions and industry will be asked to share in
    this effort . . .  making it clear that the responsibility for peace is
    the responsibility of our entire society. . . . We will only send
    abroad Americans who are wanted by the host country--who have a real
    job to do--and who are qualified . . . . Programs will be developed
    with care, and after full negotiation . . . . Life in the Peace Corps
    will not be easy. There will be no salary and allowances will be at a
    level sufficient only to maintain health and meet basic needs.''
                 national service has broad bipartisan support
        The roots of AmeriCorps are contained in national service
    legislation enacted in 1990 and signed by President George H.W. Bush.
    It reflected his belief, articulated in his Inaugural address, that
    ``America is never wholly herself unless she is engaged in high moral
    principle. We as a people have such a purpose today. It is to make
    kinder the face of the Nation and gentler the face of the world. My
    friends, we have work to do.'' To address these issues, he said ``we
    will do the wisest thing of all: We will turn to the only resource we
    have that in times of need always grows--the goodness and the courage
    of the American people.'' He called for:

        ``A new engagement in the lives of others, a new activism, hands-on
    and involved, that gets the job done. We must bring in the generations,
    harnessing the unused talent of the elderly and the unfocused energy of
    the young. For not only leadership is passed from generation to
    generation, but so is stewardship. And the generation born after the
    Second World War has come of age. The old ideas are new again because
    they are not old, they are timeless: duty, sacrifice, commitment, and a
    patriotism that finds its expression in taking part and pitching in.''

        Exactly seven years less one day before September 11, President
    Clinton swore in the first class of AmeriCorps members. Reflecting many
    of the themes articulated by President Bush, he told them that
    ``Service is never a simple act, it's about sacrifice for others and
    about accomplishment for ourselves, about reaching out, one person to
    another, about all our choices gathered together as a country to reach
    across all our divides. It's about you and me and all of us together--
    who we are as individuals and what we are as a nation. Service is a
    spark to rekindle the spirit of democracy in an age of uncertainty.''
        Like Presidents Roosevelt, Kennedy, and Bush, President Clinton
    also understood that each generation owes something to the nation for
    what it has received as well as to those who follow:

        ``And your generation is no exception. We look at you now. And we
    know you are no generation of slackers. Instead you are a generation of
    doers. And you want to give something back to the country that has
    given so much to you. The only limit to our future is what we're
    willing to demand of ourselves today. Generations of Americans before
    us have done the groundwork. Now, it falls to all of us to build on
    their foundations.''

        Two years ago, AmeriCorps was in crisis; its very survival in
    doubt. At that time, virtually every governor, more than 150 mayors,
    hundreds of university presidents, and corporate and civic leaders
    publicly recognized the good that AmeriCorps had accomplished since its
    creation 10 years ago. More than 100 editorials in large and small
    newspapers throughout the nation provided ample evidence of how
    AmeriCorps members improved their communities.
        President George W. Bush's support, important bipartisan
    legislative initiatives to improve the management of the Corporation
    for National and Community Service, installation of a new leadership
    team, and the rulemaking process still underway not only helped to save
    AmeriCorps but to remind us that service is the responsibility of all
    Americans.

                           STRENGTHENING COMMUNITIES

        AmeriCorps members serve in more than 900 local and state nonprofit
    organizations, public agencies, and faith-based organizations funded by
    the Corporation for National and Community Service through both state
    commissions as well as national nonprofit AmeriCorps programs including
    Teach for America, the National Association of Community Health
    Centers, the Red Cross, Habitat for Humanity, City Year, Public Allies,
    the National Association of Service and Conservation Corps, Jumpstart
    for Young Children, the Sisters of Notre Dame, and the Experience
    Corps.
        They serve to address problems within four broad categories:
    ``unmet human, educational, environmental, or public safety needs.''
    Communities identify their needs and choose the model that is most
    appropriate to meeting those needs. This is a bottom up, not a top-down
    program.
        AmeriCorps members also help strengthen Homeland Security and
    prevent or mitigate the effects of natural disasters. Recently,
    AmeriCorps members from Minnesota and Washington State joined
    colleagues serving in Florida to bring a measure of relief to victims
    of devastating hurricanes. They helped mobilize the largest volunteer
    disaster response in American history, repaired damaged homes, and
    distributed food and water to victims and community volunteers. Indeed,
    since September 11, 2001 the AmeriCorps program has expanded its work
    in public safety, public health, disaster relief, and homeland
    security.
        AmeriCorps members teach in underserved schools, tutor and mentor
    youth including the children of prisoners, run after-school programs,
    build affordable housing, provide public health services, prevent
    forest fires and do disaster relief, run after-school programs, and
    help communities respond to disasters. Hundreds of AmeriCorps state
    programs clean rivers and streams, enrich after school programs,
    support local law enforcement by providing meaningful alternatives to
    gangs, deliver services to the elderly, and meet other needs defined by
    the communities in which they serve.
        This year, for example, AmeriCorps members are serving more than 2
    million children and youth, providing valuable resources to reach the
    President's goal of having all children able to read by third grade.
    They are also helping to recruit and train more than 600,000 community
    volunteers.
        AmeriCorps members leverage community resources as well as perform
    direct service. In fiscal year 2003, AmeriCorps members recruited more
    than 529,000 community volunteers an increase of almost 275,000 (from
    the previous year when the Corporation stopped recruiting new members
    and new volunteers because of its self-imposed recruitment freeze).
    Last year, AmeriCorps programs generated more than $165 million from
    non-Corporation partners, $70 million more than in the previous year.

                                ACCOMPLISHMENTS

        According to the State Profiles and Performance Report 2002-2003
    published by the Corporation for National and Community Service
    (December 2004), examples of what AmeriCorps members accomplished
    include (but are not limited to):
      --In Alaska, members tutored almost 6,000 students in grades 1
            through 12 and assessed 485 homes for energy efficiency.
      --In Florida, members recruited 2,000 community volunteers to provide
            education services, maintained and expanded 200 acres of
            habitat for threatened and endangered species, and built 40
            homes for low-income families.
      --In Georgia, almost 7,500 homeless individuals received referrals to
            permanent or transitional housing.
      --In Indiana, 2,400 juveniles participated in career development
            activities for offenders or ex-offenders.
      --In Iowa, more than 4,800 elementary and middle students received
            tutoring and mentoring support, and 32,000 received education
            and training about the environment.
      --In Kentucky, members staged eight forums to educate more than 1,000
            at-risk elderly about home safety and conducted 265 Home Safety
            Assessments for seniors.
      --In Maine, members made 600 presentations on disaster preparedness,
            benefiting more than 36,000 people and almost 1,300 people
            participated in after-school activities designed to reduce
            violence in public housing.
      --In Maryland, members removed 453 tons of trash, improving the
            quality of storm water run-off into the Chesapeake Bay and
            1,900 homeless families received food, clothing, or furniture.
      --In Minnesota, members constructed 151 housing units for low income
            seniors or people with disabilities, planted almost 142,000
            trees, and conserved more than 10,000 acres of habitat and
            land.
      --In Mississippi, members trained 715 people with disabilities in
            life skills, helped train mentally, or developmentally,
            disabled adults for employment, and mentored 1,100 low income
            and underachieving middle school students.
      --In Montana, members constructed 54 miles of fence to protect wild-
            or park lands, maintained 309 miles of trails, roads, and other
            public areas, and increased access to technology for more than
            1,100 youth, parents, and members of the community.
      --In Nevada, 3,200 students in grades 1 through 12 received tutoring,
            577 homeless veterans received employment-related counseling,
            and almost 1,000 women benefited from anti-victimization
            counseling and workshops on preventing domestic violence.
      --In New Mexico, almost 24,400 people participated in after-school
            sports and violence avoidance activities, 400 adults received
            instruction in basic skills development and GED training, and
            138 homeless families found homes.
      --In New York, members transported 1,000 children to medical
            appointments, delivered meals and snacks to about 58,000
            children and seniors, and provided literacy activities to
            almost 17,000 children.
      --In Ohio, members trained more than 9,000 youth in conflict
            resolution, built repaired, or rehabilitated 364 housing units,
            and provided educational support services to 1,500 students
            during the summer months.
      --In Oregon, 7,000 students benefited from updating high school
            Career Centers with college, military, apprenticeship, and
            trade school information, planted almost 5,000 trees, and grew
            and distributed more than 900 pounds of produce.
      --In Pennsylvania, members tutored almost 14,600 elementary and high
            school students and more than 6,800 citizens received either
            needs assessment or support in the areas of domestic violence,
            foster care, mental health, and housing for homeless veterans.
      --In Tennessee, more than 900 people received access to health care,
            almost 200 children had their immunizations ensured, and more
            than 1,300 senior women received informational materials about
            breast cancer.
      --In Washington, almost 37,000 students benefited from out of class
            enrichment activities like field trips, about 6,600 peer tutors
            were recruited, and more than 19 miles of rivers, river banks,
            beaches, and fish habitat were restored or conserved,
            benefiting local salmon runs.
      --In Wisconsin, members organized or packed 290 tons of food to be
            distributed to community agencies and provided after-school
            tutoring or mentoring services to more than 1,200 students.
      --In West Virginia, more than 3,200 children received tutoring in a
            six-week summer literacy program, helping to realize an average
            four month gain in literacy skills.
        According to the Corporation's National Performance Benchmarking
    Survey, ``57 percent of organizations' AmeriCorps partners reported
    that AmeriCorps members `considerably' helped them increase their
    involvement in partnerships and coalitions. (29 percent reported
    `moderately' helped).'' Also, three quarters of grantees said that
    ``AmeriCorps had increased `by a considerable amount' the number of end
    beneficiaries served.'' About ``83 percent of grantees reported that
    AmeriCorps members helped their organization either `considerably' (53
    percent) or `moderately' (30 percent) in leveraging additional
    volunteers.'' And, ``more than 75 percent of organizations receiving
    disaster and emergency readiness and preparedness training from
    AmeriCorps programs have become better prepared by conducting emergency
    drills, changing organization operations, or preparing emergency
    kits.''
        With your support, in the next fiscal year, approximately 40,000
    AmeriCorps members will provide tutoring to students, help operate
    after-school programs, increase Americans' access to health care, and
    provide support for families in crisis. In addition, more than 5,000
    children of prisoners will receive services provided by AmeriCorps
    members.
        In 2004, the Corporation for National and Community Service
    celebrated its tenth anniversary. In the last decade, more than 400,000
    young Americans dedicated themselves to either full or part-time
    service through AmeriCorps to improve their communities and their
    country. At the same time, AmeriCorps members earned Education Awards
    worth more than $1 billion.

                        SERVICE CHANGES THOSE WHO SERVE

        Serving in AmeriCorps also changes those who serve. According to
    the recent study conducted by Abt Associates ``Serving Country and
    Community: A Longitudinal Study of Service in AmeriCorps''
    participation in AmeriCorps ``resulted in statistically significant
    positive impacts on members' connection to community, participation in
    community-based activities, and personal growth through service. While
    AmeriCorps members increased their level of civic engagement . . .
    scores for comparison group members typically showed little or no
    change. . . .'' ``Additionally, there was a positive and significant
    effect of AmeriCorps participation on volunteering for members without
    prior volunteering experience. These results are important because they
    reflect the capacity of AmeriCorps to strengthen existing beliefs in
    and commitments to civic engagement and community service, and to
    awaken new ones.''
        The Abt study also reported that service in AmeriCorps ``had a
    meaningful impact on both attitudinal and behavioral employment
    outcomes.'' It increased ``the work skills of AmeriCorps members'' and
    motivated ``members to choose public service careers, such as teaching,
    social work, and military service.''
        Thus, AmeriCorps proves its value everyday in communities across
    the country and by changing the lives of AmeriCorps members.

                          THE FISCAL YEAR 2006 REQUEST

        We are hopeful that under your leadership local communities
    throughout the nation will continue to be served by as many as 75,000
    AmeriCorps members. At the same time, we want to make clear that we are
    as committed to the quality of the service as to reaching a specific
    number of AmeriCorps members.
        We very much appreciate the increase in funding that Congress
    provided in fiscal year 2004 to save AmeriCorps. It must be noted,
    however, that funding for AmeriCorps grants has declined from the
    fiscal year 2004 enacted high of $312 million to the proposed $275
    million, a cut of more than 10 percent. At the same time funding for
    the Trust has increased from $129 to a proposed $146 million.
        The Voices for National Service Coalition believes that it will
    require $442 million to achieve the number of AmeriCorps members
    proposed by the Corporation for National and Community (75,000) while
    maintaining the historical balance between full-time, part-time, and
    Education award only AmeriCorps members. To sustain this level of
    service, we urge you to fund AmeriCorps at the level proposed by
    President Bush in his fiscal year 2005 budget. We are very concerned
    that with operating costs increasing, recruiting the same number of
    AmeriCorps members with $20 million fewer dollars than the President
    proposed just last year may force the Corporation to make programmatic
    compromises that will undermine the historic nature and fundamental
    character of AmeriCorps. While we support the Corporation's desire to
    increase the number of ``effective, lower cost programs, such as
    professional and teacher corps'' we remain convinced that
    responsiveness to local needs requires the Corporation to support a mix
    of higher, as well as lower, cost programs.
        We also want to call the Committee's attention to two other
    elements of the Corporation's request. First, we support the
    Corporation's proposal to eliminate the cap on National Direct grants.
    We share its concern that ``capping funding for National Direct grants
    may prevent [it] from supporting outstanding service programs.''
    Second, we are concerned about the Corporation's failure to seek funds
    for the Challenge Grant program. Challenge grants promote competition
    and are an important tool which programs can use to leverage additional
    private sector funds. If the Corporation truly wants to achieve program
    sustainability by reducing dependence on federal grants, it ought to
    increase Challenge Grant funds rather than eliminate them. The response
    to Challenge Grants has been overwhelming and we believe the program's
    success justifies its continuation.

                  PROMOTING QUALITY AND INCREASING EFFICIENCY

        As you begin your difficult work this year, Voices for National
    Service urges you to consider the following themes that will further
    increase the Corporation's effectiveness and meet its goal of ``put
    [ting] the customer first'':
        1. Education Award Only slots should be a tool for state
    flexibility and cost-effectiveness. They should not become a way to
    increase the number of AmeriCorps members ``on the cheap.'' We believe
    that the current ratio between full- and part-time members and
    recipients of Education Awards should be maintained and that no more
    than 40 percent of the AmeriCorps portfolio should be allocated to
    Education Award Only programs. This will allow states to reduce cost
    per member, and be responsive to both local resources and local needs.
        2. The Corporation must continue to affirm its commitment to
    diversity of AmeriCorps members and be sensitive to geographic
    diversity as well as racial, ethnic, and socio-economic diversity.
    Corporation policy should reflect an understanding of the difficulties
    that programs in rural areas and inner-cities have in recruiting
    private sector and philanthropic dollars and the fact that programs
    whose enrollment focus is on low-income, out of school and minority
    young people are likely to have greater difficulty recruiting and
    retaining members than programs that recruit more affluent members.
        3. The Re-fill Rule should be fully restored. While we appreciate
    the Corporation's effort to reintroduce its slot refill policy, the
    present one-to-one, one-time-only policy is not sufficient to ensure
    that programs can meet local needs. AmeriCorps programs that enroll
    significant numbers of economically and educationally disadvantaged
    corps members are likely to experience higher rates of attrition and
    lower rates of retention. Reverting to its prior practice of allowing
    programs to completely re-fill vacated slots at any time during the
    year would allow greater participation in AmeriCorps, encourage
    participants with a broad array of backgrounds to participate, and
    ultimately allow programs--and AmeriCorps as a whole--to provide
    deserving people, often highly disadvantaged, the opportunity to pursue
    their educational goals.

                                   CONCLUSION

        For the last 70 years, Presidents of both parties, and their
    Congressional champions, have recognized that service programs with
    government support, the active support of community-based
    organizations, faith-based institutions, and the private sector can
    play an important role in strengthening communities, teaching the
    virtues of civic engagement, and strengthening the bonds that connect
    us as a people. Service is not only an effective strategy for attacking
    our problems, it is a way to remind Americans of all ages that we have
    a responsibility to give something back to our country.
        We believe that AmeriCorps has made substantial progress in meeting
    these ambitious goals and look forward to working with you to improve
    the lives of all Americans through service.
        Thank you for the opportunity to provide this testimony.
                                     ______

                         NATIONAL INSTITUTES OF HEALTH

                  Prepared Statement of the Alpha-1 Foundation

                           SUMMARY OF RECOMMENDATIONS

        The Alpha-1 Foundation requests an allocation in the budget to
    enable the CDC, National Center for Birth Defects and Developmental
    Disabilities to implement a national targeted Alpha-1 detection
    program. The Foundation recommends that CDC receive $2 million in
    fiscal year 2006 for implementation.
        The Foundation recommends that NHLBI enhance its portfolio of
    research and education on the fourth leading cause of death in the
    United States, Chronic Obstructive Pulmonary Disease (COPD), including
    genetic risk factors such as Alpha-1 Antitrypsin Deficiency.
        The Foundation commends NIH on the roadmap and recommends that
    NHLBI, NIDDK, NHGRI, NIEHS, and other institutes establish an Alpha-1
    inter-institute coordinating committee to facilitate collaboration on
    this genetic lung and liver disease.
        The Foundation encourages HRSA to collect additional data to
    evaluate the impact of the new lung transplant organ allocation system
    being implemented by the Organ Procurement and Transplantation Network/
    United Network for Organ Sharing.
        The Foundation supports the request of the Ad Hoc Group for Medical
    Research Funding for a $30 billion appropriation for NIH in fiscal
    2006.
        Mr. Chairman and members of the Subcommittee thank you for the
    opportunity to submit testimony for the record on behalf of the Alpha-1
    Foundation.

                             THE ALPHA-1 FOUNDATION

        The Alpha-1 Foundation is a national not-for-profit organization
    dedicated to providing the leadership and resources that will result in
    increased research, improved health, worldwide detection and a cure for
    Alpha-1 Antitrypsin (Alpha-1) Deficiency. The Foundation has built the
    research infrastructure with private investment, funding over
    $15,000,000 in grants from basic to social science, establishing a
    national patient registry, tissue and DNA bank, translational
    laboratory, assisting in fast track development of new therapeutics,
    and stimulating the involvement of the scientific community. The
    Foundation has invested the resources to support clinical research
    which follows the roadmap established by the NIH; uniquely positioning
    it for a perfect private public partnership. There is a lack of
    awareness of the insidious nature of the early symptoms of the lung and
    liver disease associated with this genetic condition by both medical
    care providers and the public. It is our hope that the federal
    government will leverage the Foundation's investment with support for a
    national Alpha-1 targeted detection program.

                    ALPHA-1 IS SERIOUS AND LIFE THREATENING

        Alpha-1 is the leading genetic risk factor for Chronic Obstructive
    Pulmonary Disease (COPD) and is often misdiagnosed as such. Alpha-1
    afflicts an estimated 100,000 individuals in the United States with
    fewer than 5 percent accurately diagnosed. These are people who know
    they are sick and as yet have not put a name to their malady. Although
    Alpha-1 testing is recommended for those with COPD this standard of
    care is not being implemented. In addition, an estimated 20 million
    Americans are the undetected carriers of the Alpha-1 gene and may pass
    the gene on to their children. Of these 20 million carriers, 7-8
    million may be at risk for lung or liver disease.
        The pulmonary impairment of Alpha-1 causes disability and loss of
    employment during the prime of life (20-40 years old), frequent
    hospitalizations, family disorganization, and the suffering known only
    to those unable to catch their breath. Fully half of those diagnosed
    require supplemental oxygen. Lung transplantation, with all its
    associated risks and costs, is the most common final option. Alpha-1 is
    the primary cause of liver transplantation in infants and an increasing
    cause in adults. Alpha-1 liver disease currently has no specific
    treatment aside from transplantation. The cost to these families in
    time, energy and money is high and often devastating. Alpha-1 also
    causes liver cancer.
        Alpha-1 is a progressive and devastating disorder that in the
    absence of proper diagnosis and therapy leads to premature death; in
    spite of the availability of therapeutics for lung disease and
    preventative health measures that can be life-prolonging. It is
    estimated that untreated individuals can have their life expectancy
    foreshortened by 20 or more years. Yet early detection, the avoidance
    of environmental risk factors and pulmonary rehabilitation can
    significantly improve health.

           THE MEDICAL NEEDS OF THE ALPHA-1 COMMUNITY HAVE GONE UNMET

        Alpha-1 is a hidden killer that desperately needs new therapies.
    There is a lack of awareness of the insidious nature of the early
    symptoms of the lung and liver disease associated with this genetic
    condition by both medical care providers and the public.
        Currently, the only specific therapy for Alpha-1 lung disease is
    intravenous augmentation therapy produced from pooled human plasma at
    an average annual cost of $50,000-$100,000. This therapy increases the
    plasma levels of the deficient protein and appears to slow or halt the
    progression of the pulmonary disease described above. There is
    currently nothing available to regenerate lung tissue and restore lung
    function.
        In addition, Alpha-1 liver disease is equally life threatening, as
    is the case with many chronic liver conditions, often reaching an
    advanced stage with few symptoms and little warning. Advanced liver
    disease is often untreatable, and many with Alpha-1 have erroneously
    been told they have alcoholic liver disease because of the lack of
    physician awareness.

                                ALPHA-1 AND COPD

        As the forth leading cause of death, COPD is a major public health
    concern. Data indicates that not all individuals who smoke develop lung
    disease leading many to conclude that COPD has significant genetic and
    environmental risk factors. As the most significant genetic risk factor
    for COPD, Alpha-1 has much to tell us about the pathogenesis of lung
    disease. Discoveries and advances made in Alpha-1 will impact the
    larger 10-24 million individuals living with COPD.

                                   DETECTION

        The Alpha-1 Foundation conducted a pilot program in the state of
    Florida where we garnered the knowledge and experience necessary to
    launch an awareness and National Targeted Detection Program (NTDP). The
    goals of the NTDP are to educate the medical community and people with
    COPD and liver disease, alerting them that Alpha-1 may be an underlying
    factor of their disease; and stimulating testing for Alpha-1. This
    effort will uncover a significant number of people who would benefit
    from early diagnosis, treatment and preventative health measures.
        The Foundation distributes the American Thoracic Society/European
    Respiratory Society (ATS/ERS) ``Standards for the Diagnosis and
    Management of Individuals with Alpha-1 Antitrypsin Deficiency'' to
    physicians, nurses and respiratory therapists. Additionally, health
    care practitioners and the COPD community are being targeted through
    press releases, newsletter articles and various website postings.
        The national implementation of the NTDP is enhanced through the 7
    Clinical Resource Network Centers of the National Heart, Lung, Blood
    Institute of the National Institutes of Health; 51 Foundation
    affiliated Clinical Resource Centers; large pulmonary practices and
    various teaching hospitals and universities. The NTDP also employs a
    direct to consumer approach targeted to people with COPD.
        The Alpha-1 Foundation's Ethical Legal and Social Issues (ELSI)
    Working Group endorsed the recommendations of the ATS/ERS Standards
    Document which recommends testing symptomatic individuals or siblings
    of those who are diagnosed with Alpha-1. Early diagnosis in Alpha-1 can
    significantly impact disease outcomes by allowing individuals to seek
    appropriate therapies, and engage in essential life planning.
    Unfortunately, seeking a genetic test may lead to discrimination
    against individuals who have no control over their inherited condition.
    The absence of federal protective legislation has caused the ELSI to
    recommend against population screening and genetic testing in the
    neonatal population. The Foundation commends the Senate for passing the
    Genetic Non-Discrimination Act of 2005 and is working to ensure that
    the House takes the same positive action.
        The Alpha-1 Coded Testing (ACT) Trial, funded by the Alpha-1
    Foundation and conducted at the Medical University of South Carolina
    offers a free and confidential finger-stick test that can be completed
    at home. The results are mailed directly to the participants. The ACT
    Trial has offered individuals the opportunity to receive confidential
    test results since September of 2001, to date over 2,400 test kits have
    been requested.

                                ALPHA-1 RESEARCH

        The Alpha-1 Foundation believes that significant federal investment
    in medical research is critical to improving the health of the American
    people and specifically those affected with Alpha-1. The support of
    this Subcommittee has made a substantial difference in improving the
    public's health and well-being.
        The Foundation requests that the National Institutes of Health
    increase the investment in Alpha-1 Antitrypsin (AAT) Deficiency and
    that the Centers for Disease Control and Prevention initiate a federal
    partnership with the Alpha-1 community to achieve the following goals:
      --Promotion of basic science and clinical research related to the AAT
            protein and AAT Deficiency;
      --Funding to attract and train the best young clinicians for the care
            of individuals with AAT Deficiency;
      --Support for outstanding established scientists to work on problems
            within the field of AAT research;
      --Development of effective therapies for the clinical manifestations
            of AAT Deficiency;
      --Expansion of awareness and targeted detection to promote early
            diagnosis and treatment.

                 SPECIFIC AREAS OF CONCERN AND RECOMMENDATIONS

        1. The Foundation requests an allocation in the budget to enable
    the CDC, National Center for Birth Defects and Developmental
    Disabilities to implement a national targeted Alpha-1 detection
    program. The Foundation recommends that CDC receive $2 million in
    fiscal year 2006 for implementation.
        2. The Foundation recommends that NHLBI enhance its portfolio of
    research and education on the fourth leading cause of death in the
    United States, Chronic Obstructive Pulmonary Disease (COPD), including
    genetic risk factors such as Alpha-1 Antitrypsin Deficiency.
        3. The Foundation commends NIH on the roadmap and recommends that
    NHLBI, NIDDK, NHGRI, NIEHS, and other institutes establish an Alpha-1
    inter-institute coordinating committee to facilitate collaboration on
    this genetic lung and liver disease.
        4. The Foundation encourages HRSA to collect additional data to
    evaluate the impact of the new lung transplant organ allocation system
    being implemented by the Organ Procurement and Transplantation Network/
    United Network for Organ Sharing.
        5. The Foundation supports the request of the Ad Hoc Group for
    Medical Research Funding for a $30 billion appropriation for NIH in
    fiscal 2006.

                               ALPHA-1 FAST FACTS

        Alpha-1 Antitrypsin Deficiency (Alpha-1) is one of the most common
    fatal genetic diseases, 95 percent of those with Alpha-1 are
    undiagnosed.
        Alpha-1 is commonly misdiagnosed as asthma and Chronic Obstructive
    Pulmonary Disease (COPD) as symptoms are similar. It usually takes
    seven years and five physicians to be accurately diagnosed after the
    onset of symptoms.
        The World Health Organization (WHO) and the American Thoracic
    Society/European Respiratory Society recommends that all individuals
    with chronic obstructive pulmonary disease (an estimated 10-24 million
    Americans) as well as adults and adolescents with asthma (an estimated
    14.6 million Americans) be tested for Alpha-1.
        Alpha-1 is more prevalent than Cystic Fibrosis. An estimated 20
    million Americans are undetected carriers of the Alpha-1 gene and may
    be at risk for lung and/or liver disease and may pass the gene on to
    their children.
        Alpha-1 is a life-threatening adult onset lung disease that is
    progressive and irreversible. It is a major reason for lung
    transplantation. Nothing repairs lung tissue damage but early diagnosis
    allows individuals to engage in preventative health strategies and
    receive appropriate therapy which saves health care dollars.
        Alpha-1 can also manifest as liver disease (5-10 percent) in adults
    as well as newborns for which the only treatment is a liver transplant.
    Alpha-1 is a leading cause of liver transplants in newborns.

                       COMMON SYMPTOMS OF ALPHA-1 INCLUDE

      --Recurring respiratory infections
      --Shortness of breath or awareness of one's breathing
      --Non-responsive Asthma or Year-Round Allergies
      --Rapid deterioration of lung function without a history of
            significant smoking
      --Decreased exercise tolerance
      --Chronic liver problems
      --Elevated liver enzymes
                                     ______

    Prepared Statement of the American Association for Geriatric Psychiatry

        The American Association for Geriatric Psychiatry (AAGP)
    appreciates this opportunity to present its recommendations on issues
    related to fiscal year 2006 appropriations for mental health research
    and services. AAGP is a professional membership organization dedicated
    to promoting the mental health and well being of older Americans and
    improving the care of those with late-life mental disorders. AAGP's
    membership consists of approximately 2,000 geriatric psychiatrists as
    well as other health professionals who focus on the mental health
    problems faced by senior citizens.
        AAGP would like to thank the Subcommittee for its continued strong
    support for increased funding for the National Institutes of Health
    (NIH) over the last several years, particularly the additional funding
    you have provided for the National Institute of Mental Health (NIMH),
    the National Institute on Aging (NIA), the National Institute on
    Alcohol Abuse and Alcoholism (NIAAA), and the Center for Mental Health
    Services (CMHS) within the Substance Abuse and Mental Health Services
    Administration (SAMHSA). Although we generally agree with others in the
    mental health community about the importance of sustained and adequate
    Federal funding for mental health research and treatment, AAGP brings a
    unique perspective to these issues because of the elderly patient
    population served by our members.
        There are serious concerns, shared by AAGP and researchers,
    clinicians, and consumers that there exists a critical disparity
    between appropriations for research, training, and health services and
    the projected mental health needs of older Americans. This disparity is
    evident in the convergence of several key factors:
      --demographic projections inform us that, with the aging of the U.S.
            population, there will be an unprecedented increase in the
            burden of mental illness among aging persons, especially among
            the baby boom generation;
      --this growth in the proportion of older adults and the prevalence of
            mental illness is expected to have a major direct and indirect
            impact on general health service use and costs;
      --despite the fact that effective treatment exists, the current
            mental health needs of many older adults remain unmet;
      --the number of physicians being trained in geriatric mental health
            research and clinical care is insufficient to meet current
            needs, and this workforce shortfall is projected to become a
            crisis as the U.S. population ages over the next decade;
      --a major gap exists between research, mental health care policy, and
            service delivery; and
      --despite recent significant increases in appropriations for support
            of research in mental health, the allocation of NIMH and CMHS
            funds for research that focuses specifically on aging and
            mental health is disproportionately low, and woefully
            inadequate to deal with the impending crisis of mental health
            in older Americans.

           DEMOGRAPHIC PROJECTIONS AND THE MENTAL DISORDERS OF AGING

        With the baby boom generation nearing retirement, the number of
    older Americans with mental disorders is certain to increase in the
    future. By the year 2010, there will be approximately 40 million people
    in the United States over the age of 65. Over 20 percent of those
    people will experience mental health problems. A national crisis in
    geriatric mental health care is emerging and has received recent
    attention in the medical literature. Action must be taken now to avert
    serious problems in the near future. While many different types of
    mental and behavioral disorders can occur late in life, they are not an
    inevitable part of the aging process, and continued research holds the
    promise of improving the mental health and quality of life for older
    Americans.
        The current number of health care practitioners, including
    physicians, who have training in geriatrics is inadequate. As the
    population ages, the number of older Americans experiencing mental
    problems will almost certainly increase. Since geriatric specialists
    are already in short supply, these demographic trends portend an
    intensifying shortage in the future. There must be a substantial public
    and private sector investment in geriatric education and training, with
    attention given to the importance of geriatric mental health needs. We
    will never have, nor will we need, a geriatric specialist for every
    older adult. However, without mainstreaming geriatrics into every
    aspect of medical school education and residency training, broad-based
    competence in geriatrics will never be achieved. There must be adequate
    funding to provide incentives to increase the number of academic
    geriatricians to train health professionals from a variety of
    disciplines, including geriatric medicine and geriatric psychiatry.
        Current and projected economic costs of mental disorders alone are
    staggering. The direct medical expense to care for a patient with
    Alzheimer's disease ranges from $18,000 to $36,000 a year per patient,
    depending on the severity of the disease. In addition, there are
    substantial indirect costs associated with caring for an Alzheimer's
    disease patient including social support, care giving, and often
    nursing home care. It is estimated that total costs associated with the
    care of patients with Alzheimer's disease is over $100 billion per year
    in the United States. Psychiatric symptoms (including depression,
    agitation, and psychotic symptoms) affect 30 to 40 percent of people
    with Alzheimer's and are associated with increased hospitalization,
    nursing home placement, and family burden. These psychiatric symptoms,
    associated with Alzheimer's disease, can increase the cost of treating
    these patients by more than 20 percent. Although NIA has supported
    extensive research on the cause and treatment of Alzheimer's, treatment
    of these behavioral and psychiatric symptoms has been neglected and
    should be supported through NIMH.
        Depression is another example of a common problem among older
    persons. Approximately 30 percent of older persons in primary care
    settings have significant symptoms of depression; and depression is
    associated with greater health care costs, poorer health outcomes, and
    increased mortality. Of the approximately 32 million Americans who have
    attained age 65, about five million suffer from depression, resulting
    in increased disability, general health care utilization, and increased
    risk of suicide. Older adults have the highest rate of suicide rate
    compared to any other age group. Comprising only 13 percent of the U.S.
    population, individuals age 65 and older account for 19 percent of all
    suicides. The suicide rate for those 85 and older is twice the national
    average. More than half of older persons who commit suicide visited
    their primary care physician in the prior month--a truly stunning
    statistic.
        The enormous and widely underestimated costs of late-life mental
    disorders justify major new investments. The personal and societal
    costs of mental illness and addictive disorders are high, but advances
    in research and treatment will help save lives, strengthen families,
    and save taxpayer dollars.

                   THE BENEFITS OF RESEARCH ON PUBLIC HEALTH

        The U.S. Surgeon General's Report on Mental Health (1999) and the
    Administration on Aging Report on Older Adults and Mental Health (2001)
    underscore the prevalence of mental disorders in older persons and
    provide evidence that research has lead to the development of effective
    treatments. These reports summarize research findings showing that
    treatments are effective in relieving symptoms, improving functioning,
    and enhancing quality of life. Preliminary findings suggest that these
    interventions reduce the need for expensive and intensive acute and
    long-term services. However, it is also well demonstrated that there is
    a pronounced gap between research findings on the most effective
    treatment interventions and implementation by health care providers.
    This gap can be as long as 15 to 20 years. These reports stress the
    need for translational and health services research focused on
    identifying the most cost-effective interventions, as well as creating
    effective methods for improving the quality of health care practice in
    usual care settings. A major priority (neglected to date) is the
    development of a health services research agenda that examines the
    effectiveness and costs of proven models of mental health service
    delivery for older persons.
        Special attention also needs to be paid to inadequately or poorly
    studied, serious late-life mental disorders. Illnesses such as
    schizophrenia, anxiety disorders, alcohol dependence and personality
    disorders have been largely ignored by both the research community and
    the funding agencies, despite the fact that these conditions take a
    major toll on patients, their care givers, and society at large. Many
    of AAGP's members are at the forefront of groundbreaking research on
    Alzheimer's disease, depression, and psychosis among the elderly, and
    we strongly believe that more research funds must be focused in these
    areas. Improving the treatment of late-life mental health problems will
    benefit not only the elderly, but also their children, whose lives are
    often profoundly affected by their parents' illness.
        While the funding increases supported by this Subcommittee in
    recent years have been essential first steps to a better future, a
    committed and sustained investment in research is necessary to allow
    continuous progress on the many research advances made to date.

                      NATIONAL INSTITUTE OF MENTAL HEALTH

        In his fiscal year 2006 budget, the President proposed an increase
    of $200 million for the National Institutes of Health (NIH), which
    would bring the entire NIH budget to a level of $28.8 billion. However,
    this 0.7 percent increase over the fiscal year 2005 funding level pales
    in comparison with recent annual double-digit increases. A decline in
    adequate funding increases could have a devastating impact on the
    ability of NIH to sustain the ongoing, multi-year research grants that
    have been initiated in recent years.
        For NIMH, the President is proposing $1.418 billion for scientific
    and clinical research, a 0.4 percent increase over the agency's fiscal
    year 2005 appropriation of $1.412 billion. It is important to note that
    from fiscal year 1999 through fiscal year 2005, NIMH received increases
    that lagged behind the increases received by many of the other NIH
    institutes. Furthermore, the increase proposed by the Administration
    for NIMH for fiscal year 2006 is lower than that proposed for most of
    the other institutes at NIH. As Congress moves forward with
    deliberations on the fiscal year 2006 budget, AAGP believes that NIMH
    should receive a percentage increase that, at the very minimum, is
    equal to the average percentage increase for the other NIH institutes.
        Commendable as recent funding increases for NIH and NIMH have been,
    AAGP would like to call to the Subcommittee's attention the fact that
    these increases have not always translated into comparable increases in
    funding that specifically address problems of older adults. Data
    supplied to AAGP by NIMH indicates that while extramural research
    grants by NIMH increased 59 percent during the five-year period from
    fiscal year 1995 through fiscal year 2000 (from $485,140,000 in fiscal
    year 1995 to $771,765,000 in fiscal year 2000), NIMH grants for aging
    research increased at less than half that rate: only 27.2 percent
    during the same period (from $46,989,000 to $59,771,000). Furthermore,
    despite the fact that over the past four years, Congress, through
    Committee report language, has specifically urged NIMH to increase
    research grant funding devoted to older adults, this has not occurred.
        AAGP is pleased that NIMH has recently renewed its emphasis on
    mental disorders among the elderly, and commends the recent creation of
    a new Aging Treatment and Prevention Intervention Research Branch at
    NIMH. AAGP would like the scope of this Branch increased into a
    comprehensive aging Branch that is responsible for all facets of
    clinical research, including translational, interventions, and disease-
    based psychopathology. The Branch should also be given adequate
    resources to fulfill its primary mission within NIMH.
        In addition to supporting research activities at NIMH, AAGP
    supports increased funding for research related to geriatric mental
    health at the other institutes of NIH that address issues relevant to
    mental health and aging, including the National Institute of Aging
    (NIA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA),
    the National Institute on Drug Abuse (NIDA), and the National Institute
    of Neurological Disorders and Stroke.

                       CENTER FOR MENTAL HEALTH SERVICES

        It is also critical that there be adequate funding increases for
    the mental health initiatives under the jurisdiction of the CMHS within
    SAMHSA. While research is of critical importance to a better future,
    the patients of today must also receive appropriate treatment for their
    mental health problems. SAMHSA provides funding to State and local
    mental health departments, which in turn provide community-based mental
    health services to Americans of all ages, without regard to the ability
    to pay. AAGP was pleased that the final budgets for fiscal years 2002,
    2003, 2004, and 2005 included $5 million for evidence-based mental
    health outreach and treatment to the elderly. AAGP worked with members
    of this Subcommittee and its House counterpart on this initiative,
    which is a very important first step in addressing the mental health
    needs of the nation's senior citizens. Increasing this mental health
    outreach and treatment program must be a top priority, as it is the
    only Federally funded services program dedicated specifically to the
    mental health care of older adults.
        Funding for the dissemination and implementation of evidence-based
    practices in ``real world'' care settings must also be a top priority
    for Congress. Despite significant advances in research on the causes
    and treatment of mental disorders in older persons, there is a major
    gap between these research advances and clinical practice in usual care
    settings. The greatest challenge for the future of mental health care
    for older Americans is to bridge this gap between scientific knowledge
    and clinical practice in the community, and to translate research into
    patient care. Adequate funding for this geriatric mental health
    services initiative is essential to disseminate and implement evidence-
    based practices in routine clinical settings across the states.
    Consequently, we would urge that the $5 million for mental health
    outreach and treatment for the elderly included in the CMHS budget for
    fiscal year 2005 be increased to $20 million for fiscal year 2006.
        Of that $20 million appropriation, AAGP believes that $10 million
    should be allocated to a National Evidence-Based Practices Program,
    which will disseminate and implement evidence-based mental health
    practices for older persons in usual care settings in the community.
    This program will be a collaborative effort, actively involving family
    members, consumers, mental health practitioners, experts, professional
    organizations, academics, and mental health administrators. With $10
    million dedicated to a program to disseminate and implement evidence-
    based practice in geriatric mental health, there will be an assured
    focus on facilitating accurate, broad-based sustainable implementation
    of proven effective treatments, with an emphasis on practice change and
    consumer outcomes. Such a program should include several development
    phases including identification of a core set of evidence-based
    practices, development of evidence-based implementation, and practice
    improvement toolkits and field-testing of evidence-based
    implementation. This program will provide the foundation for a longer-
    term national effort that will have a direct effect on the well-being
    and mental health of older Americans.
        The Community Mental Health Services Block Grant Program
    distributes funds to 59 eligible States and Territories through a
    formula based upon specified economic and demographic factors.
    Applications must include an annual plan for providing comprehensive
    community mental health services to adults with a serious mental
    illness and children with a serious emotional disturbance. Because the
    mental health needs of our Nation's elderly population are often not
    met by existing programs and because the need for such services is
    dramatically and rapidly increasing, AAGP recommends that SAMHSA
    require States' plans to include specific provisions for mental health
    services for older adults. Experience has demonstrated that States do
    not make adequate provisions for older adults. This population, which
    has unique needs, has been neglected in the planning process. Steps
    need to be taken to ensure that adequate mental health services are
    available to them.

                   AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

        One of the most valuable resources in our efforts to improve access
    to and the quality of geriatric mental health services is the Agency
    for Healthcare Research and Quality (AHRQ). In recent years the Agency
    has supported important research on mental health topics including
    studies on children's mental health issues, the impact of mental health
    parity on consumers' share of mental health costs, improving care for
    depression in primary care, and cultural issues in the treatment of
    mental illness in minority populations. This work has led to important
    contributions to the mental health literature, and the advancement of
    effective diagnosis and treatment of mental illness. We applaud these
    efforts and urge the Committee to increase support for the critical
    work of this Agency.
        However, we are concerned that the research agenda of the Agency
    has not given more attention to geriatric mental health issues. The
    prevalence of undiagnosed and untreated mental illness among the
    elderly is alarming. Conditions such as depression, anxiety, dementia,
    and substance abuse in older adults are often misdiagnosed or not
    recognized at all by primary and specialty care physicians. There is
    accumulating evidence that depression can exacerbate the effects of
    cardiac disease, cancer, strokes, and diabetes. Research has also shown
    that treatment of mental illness can improve health outcomes for those
    with chronic diseases. Effective treatments for mental illnesses in the
    elderly are available, but without access to physicians and other
    health professionals with the training to identify and treat these
    conditions, far too many seniors fail to receive needed care.
        AAGP believes there is an urgent need to translate findings from
    aging-related biomedical and behavioral research into geriatric mental
    health care. By utilizing the resources of the evidence-based practice
    centers under contract to AHRQ, results from geriatric mental health
    research can be evaluated and translated into findings that will
    improve access, foster appropriate practices, and reduce unnecessary
    and wasteful health care expenditures. We urge the Committee to direct
    AHRQ to support additional research projects focused on the diagnosis
    and treatment of mental illnesses in the geriatric population. We also
    believe a high priority should be given to the dissemination of
    scientific findings about what works best, to encourage physicians and
    other health professionals to adopt ``best practices'' in geriatric
    mental health care.

                                   CONCLUSION

        Based on AAGP's assessment of the current need and future
    challenges of late life mental disorders, we submit the following
    fiscal year 2006 funding recommendations:
        1. The current rate of funding for aging grants at NIMH and CMHS is
    inadequate. Funding for NIMH and CMHS aging-related health services
    grants should be increased to be commensurate with current need--at
    least three times their current funding levels. In addition, the
    substantial projected increase in mental disorders in our aging
    population should be reflected in the budget process in terms of dollar
    amount of grants and absolute number of new grants.
        2. To help the country's elderly access necessary mental health
    care, previous years' funding of $5 million for evidence-based mental
    health outreach and treatment for the elderly within CMHS must be
    increased to $20 million.
        3. A fair grant review process will be enhanced by committees with
    specific expertise and dedication to mental health and aging.
        4. Adequate infrastructure and funding within both NIMH and CMHS to
    support the development of initiatives in aging research, to monitor
    the number and quality of applicants for aging research grants, to
    promote funding of meritorious projects, and to manage those grant
    portfolios.
        5. The scope of the recently formed Aging Treatment and Prevention
    Intervention Research Branch at NIMH should be increased to include all
    relevant clinical research, including translational, interventions, and
    disease-based psychopathology, and must receive NIMH's full support so
    it may fulfill its primary mission.
        6. AHRQ should undertake additional research projects focused on
    the diagnosis and treatment of mental illnesses in the geriatric
    population, and dissemination of information on best practices.
        7. Funding for NIAAA must be increased by at least 20 percent to
    enable it to undertake more research and collect more data focused on
    issues such as the link between alcohol use and late-life suicide and
    the impact of alcohol use across the lifespan.
        AAGP strongly believes that the present research infrastructure,
    professional workforce with appropriate geriatric training, health care
    financing mechanisms, and mental health delivery systems are grossly
    inadequate to meet the challenges posed by the expected increase in the
    number of older Americans with mental disorders. Congress must support
    funding for research that addresses the diagnosis and treatment of
    mental illnesses, as well as programs for delivery of geriatric mental
    health services that increase the quality of life for those with late-
    life mental illness.
        AAGP looks forward to working with the members of this Subcommittee
    and others in Congress to establish geriatric mental health research
    and services as a priority at NIMH, CMHS, AHRQ and NIAAA.
                                     ______

        Prepared Statement of the American Autoimmune Related Diseases
                                  Association

        The American Autoimmune Related Diseases Association (AARDA) is the
    only national voluntary health agency advocating for the over 100
    autoimmune diseases as a genetically and clinically interrelated
    family, like cancer. AARDA's aim is to initiate, foster and facilitate
    collaboration in autoimmune awareness, education, advocacy and
    research. AARDA initiated, supports and facilitates the National
    Coalition of Autoimmune Patient Groups (NCAPG), a coalition of 25
    voluntary health agencies focusing on individual autoimmune diseases.
        The family of autoimmune diseases is under-recognized and as a
    result poses a major healthcare problem in the United States. These
    diseases afflict over 22 million Americans, more than twice as many as
    cancer. Treatment costs exceed $120 billion per year and are rising
    rapidly, putting autoimmune disease's financial burden on the same
    level as heart and stroke disease and cancer. Autoimmune diseases are
    one of the top ten leading causes of death in females under the age of
    65.
        Autoimmune diseases are a major cause of chronic disability,
    further increasing their financial burden on society. Well-known
    autoimmune diseases include lupus, rheumatoid arthritis, multiple
    sclerosis, and juvenile (Type 1) diabetes. Lesser-known are
    scleroderma, Crohn's disease, myasthenia gravis, polymyositis,
    autoimmune liver diseases, Sjogren's syndrome and autoimmune blood
    disorders.
        There is a huge disparity in autoimmune disease research funding
    compared to other major disease groups, such as cancer and heart
    disease. And some autoimmune diseases get a disproportionate amount of
    research funding compared to the others.
        Congress addressed these issues in the Children's Health Act of
    2000, which mandated the National Institutes' of Health (NIH)
    Autoimmune Disease Coordinating Committee to develop an integrated
    Autoimmune Diseases Research Plan to address the entire family of
    autoimmune diseases and their common underlying cause--the immune
    system mistakenly attacking healthy body tissue and organs. All NIH
    institutes, the CDCP, VA, FDA and many patients' organizations provided
    input to develop and review the Research Plan. It is an excellent plan
    recommending an integrated cost-effective approach to autoimmune
    disease research and information dissemination.
        Some of the Autoimmune Diseases Research Plan's recommendations
    have been implemented, but most have not. Much remains to be done,
    especially in the new and promising research areas identified in the
    Plan. AARDA strongly supports additional funding for the NIH Autoimmune
    Disease Coordinating Committee to further expand implementation of the
    Autoimmune Diseases Research Plan. This additional funding will allow
    the Coordinating Committee to pursue promising research in the areas of
    environmental triggers, biomarkers and underlying disease mechanisms to
    help identify individuals at risk of developing an autoimmune disease
    and develop techniques to prevent the disease or minimize its impact.
        AARDA respectfully requests Congress to appropriate $40 million for
    the NIH Autoimmune Disease Coordinating Committee to expand
    implementation of the Autoimmune Diseases Research Plan to study
    environmental triggers of autoimmune disease. This research will pay
    for itself many times over by helping to reduce the major financial
    burden the family of autoimmune diseases places on our country.
        On behalf of the many millions afflicted with an autoimmune disease
    and their families, thank you for the opportunity to address this
    important issue as Congress develops the Labor, HHS fiscal year 2006
    budget. For More information, contact Virginia T. Ladd, Director,
    American Autoimmune Related Diseases Assoc., 22100 Gratiot, Eastpointe,
    MI., 48021, 586-776-3900 (p) 586-776-3903 (F)
                                     ______

               Prepared Statement of the American Brain Coalition

                     WHAT IS THE AMERICAN BRAIN COALITION?

        The American Brain Coalition (ABC) is a nonprofit organization that
    seeks to reduce the burden of brain disorders and advance the
    understanding of the functions of the brain. ABC, unlike any other
    organization, brings together all types of organizations representing
    the 50 million individuals affected by brain disorders. This includes
    the afflicted patients, the families of those that suffer, the
    caregivers, and the professionals that research and treat diseases of
    the brain.
        ABCs' goals are to: (1) promote research funding and progress
    towards cures, (2) help to build a healthcare system that is more
    responsive to people with both acute and chronic brain disorders, and
    (3) advance public understanding about the causes, impacts, and
    consequences of neurologic and psychiatric illness in our society.
        The brain is the center of human existence, and the most complex
    living structure known. As such, ABC members have a broad range of
    interests. Among others, the coalition includes organizations and
    individuals that:
      --are clinicians who treat neurological diseases
      --are scientists who research the brain, including the neurological
            and psychiatric disorders that affect it
      --investigate basic and clinical aspects of epilepsy
      --fund research on Rett Syndrome, a debilitating neurological
            disorder
      --are pioneers in educational and vocational training for the
            mentally retarded
      --have family members affected by mental health conditions, such as
            depression, schizophrenia, and obsessive-compulsive disorder
      --are affected by Parkinson's disease and essential tremor

                  CONGRESSIONAL SUPPORT ACCELERATES DISCOVERY

        The National Institutes of Health (NIH), the world's premier
    medical research enterprise, is leading the way in research related to
    the brain. Thanks to this subcommittee, Congress held to its commitment
    to double the budget of the NIH in the late 1990s and early 2000s. The
    primary goal for the added funds was to discover better treatments and
    cures for human disease. Since then, scientists have amassed a wealth
    of medical knowledge. Today, researchers have a greater understanding
    of how the brain and nervous system function due to NIH-funded
    research. On behalf of the millions of Americans suffering from a
    disorder of the brain, ABC thanks the Chairman and Ranking Member for
    their continued support of this life altering research.
        Many recent scientific discoveries, including those in neurology
    and psychiatry, have just begun to show their potential. Some
    accomplishments that are a direct result of NIH research include:
      --The development of drugs that reduce the severity of symptoms for
            those suffering with multiple sclerosis and Parkinson's disease
      --The identification of stroke treatment and prevention methods
      --The discovery of a new class of anti-depressants that produce fewer
            side effects than their predecessors
      --The creation of new drugs to help prevent epileptic seizures
      --The expansion of treatments for the psychotic symptoms of
            schizophrenia
        Insights into the biology of schizophrenia, post-traumatic stress
    disorder, and other diseases have led to the development of enhanced
    diagnostic techniques, better prevention methods, and more effective
    treatments. Simply put: the result of Congressional support for
    research leads to improved patient care.

                    WHAT COMES NEXT? THE FUTURE OF RESEARCH

        ABC supports NIH in its entirety, with a more specific interest in
    the institutes and centers that focus on diseases and disorders of the
    brain and nervous system. Because the brain affects all parts of the
    body, brain research is broad and must be conducted across institutes
    in order to fully understand the diseases that affect so many
    Americans.
        The NIH Neuroscience Blueprint is a framework to enhance
    cooperation among 15 NIH institutes and centers that support this
    research. Over the past 10 years, driven by the science, the NIH
    neuroscience institutes and centers have increasingly joined forces
    through initiatives and working groups focused on specific disorders.
    The Blueprint builds on this foundation, making collaboration an
    everyday part of how the NIH does business in neuroscience. By pooling
    resources and expertise, the Blueprint can take advantage of economies
    of scale, confront challenges too large for any single institute, and
    develop research tools and infrastructure that will serve the entire
    neuroscience community.
        The Neuroscience Blueprint encourages the collaboration necessary
    in order to advance basic science and to develop new more effective
    bedside treatments. The following diseases, along with many others,
    have the potential to be greatly affected from this research.
        1. Stroke.--Research has already led to the development of more
    effective stroke treatments, the identification of new prevention
    methods, and the creation of improved rehabilitation techniques.
    Despite much progress in stroke research over the past decade, much
    remains to be done.
        With continued funding, therapies to reverse paralysis of limbs may
    be possible. A preliminary analysis indicates that the resulting
    financial benefits from reduced medical care, a quicker return to work,
    and improved quality of life outweigh the costs of therapy. Future
    studies seek to refine the technique, called constraint-induced
    movement therapy to further improve outcomes and lower costs.
        2. Epilepsy.--Research in the field of Epilepsy has already led to
    the discovery of genetic mutations that play a role in how seizures
    begin. Additionally, research has aided in the development of a new
    generation of antiepileptic drugs and better brain scanning techniques
    that assist in diagnosis.
        With continued funding, additional drug therapies might be
    developed to control seizures. Currently, up to one-third of patients
    are resistant to drug therapy. More research must be done in order to
    improve the quality of life for these people. One promising approach
    may be to use gene therapy to modify the excitability of hyperactive
    brain cell circuits. Additionally, increased funding might aid in the
    development of devices that are implanted into the brain that could
    forewarn doctors and patients of an impending seizure. These tiny
    devices could then deliver the drugs directly to the epileptic brain
    region in doses that could be regulated by the patient or doctor. Much
    more work is needed before such a system could be widely used.
        3. Bipolar Disorder.--Past funding from NIH and the Department of
    Veterans Affairs has helped scientists make great progress in
    understanding bipolar disorder. Today, we know that bipolar disorder is
    a biologically based disorder, and not a result of a weak personal
    character. Using the latest brain imaging techniques, scientists have
    discovered that the brain function and structure in patients with
    bipolar disorder differs markedly from that in people without the
    illness.
        Continued funding for research could lead to the development of
    tests for earlier diagnosis and treatment, as well as drug therapies to
    prevent or reverse the progressive loss of brain cells that occurs with
    bipolar disorder. Already, scientists are exploring the possibility for
    low-dose lithium as a preventative measure against atrophy and loss of
    cells. Research on lithium may prove advantageous for a variety of
    diseases, including schizophrenia and Alzheimer's disease.
        Only with continued funding will scientists be able to bring hope
    to the millions of Americans suffering from a brain disorder.

    BEYOND HELPING PEOPLE: FEDERAL INVESTMENTS IN RESEARCH ARE ECONOMICALLY
                                   BENEFICIAL

        Not only does research save lives, but it is a good investment for
    the future of America. We know that illness is expensive. Depressive
    diseases alone cost U.S. businesses $83 billion in medical
    expenditures, suicide-related costs, absences from work, and reduced
    productivity while at work. The annual cost of Alzheimer's disease in
    the United States is over $100 billion, with more that $30 billion of
    that amount paid out by Medicare. As the baby boomers age, without
    effective therapy, the number of people affected by Alzheimer's will
    quadruple. This number is only expected to increase.
        NIH-funded research could alleviate some of the financial strains
    that brain disorders place on businesses, government, and families. For
    example, a one month delay in admitting Alzheimer's patients to nursing
    homes could save $1billion per year. Without additional research, the
    economic burden placed on U.S. resources will be exacerbated.
        In addition to helping control costs, the federal investment in
    research helps stimulate local economies. NIH dollars are sent to every
    state in the country, helping to employ thousands of people. According
    to the Bureau of Labor Statistics, nearly 1 million people in the
    United States are employed in the biosciences. This number is projected
    to grow at an annual rate of 13 percent.

                                 RECOMMENDATION

        As the Subcommittee considers the fiscal year 2006 appropriations
    for the Department of Health and Human Services, we urge you to support
    a 6 percent increase in funding for the National Institutes of Health
    in order to sustain the pace of recent discoveries.
        Treatments for diseases and disorders of the brain will only be
    possible if the NIH, the world's leading medical research enterprise,
    has a longstanding commitment from Congress.
        ABC's request is based on the following information:
      --$1 billion is needed to cover biomedical research inflation, which
            is projected to be 3.5 percent;
      --$560 million is needed to replace the evaluation set-aside (an
            amount taken from each institute), which this year amounted to
            2.4 percent (it used to be 1 percent); and
      --The total number of research project grants (RPGs) is declining by
            402 from what it was in fiscal year 2005.
        Thank you for the opportunity to provide testimony to this
    Subcommittee.
                                     ______

            Prepared Statement of the American College of Cardiology

        More than 70 million Americans are living with cardiovascular
    disease, with more than 900,000 of them dying this year from disease-
    related complications. In fact, heart disease claims more lives than
    cancer, diabetes, and chronic respiratory diseases combined. As
    physicians toil to keep these patients alive, another group of
    individuals is working just as hard to fight the ravages of heart
    disease: Medical researchers.
        The American College of Cardiology (ACC), a 33,000-member nonprofit
    professional medical society advocating for quality cardiovascular
    care, supports increased federal funding of medical research and
    urgently calls on Congress to continue to invest in future
    cardiovascular care.
        As with any financial outlay, there needs to be a healthy return on
    investment. The same holds true for medical research, and the ACC
    believes the data speaks loudly. Between 1982 and 2002, death rates
    attributed to cardiovascular diseases declined by 37 percent. This
    remarkable achievement can be attributed to clinically proven
    treatments and techniques for managing heart disease. These life-saving
    technology advances and treatments originate with cutting-edge
    research. Without federally-funded clinical trials, there would not be
    stents or statins, ICDs or AEDs, and millions more Americans would die
    prematurely from cardiovascular disease.
        Each year, agencies such as the National Institutes of Health (NIH)
    release groundbreaking studies that fundamentally change the course of
    medicine. This year was no exception. Initially presented at the ACC's
    Annual Scientific Session in early March and published March 31, 2005,
    in The New England Journal of Medicine, The Women's Health Study has
    left its mark on the cardiovascular world. This 10-year study of 40,000
    healthy women showed that aspirin did not reduce the risk of major
    cardiovascular events, a stark contrast to the effects of aspirin in
    men. In addition, researchers concluded that many women, especially
    those 65 and older, may benefit from taking low-dose aspirin every
    other day with the primary goal to prevent stroke. The results of this
    study hold immediate implications for the treatment of women at risk
    for heart disease, but also point to the broader role of understanding
    and adjusting for gender in the development of medical regimens.
        Compelling cardiovascular research conducted by the NIH and the
    National Heart, Lung and Blood Institute (NHLBI) is critical to
    physicians winning the fight against heart disease. The ACC does not
    believe that President Bush's proposed fiscal year 2006 budget reflects
    the commitment needed to these critical research institutions. Under
    the President's plan, the National Institutes of Health (NIH) would
    receive a 0.5 percent increase, which is significantly less than the
    current rate of inflation. As one of 27 institutes falling under the
    NIH umbrella, the NHLBI stands to receive a pittance of this modest
    increase. The Centers for Disease Control and Prevention (CDC) fare
    even worse, facing millions of dollars in actual funding cuts for
    fiscal year 2006.
        In order to continue life-saving cardiovascular research and
    education, the ACC supports the following fiscal year 2006
    appropriations funding levels:
      --$30 billion for the NIH, including $2.3 billion for heart research
            and $341 million for stroke research
      --$3.1 billion for the NHLBI, including $1.9 billion for heart and
            stroke-related research
      --$55.6 million for the CDC's Heart Disease and Stroke Prevention
            Program
        These allocations will enable core cardiovascular research that
    improves clinical outcomes and quality of care. As the medical
    landscape continues to shift with the introduction of new technology
    and more complex caseloads, evidence-based research serves as the
    foundation of clinical guidelines that direct physician practice. The
    ACC draws on federally-funded research to craft documents that set the
    standard for cardiovascular care and guide the practice of our members
    worldwide.
        Adequately funding research today will reap dividends tomorrow,
    upon which the federal government through its Centers for Medicare &
    Medicaid Services (CMS) will undoubtedly benefit. Even now, CMS is
    sponsoring pilot projects designed to pay physicians based on evidence-
    driven performance. Advances in medical protocols derived from
    federally underwritten research will become the backbone for this push
    to deliver better, more cost-effective patient care.
        By investing in medical research now, Congress can help at-risk
    patients minimize the impact of cardiovascular disease and improve
    quality of care for more than 70 million heart patients. The ACC
    encourages the subcommittee to continue its support of federally-funded
    cardiovascular research by supplying federal agencies with the
    resources to continue their life-saving work. Thank you for permitting
    the ACC to share its views on this important topic.
                                     ______

       Prepared Statement of the American Dental Hygienists' Association

        The American Dental Hygienists' Association (ADHA) appreciates this
    opportunity to submit written testimony regarding fiscal year 2006
    appropriations for the Department of Health and Human Services.
        ADHA is the largest national organization representing the
    professional interests of the more than 120,000 dental hygienists
    across the country. Dental hygienists are preventive oral health
    professionals who are licensed in each of the fifty states. As
    prevention specialists, dental hygienists understand that recognizing
    the connection between oral health and total health can prevent
    disease, treat problems while they are still manageable, and conserve
    critical health care dollars. Dental hygienists are committed to
    improving the nation's oral health, a fundamental part of total health.
        Indeed, in order to improve access to oral health care, ADHA is
    working to establish a new oral health care provider, the ``Advanced
    Dental Hygiene Practitioner.'' This new provider would deliver
    preventive, therapeutic and restorative services directly to
    underserved Americans. Please visit the ADHA web site at www.adha.org
    for more information.

    U.S. SURGEON GENERAL REPORT ON ORAL HEALTH IN AMERICA AND THE NATIONAL
                           ORAL HEALTH CALL TO ACTION

        In May 2000, the U.S. Surgeon General issued Oral Health in
    America: A Report of the Surgeon General. This landmark report confirms
    what dental hygienists have long known: that oral health is an integral
    part of total health and that good oral health can be achieved. The
    Surgeon General's Report on Oral Health challenges all of us--in both
    the public and private sectors--to address the compelling evidence that
    not all Americans have achieved the same level of oral health and well-
    being. The Report describes a ``silent epidemic'' of oral diseases,
    which affect our most vulnerable citizens--poor children, the elderly
    and many members of racial and ethnic minority groups.
        ADHA suggests that one step that needs to be taken is to improve
    access to the preventive oral health care services provided by dental
    hygienists. This is important because unlike most medical conditions,
    the three most common oral diseases--dental caries (tooth decay),
    gingivitis (gum disease) and periodontitis (advanced gum and bone
    disease)--are proven to be preventable with the provision of regular
    oral health care. Despite this prevention capability, tooth decay--
    which is an infectious transmissible disease--still affects more than
    half of all children by second grade. Clearly, more must be done to
    increase children's access to oral health care services.
        While the profession of dental hygiene was founded in 1923 as a
    school-based profession, today the provision of dental hygiene services
    is largely tied to the private dental office. Increased utilization of
    dental hygienists in schools, nursing homes, and other sites--with
    appropriate referral mechanisms in place to dentists--will improve
    access to needed preventive oral health services. This increased access
    to preventive oral health services will likely result in decreased oral
    health care costs per capita and, more importantly, improvements in
    oral and total health.
        As the General Accounting Office (GAO) confirmed in two recent
    separate reports to Congress, ``dental disease is a chronic problem
    among many low-income and vulnerable populations'' and ``poor children
    have five times more untreated dental caries (cavities) than children
    in higher-income families.'' The GAO further found that the major
    factor contributing to the low use of dental services among low-income
    persons who have coverage for dental services is ``finding dentists to
    treat them.'' Increased utilization of dental hygiene services--
    appropriately linked to the services of dentists--is critical to
    addressing the nation's crisis in access to oral health care for
    vulnerable populations. Indeed, ADHA is committed to working with the
    Congress to improve access to oral health care services, particularly
    for children eligible for Medicaid and the State Children's Health
    Insurance Program (SCHIP). ADHA urges this Subcommittee and all members
    of Congress to support the Medicaid and SCHIP programs. ADHA strongly
    supports the Smith-Bingaman amendment in the fiscal year 2006 Senate
    Budget Resolution that strikes cuts to the Medicaid program and calls
    for a Medicaid Commission to carefully study and recommend changes to
    the program.

             NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

        As the Surgeon General's Report on Oral Health so clearly
    demonstrates, the nation's oral health can and must be further
    improved. The National Institute of Dental and Craniofacial Research
    (NIDCR) is the nation's focal point for oral health research and
    NIDCR's work has yielded significant advancements in oral health.
        Over the past 50 years, our nation's investment in dental and
    craniofacial research has yielded tremendous advances in American
    public health. Some of the often-cited examples include a sharp
    reduction in the once rampant rate of dental caries and tooth loss,
    improved care of all aspects of gum (periodontal) diseases, and the
    effective management of oral pain. In its ongoing quest to improve the
    nation's oral health, a fundamental part of overall health and general
    well-being, NIDCR is, for example, working to realize the potential of
    salivary diagnostics. As NIDCR Director Lawrence A. Tabak, DDS, PhD
    explains, ``scientists have long recognized that our saliva serves as a
    mirror' of the body's health, in that it contains the full repertoire
    of proteins, hormones, antibodies, and other molecular analytes that
    are frequently measured in standard blood tests.''
        NIDCR's work in dental research has not only resulted in better
    oral health for the nation, it has also helped curb increases in oral
    health care costs. Americans save nearly $4 billion annually in dental
    bills because of advances in dental research and an increased emphasis
    on preventive oral health care. To enable NIDCR to continue and to
    build upon its important research mission, ADHA joins with other groups
    in the oral health community to recommend that NIDCR be funded at $420
    million for fiscal year 2006. ADHA further urges that NIDCR be
    preserved as an independent institute in any future NIH reorganization.

     DENTAL HEALTH IMPROVEMENT ACT, A COMPONENT OF THE HEALTH CARE SAFETY
                           NET AMENDMENTS ACT OF 2002

        ADHA is pleased to see the increasing recognition among federal
    policymakers of the importance of oral health to overall health and
    well-being. A primary illustration of this appreciation for the link
    between oral health and general health is the Dental Health Improvement
    Act, which was passed by Congress as part of the Health Care Safety Net
    Amendments Act of 2002 (Public Law 107-261). This important legislation
    will assist states in addressing the crisis in access to oral health
    services. ADHA joins with others in the oral health community to
    recommend $10 million to fund the oral health programs and initiatives
    contained within the Act.

                CENTERS FOR DISEASE CONTROL ORAL HEALTH PROGRAM

        ADHA would also like to lend its support to the Centers for Disease
    Control and Prevention (CDC) Oral Health Program. ADHA joins with other
    dental groups in urging a budget of $18 million for the CDC Oral Health
    Program. This funding level will enable the Oral Health Program to
    continue its vital work to control and prevent oral disease, including
    its important work in the area of community water fluoridation and
    school-based dental sealant programs. ADHA also requests $130 million
    for the CDC prevention block grant. Last year, approximately $3.5
    million in block grant monies flowed to the states for critical oral
    health projects such as replacement of fluoridation equipment.

                RYAN WHITE HIV/AIDS DENTAL REIMBURSEMENT PROGRAM

        Included in the Ryan White CARE Act is a dental reimbursement
    program that assists in meeting the oral health needs of people living
    with HIV/AIDS, most of whose care is not covered under existing federal
    and state assistance programs. The dental reimbursement program
    provides participating institutions with partial reimbursement for the
    cost of providing oral health care services to low income people living
    with HIV and AIDS. In 1999, oral health care was provided to more than
    65,000 patients under the program.
        The ``Ryan White CARE Act Amendments of 2000'' rendered--for the
    first time--dental hygiene programs eligible for the dental
    reimbursement program. While there are only 55 dental schools in the
    United States, there are presently 279 accredited dental hygiene
    education programs in the United States. In fact, all states have at
    least one dental hygiene education program.
        ADHA joins with the American Dental Education Association in
    recommending $19 million for this important program. ADHA further urges
    this Subcommittee to direct HRSA to work to actively encourage and
    facilitate the participation of dental hygiene programs in the Ryan
    White HIV/AIDS reimbursement effort.

                       MATERNAL AND CHILD HEALTH PROGRAM

        The Maternal and Child Health Block Grant Program provides vital
    support and services that improve the health of women and children. It
    is critical that the oral health component of this program be
    strengthened. This is important because, for example, research
    increasingly recognizes the link between severe periodontal disease in
    pregnant women and pre-term low birth weight babies. ADHA strongly
    supports the MCH programs and urges full funding for fiscal year 2006.

                          HEALTH PROFESSIONS EDUCATION

        ADHA supports the important work of Title VII of the Public Health
    Service Act, in particular, the Allied Health Project Grants and the
    Scholarships for Disadvantaged Students Program. Allied health
    disciplines constitute fully 60 percent of the health care work force.
    The Scholarships Program seeks to recruit and retain minority and
    disadvantaged students.
        ADHA joins the Association of Schools of Allied Health Professions
    in recommending $20 million for Allied Health Project Grants and full
    funding for the Scholarships for Disadvantaged Students program. With
    the acknowledged need for cost-effective health care providers, it is
    time to augment funding for and recognition of these important allied
    health programs. ADHA further urges full funding for the Centers for
    Excellence Program, the Faculty Loan Repayment Program and the Health
    Careers Opportunity Program.

                         NATIONAL HEALTH SERVICE CORPS

        ADHA strongly supports the National Health Service Corps (NHSC) and
    its Scholarship and Loan Forgiveness Programs. Scholarships and loan
    forgiveness provide vital assistance to students entering the health
    professions. ADHA urges that the committee again direct the NHSC to
    increase the participation of dental health providers, dentists and
    dental hygienists alike. This is important because too few Americans--
    particularly low-income Americans--regularly access needed oral health
    services. ADHA supports $213 million for this important effort.

                     INDIAN HEALTH SERVICE DENTAL PROGRAMS

        American Indians and Alaska Natives suffer disproportionately from
    poor oral health. Indeed, 75 percent of American Indian and Alaska
    Native children aged 2-5 years old experience untreated dental decay
    (caries). The prevalence of dental disease only increases with age. A
    staggering 91 percent of American Indian and Alaska Native children
    aged 15-19 years old experience tooth decay. In fiscal year 2004, the
    proportion of American Indian and Alaska Natives with access to dental
    care was only 24 percent. Presently, there are 109 vacancies in the IHS
    dental program. Clearly, there is much to be done to improve access to
    oral health services for Alaska Natives and American Indians.
    Accordingly, ADHA strongly supports the Community Health Aide Program,
    including the use of dental health aide therapists. ADHA joins with the
    American Academy of Pediatrics and the American Dental Association in
    recommending $124 million for IHS dental programs.

                                   CONCLUSION

        In closing, the American Dental Hygienists' Association appreciates
    the important contributions this Subcommittee has made in improving the
    quality and availability of oral health services throughout the
    country. ADHA is committed to working with this Subcommittee--and all
    Members of Congress--to improve the nation's oral health which, as Oral
    Health in America: A Report of the Surgeon General so rightly
    recognizes, is a vital part of overall health and well-being.
        Please contact our Washington Counsel, Karen Sealander of McDermott
    Will & Emery (202/756-8024 or ksealander@mwe.com), with questions or
    for further information. Thank you for this opportunity to submit the
    views of the American Dental Hygienists' Association.
                                     ______

            Prepared Statement of the American Diabetes Association

        Thank you for the opportunity to submit testimony on the importance
    of federal funding for diabetes programs at the Centers for Disease
    Control and Prevention (CDC) and diabetes research at the National
    Institutes of Health (NIH).
        As the nation's leading nonprofit health organization providing
    diabetes research, information and advocacy, the American Diabetes
    Association feels strongly that federal funding for diabetes prevention
    and research efforts is critical not only for the 18.2 million
    Americans who currently have diabetes, but also for the more than 40
    million who have a condition known as ``pre-diabetes.''
        Diabetes is a serious disease, and is a contributing and underlying
    cause of many of the diseases on which the federal government spends
    the most health care dollars. In addition to the $132 billion in 2002
    dollars in direct and indirect costs spent solely on diabetes each
    year, diabetes is a significant cause of heart disease (which costs our
    nation $183.1 billion each year), a significant cause of stroke ($43.3
    billion each year), and the leading cause of kidney disease ($40.3
    billion). Diabetes is also the leading cause of adult-onset blindness
    and lower limb amputations.
        Approximately 42,000 people suffering from diabetes live in each
    congressional district and the number of people living with diabetes in
    this country is growing at a shocking rate. Between 1990 and 2001,
    diabetes prevalence in the United States has increased by more than 60
    percent. The number of Americans with diabetes is now growing at a rate
    of 8 percent per year and is the single most prevalent chronic illness
    among children. Because the systemic damage diabetes imposes throughout
    the body, it is no surprise that the life expectancy of a person with
    the disease averages 10-15 years less than that of the general
    population.
        As the statistics listed above illustrate, we are facing an
    epidemic of diabetes in this country, which if left unchecked could
    have significant implications for many future generations. The picture,
    however, is not without hope. We can stem the tide of this disease, but
    to do so requires a renewed federal commitment not only to research,
    but also to prevention.
        The Association appreciates the increased attention by Congress to
    diabetes research at the National Institutes of Health (NIH) in recent
    years. While there is not yet a cure for diabetes, researchers at NIH
    are working on a variety of projects that represent hope for the
    millions of individuals with type 1 and type 2 diabetes. The
    Association strongly encourages you to provide a 6 percent increase to
    the NIH to fulfill this promise. Unfortunately, while the death rate
    due to diabetes has increased by more than 40 percent in recent years,
    diabetes research funding has not kept pace. Indeed, from 1987-2001,
    appropriated diabetes funding as a share of the overall NIH budget has
    dropped by more than 20 percent (from 3.9 percent to 2.9 percent). Over
    the last 4 years, Congress has begun to address this discrepancy. We
    respectfully ask you to continue this commitment.
        While the NIH continues to work towards finding a cure, we must
    also adequately fund the diabetes prevention and outreach work being
    done at the Centers for Disease Control and Prevention. Therefore, we
    are requesting:
      --At least a 10 percent increase over fiscal year 2005 levels for the
            CDC's Center on Chronic Disease Prevention and Health,
            including an additional $10 million increase for the CDC's
            Division of Diabetes Translation (DDT); and
      --Restoration of the Preventive Health & Health Services Block Grant.
        The CDC's Division of Diabetes Translation is critical to our
    national efforts to prevent and manage diabetes because they translate
    the research that has already been done to real programs at the
    community level. Currently, for every $1 that diabetes costs this
    country, the federal government invests less than $.01 to help
    Americans prevent and manage this deadly disease. This dynamic must be
    changed. While the Association strongly believes that significant
    funding is needed to fully fund programs in all 50 states, our request
    of $10 million recognizes the current budget realities.
        In 2004 DDT provided support for more than 50 state- and
    territorial-based Diabetes Prevention and Control Programs (DPCPs) to
    increase outreach and education, and reduce the complications
    associated with diabetes. However, funding constraints required DDT to
    provide severely limited support to 24 states, 8 territories, and D.C.
    This level of funding, referred to as ``capacity building,'' allows a
    state to do surveillance, but is not enough for the state to do much--
    or anything--in the way of intervention.
        DDT was able to provide the higher level of support, ``basic
    implementation,'' to the other 26 states. At the basic implementation
    level, states are able to devise and execute community-level programs.
    With an additional $10 million over fiscal year 2005 funding levels, an
    additional 7 states could start to receive the substantial benefits of
    basic implementation programs.
        The basic implementation programs undoubtedly make a major impact
    on local communities. For example, Daviess County in Kentucky is using
    their DPCP funding to support a community-based program that has
    trained more than 500 health professionals through professional
    education programs, screened and referred more than 1,500 people for
    diabetes through innovative events designed to reach the neediest
    individuals, provides test strips and emergency medications to more
    than 150 individuals annually, and lead comprehensive media and
    outreach campaigns to educate the public to recognize the risk factors
    for diabetes. While this example highlights the accomplishments from
    only one county in one state; it demonstrates the broad approach
    enabled by the basic implementation programs. Our goal is to make this
    a reality for the rest of the country, so that communities have the
    ability to invest in their future by investing in diabetes prevention
    and education.
        Without fully-funded diabetes programs and projects in all parts of
    the country, it will be exceedingly difficult -if not impossible--to
    control the escalating costs associated with diabetic complications and
    to stem the epidemic rise in diabetes rates. State DPCPs, when provided
    with enough funding, are proven programs that have been extremely
    successful in helping Americans prevent and manage their diabetes. In
    the Division of Diabetes Translation Program Review fiscal year 2004,
    the CDC stated, ``The Basic Implementation DPCPs serve as the backbone
    for our growing primary prevention efforts. These state programs are
    the key elements to our success in meeting the challenges of
    controlling and preventing diabetes.'' For example, in Minnesota, the
    DPCP initiated a unified, statewide strategic plan for combating
    diabetes which resulted in more than 800,000 Minnesotans getting
    educational messages through television, radio, print, and web
    coverage. In Utah, innovative messaging such as bus wraps on public
    transportation are being used to inform hard-to-reach, at-risk
    populations of the NDEP messages, ``You are the Heart of Your Family''
    and ``Control Your Diabetes. For Life.'' Americans in every state
    should have access to such quality programs. Unfortunately, the
    Division's fiscal year 2005 budget of just over $63 million, and the
    President's request for near flat-funding in fiscal year 2006, will
    prevent more counties from implementing programs such as the one
    described above.
        In addition to DPCP, the CDC's Division of Diabetes Translation
    also conducts other activities to help people currently living with
    diabetes. For example, CDC works with NIH to jointly sponsor the
    National Diabetes Education Program (NDEP), which seeks to improve the
    treatment and outcomes of people with diabetes, promote early
    detection, and prevent the onset of diabetes. The CDC is also currently
    working to develop a National Public Health Vision Loss Prevention
    Program that will investigate the economic burden and strength the
    surveillance and research of this all-to-common complication of
    diabetes. In addition, CDC funds work at the National Diabetes
    Laboratory to support scientific studies that will improve the lives of
    people with diabetes. In fiscal year 2004, the Division of Diabetes
    Translation alone published 46 manuscripts on the care, prevention, and
    science of diabetes.
        The Association is also supportive of restoration of the CDC's
    Preventive Health & Health Services Block Grant (PBG). The PBG, which
    allows states to develop innovative health programs at the community
    level, received $132 million in FYO5, but is currently slated for no
    funding for fiscal year 2006. These programs have been very successful.
    For example, New York State uses theirs to help fund statewide regional
    partnerships that provide much needed diabetes prevention and control
    activities for medically underserved individuals and communities.
    Currently, about $2.2 million goes toward diabetes-related programs.
    While this is a relatively small amount, it is nonetheless important to
    the communities it is currently helping.
        The Association, and the millions of individuals with diabetes we
    represent, firmly believes that we could rapidly move toward curing,
    preventing, and managing this disease by increasing funding for
    diabetes programs and research both at CDC and NIH. Your leadership is
    essential to accomplishing this goal. As you are considering fiscal
    year 2006 funding, we ask you to remember that chronic diseases,
    including diabetes, account for nearly 70 percent of all health care
    costs as well as 70 percent of all deaths annually. Unfortunately, less
    than $l.25 per person is directed toward public health interventions
    focused on preventing the debilitating effects associated with chronic
    diseases, demonstrating that federal investment in chronic disease
    prevention remains grossly inadequate. We cannot ignore those Americans
    who are currently living with diabetes and other diseases.
        In closing, the American Diabetes Association strongly urges the
    Subcommittee and Congress to provide a 10 percent increase for the
    CDC's Center on Chronic Disease Prevention and Health, including a $10
    million increase for the CDC's Division of Diabetes Translation, and to
    restore the Preventive Health & Health Services Block Grant. Providing
    this funding would be an important step towards empowering states to
    fight diabetes at the community level. Additionally, we urge the
    Subcommittee to increase NIH funding by 6 percent to allow for an
    increased commitment to diabetes research.
        On behalf of the 18.2 million Americans with diabetes--a disease
    that crosses gender, race, ethnicity and political party; a disease
    that is among the most costly, debilitating, deadly and prevalent in
    our nation; and a disease that is exploding throughout our nation--
    thank you for the opportunity to submit this testimony. The American
    Diabetes Association is prepared to answer any questions you might have
    on these important issues.
                                     ______

              Prepared Statement of the American Lung Association

                        SUMMARY: FUNDING RECOMMENDATIONS
                            [In millions of dollars]
    ------------------------------------------------------------------------
                               Agency                               Amount
    ------------------------------------------------------------------------
    National Institutes of Health..............................         30.1
        National Heart, Lung, and Blood Institute..............      3,117.4
        National Institute of Allergy and Infectious Disease...      4,667.1
        National Institute of Environmental Health Sciences....        680.0
        National Institute of Nursing Research.................        146.2
        Fogarty International Center...........................         71.0
    Centers for Disease Control and Prevention.................      8,500.0
        National Institute for Occupational Safety and Health..        326.0
        Office on Smoking and Health...........................        130.0
        Environmental Health: Asthma Activities................         70.0
        Tuberculosis Control Programs..........................        215.0
    ------------------------------------------------------------------------

                  SUMMARY OF FISCAL YEAR 2006 RECOMMENDATIONS

        American Lung Association (ALA) is pleased to present our
    recommendations for programs in the Labor Health and Human Services and
    Education Appropriations Subcommittee purview.
        The American Lung Association is the oldest voluntary health
    organization in the United States, with a National Office, constituent,
    and affiliate associations around the country. Founded in 1904 to fight
    tuberculosis, the American Lung Association today fights lung disease
    in all its forms, with special emphasis on asthma, tobacco control and
    environmental health. The Lung Association is funded by contributions
    from the public, along with gifts and grants from corporations,
    foundations and government agencies. The American Lung Association
    achieves its many successes through the work of thousands of committed
    volunteers and staff.

                           MAGNITUDE OF LUNG DISEASE

        Each year, an estimated 341,500 Americans die of lung disease. Lung
    disease is America's number three killer, responsible for 1 in every 7
    deaths. More than 25 million Americans suffer from a chronic lung
    disease. This year, lung diseases cost the U.S. economy an estimated
    $94.9 billion.
        Lung diseases represent a spectrum of chronic and acute conditions
    that interfere with the lung's ability to extract oxygen from the
    atmosphere, protect against environmental or biological challenges and
    regulate a number of metabolic processes. Lung diseases include:
    chronic obstructive pulmonary disease, lung cancer, tuberculosis,
    pneumonia, influenza, sleep disordered breathing, pediatric lung
    disorders, occupational lung disease, sarcoidosis and asthma.
        Mr. Chairman, while our comments today will focus on selected parts
    of the Public Health Service; the American Lung Association is firmly
    committed to appropriate funding for all sectors of our nation's public
    health infrastructure.

                                      COPD

        Chronic Obstructive Pulmonary Disease, or COPD, is a growing health
    problem. Yet it remains relatively unknown to most Americans and much
    of the research community. COPD is an umbrella term used to describe
    the airflow obstruction associated mainly with emphysema and chronic
    bronchitis. COPD is the fourth leading cause of death in the United
    States and worldwide.
        While the exact prevalence of COPD is not well defined, it affects
    tens of millions of Americans and can be an extremely debilitating
    condition. It has been estimated that 16 million patients have been
    diagnosed with some form of COPD and as many as 16 million more are
    undiagnosed. New government data based on a 1998 prevalence survey
    suggest that 3 million Americans have been diagnosed with emphysema and
    9 million are diagnosed with chronic bronchitis. Emphysema affects more
    men than women, while chronic bronchitis affects more women than men.
    In 1999, 119,524 people in the United States died of COPD. During the
    period 1979-1998, the number of deaths from COPD rose almost 126
    percent. COPD costs the U.S. economy an estimated $30.4 billion a year.
        Today, COPD is treatable but not curable. Fortunately, promising
    research is on the horizon for COPD patients. Research in the genetic
    susceptibility underlying COPD is making progress. Research is also
    showing promise for reversing the damage to lung tissue caused by COPD.
        Despite these promising research leads, the American Lung
    Association feels that research resources committed to COPD are not
    commensurate with the impact COPD has on the United States and the
    world. The American Lung Association strongly recommends that the NIH
    and other federal research programs commit additional resources to COPD
    research programs.

                                     ASTHMA

        Asthma is a chronic lung disease in which the bronchial tubes of
    the lungs become swollen and narrowed, preventing air from getting into
    or out of the lung. A broad range of environmental triggers that vary
    from one asthma-sufferer to another causes these obstructive spasms of
    the bronchi.
        Asthma is on the rise. A 1998 survey found that an estimated 26
    million Americans (including 8.6 million children under the age of 18)
    have at some point in their lifetime been told by their doctor that
    they have asthma. Rates are increasing for all ethnic groups and
    especially for African American and Hispanic children. While some
    children appear to out grow their asthma when they reach adulthood, 75
    percent will require life-long treatment and monitoring of their
    condition.
        Asthma is expensive. The growth in the prevalence of asthma will
    have a significant impact on our nation's health expenditures,
    especially Medicaid. Currently, asthma costs the United States $12.7
    billion annually, including $8.1 billion in direct medical
    expenditures. Asthma attacks bring nearly two million people to the
    emergency room each year. Asthma also kills. In 1998, 5,438 people in
    the United States died as a result of an asthma attack. That is a 109
    percent increase from 1979. A disproportionate share of these deaths
    occurred in African American families.

    Federal Response to Asthma
        The federal response to asthma has three components: research,
    programs and planning. We are pleased to report that, with support from
    the subcommittee, we are making progress on all three fronts.

                Asthma Research
        As the prevalence of asthma has grown, so has asthma research.
    Researchers are developing better ways to treat and manage chronic
    asthma. Research supported by National Heart, Lung and Blood Institute
    (NHLBI) has shown that using corticosteroids to treat children with
    mild to moderate asthma is safe and effective. For several years there
    had been concern that corticosteriods would stunt the growth of
    children who used them. This five-year study showed that children had a
    one-year small reduction in their growth rate. But they had normal
    growth rates compared with children who did not use corticosteriods for
    the following four years. Children who used corticosteroids did suffer
    fewer asthma attacks and made fewer trips to the emergency room.

                Genetic Research
        Genetic Research is also providing insights into asthma. Physicians
    have noticed that while most people respond well to inhaled beta-
    agonists--a commonly prescribed drug to treat asthma--some patients do
    not response or have worse asthma using inhaled beta-agonists.
    Researchers in the NHLBI supported Asthma Clinical Research Network
    have discovered that a genetic variation in the beta-adrenegric
    receptor determines how well asthma patients will respond to inhaled
    beta-agonists. This discovery will enable physicians to better target
    the drugs they proscribe to treat asthma.
        Researchers supported by NHLBI have developed better animal models
    to allow expression of selected asthmatic genetic traits. This will
    allow researchers to develop a greater understanding of how genes and
    environmental triggers influence asthma's onset, severity and long-term
    consequences.

                Asthma Programs
        Last year, Congress provided approximately $32.7 million for the
    Centers for Disease Control and Prevention (CDC) to conduct asthma
    programs. The American Lung Association recommends that CDC be provided
    $70 million in fiscal year 2006 to expand its asthma programs.

                                  TUBERCULOSIS

        Mr. Chairman, tuberculosis has been with us since the dawn of time.
    It is an airborne infection caused by a bacterium, Mycobacterium
    tuberculosis (TB). TB primarily affects the lungs but can also affect
    other parts of the body, such as the brain, kidneys or spine.
        TB is spread through coughs, sneezes, speech and close proximity to
    someone with active tuberculosis. People with active tuberculosis are
    most likely to spread TB to others they spend a lot of time with, such
    as family members or coworkers. It cannot be spread by touch or sharing
    utensils used by an infected person.
        There are an estimated 10 million to 15 million Americans who carry
    latent TB infection. Each has the potential to develop active TB in the
    future. About 10 percent of these individuals will develop active TB
    disease at some point in their lives. In 2001, there were 15,991 cases
    of active TB reported in the United States.
        The Institute of Medicine (IOM) recently published a report,
    entitled Ending Neglect: The Elimination of Tuberculosis in the United
    States. The report documents the cycles of attention and progress
    toward TB elimination, the periods of insufficient funding and the re-
    emergence of TB. The American Lung Association is pleased to note that,
    for the time being, TB rates in the United States are declining. From a
    high in 1992 of 26,673 new cases, we have seen 9 straight years of
    decline. However, the drop in 2001 was reportedly only 2 percent,
    indicating a leveling off of the overall decline in cases and a cause
    for concern within the public health community. This is no time to
    lower our defenses in funding TB programs.
        While declining overall TB rates is good news, the emergence and
    spread of multi-drug resistant TB poses a significant threat to the
    public health of our nation. Continued support is need if the United
    States is going to continue progress toward the elimination of TB.
        The IOM report provides the United States with a road map of
    recommendations on how to eliminate TB in the United States. The IOM
    report identifies needed detection, treatment, prevention and research
    activities. The American Lung Association has endorsed the IOM report
    and its recommendations. We estimate it will cost $528 million for the
    CDC Tuberculosis Elimination Program to implement the report
    recommendations.
        The NIH also has a prominent role to play in the elimination of TB.
    Currently there is no highly effective vaccine to prevent TB
    transmission. However, the recent sequencing of the TB genome and other
    research advances has put the goal of an effective TB vaccine within
    reach. In addition, the American Lung Association encourages the
    subcommittee to fully fund the tuberculosis vaccine blueprint
    development effort at the National Institutes of Allergy and Infectious
    Disease (NIAID).

    Fogarty International Center TB Training Programs
        The Fogarty International Center (FIC) at NIH provides training
    grants to U.S. universities to teach AIDS treatment and research
    techniques to international physicians and researchers. The goal is to
    develop a cadre of health professionals in the developing world who can
    begin controlling the global AIDS epidemic.
        Because of the link between AIDS and TB infection, FIC has created
    supplemental TB training grants for these institutions to train
    international health care professionals in the area TB treatment and
    research. This supplemental program has been highly successful in
    beginning to create the human infrastructure to treat the nearly two
    billion people who have TB worldwide.
        However, we believe TB training grants should not be offered
    exclusively to institutions that have received AIDS training grants.
    The TB grants program should be expanded and open to competition from
    all institutions. The American Lung Association recommends Congress
    provide $71 million for FIC to expand the TB training grant program
    from a supplemental grant to an open competition grant.

              RESEARCHING AND PREVENTING OCCUPATIONAL LUNG DISEASE

        Protecting the health of our nation's workforce will require
    research, training, tracking and new technologies. The American Lung
    Association recommends that the subcommittee provide $326 million for
    the National Institute for Occupational Safety and Health (NIOSH) at
    the Centers for Disease Control and Prevention (CDC), including $25
    million for the NIOSH National Occupational Research Agenda (NORA).
    NORA represents a partnership research plan for occupational disease.
    The NORA agenda was developed with input from labor, business and the
    health community.

                                   CONCLUSION

        In conclusion, Mr. Chairman, lung disease is a growing problem in
    the United States. It is America's number three killer, responsible for
    1 in 7 deaths. The lung disease death rate continues to climb. Overall,
    lung disease and breathing problems constitute the number one killer of
    babies under the age of one year. Worldwide, tuberculosis kills three
    million people each year, more people than any other single infectious
    agent does. Mr. Chairman, the level of support this committee approves
    for lung disease programs should reflect the urgency illustrated by
    these numbers.
                                     ______

          Prepared Statement of the American Psychological Association

        The American Psychological Association (APA) is the largest
    association of psychologists in the world, representing 155,000
    members, affiliates and students. APA exists to advance psychology as a
    science, a profession, and a means of promoting education and human
    welfare. APA members serve as scientists funded by the National
    Institutes of Health and Centers for Disease Control and Prevention, as
    teachers and professors in our nation's high schools, colleges and
    universities, and as health professionals who treat patients in public
    and private clinics and programs. APA encourages the committee to
    strengthen U.S. investment in a continuum of programs on health
    promotion, disease prevention and care, ranging from basic research to
    clinical applications that will improve the health and education of all
    Americans. We appreciate the opportunity to submit testimony for the
    record.

                  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

    National Institutes of Health
        The Administration's fiscal year 2006 budget proposes an NIH
    funding increase of 0.5 percent, lower than the biomedical inflation
    rate. This would not allow NIH to take advantage of many scientific
    opportunities. The success rate is already falling from one in three
    grant applications funded, to one in four. APA encourages the Committee
    to include a six percent funding increase for NIH in this year's
    legislation.
        Funding increases for the NIH Office of Behavioral and Social
    Sciences Research (OBSSR) have been negligible for the past two years,
    and the Administration's budget continues the trend (the request is
    $26.2 million). The Committee has praised OBSSR for making it easier
    for NIH institutes to cooperate to fund cross-cutting initiatives.
    OBSSR has been able to leverage substantive funding initiatives with a
    small budget. However, its ability to do so is eroding. OBSSR is
    planning trans-NIH programs to fund behavioral and social research on
    health disparities in minority populations, and on how gene/environment
    interactions affect health. It would benefit from a six percent
    increase. APA supports an appropriation of $27.66 million for OBSSR.
        Critically important behavioral research is being conducted by most
    NIH institutes. We can list only a few examples here. Epidemiology
    studies supported by NIAAA show that alcohol is a drug of choice for
    youth and that it is associated with a host of consequences in this age
    group, including death and increased risk of harm and other negative
    outcomes. Recent data show that 18- to 24-year-olds have the highest
    prevalence of alcohol dependence of any age group. These and other data
    make it clear that alcohol has become entrenched in the developmental
    processes of adolescence, and that the developmental changes of
    adolescence appear to make this age group particularly vulnerable to
    alcohol's effects. Research by NIDA and others shows that the human
    brain does not fully develop until about age 25. Having insight into
    how the human brain works, and understanding the biological
    underpinnings of risk taking among young people will help in developing
    more effective prevention programs. NIAAA and NIDA are to be commended
    for pursuing research to understand how to extricate alcohol and other
    addictive drugs from adolescent development and how to change
    adolescents' behaviors toward addictive substances.
        Psychological research supported by the NICHD is providing critical
    answers to many questions about childhood development, including how
    children learn to read and how they can overcome learning disabilities.
    Additional work is needed to improve our understanding of the role of
    cognition in learning mathematical and scientific concepts. Additional
    research is also needed to inform the public health community of how
    best to modify high-risk behaviors in children and families that
    contribute to the rising incidence of childhood obesity.
        As NIMH implements its reorganization, APA is encouraging the
    institute to maintain its support for a comprehensive research
    portfolio that includes funding for a broad array of basic behavioral
    research and continues to support research on the promotion of mental
    health and the study of psychological, social, and legal factors that
    influence behavior. Given the increasing burden of mental disorders on
    children and adolescents, behavioral interventions are especially
    needed for children and adolescents with eating disorders, attention
    deficit-hyperactivity disorder, post-traumatic stress disorder and the
    most common forms of depression. Translational research in the
    behavioral and social sciences is especially needed to address how
    basic behavioral processes, such as cognition, emotion, motivation,
    development and social interaction, inform the diagnosis, treatment and
    delivery of services for mental disorders.
        APA remains concerned that basic behavioral research at NIH--that
    is, research on the mechanisms that influence and underlie behavior,
    conducted outside a disease context--is vulnerable to budget pressures
    and pressures to demonstrate effective interventions. NIH institutes
    must balance the imperative for translation with the need to continue
    posing basic questions that will fuel the next generation of
    interventions. Much basic research is supported at NIH by the National
    Institute of General Medical Sciences, yet NIGMS funds very little
    basic behavioral research. APA asks that the committee continue to
    encourage or direct NIGMS, as it has for the past five years, to fill
    some of the gaps that now appear in NIH support of basic behavioral
    research and research training.

                    ADMINISTRATION FOR CHILDREN AND FAMILIES

    Prevention of child maltreatment
        Nationwide, an estimated 896,000 children are abused and neglected
    each year, resulting in an estimated 1,400 child deaths. The negative
    effects of child maltreatment can persist into adulthood. An increase
    of $15 million will enhance prevention activities for child
    maltreatment by population-based monitoring to capture information
    about children outside child protective service systems and improve
    data collection to inform policy, research and public awareness
    programs. These funds will also advance research to prevent the
    negative consequences of child maltreatment and to examine risk and
    protective factors to further the development and implementation of
    culturally and linguistically appropriate prevention and intervention
    approaches.

    Bullying prevention
        Research indicates that bullying directly affects approximately one
    in three school children within a school semester. In addition,
    research confirms that bullying among children poses serious risks for
    victims and perpetrators and may seriously undermine the climate of
    schools. APA urges the adoption of research-based comprehensive
    bullying prevention programs and adequate federal funding to support
    the implementation of effective, comprehensive bullying prevention
    programs.

         HEALTH RESOURCES AND SERVICES ADMINISTRATION BUREAU OF HEALTH
                                  PROFESSIONS

    Graduate Psychology Education (GPE) Program
        Funding in the amount of $6 million for fiscal year 2006 is
    requested to continue the Graduate Psychology Education (GPE) Program,
    which was established in fiscal year 2002. The GPE Program,
    administered by the Bureau of Health Professions, is the only federal
    program dedicated solely to psychology education and training.
        Funded in fiscal year 2003 at $4.5 million and flat-funded for
    fiscal year 2004 and fiscal year 2005, the funds are now obligated to
    27 grants on a three year cycle. As a result there will be no new
    competition this year. Without a modest increase of $1.5 million there
    will not be a new competition in fiscal year 2006. The $6 million
    request for fiscal year 2006 will enable hundreds of interested
    universities and training sites (e.g., veterans hospitals, children's
    hospitals, academic science centers and public health facilities) to
    apply for a GPE grant to increase the number of psychologists
    practicing in underserved rural and urban communities.
        The GPE Program provides grants to APA accredited doctoral,
    internship and post-doctoral programs in support of interdisciplinary
    training of psychology students for the provision of mental and
    behavioral health services to underserved populations (i.e., older
    adults, children, chronically ill persons, and victims of abuse and
    trauma), especially in rural and urban communities. Furthermore, the
    GPE Program addresses the need for mental health services that was well
    documented in the New Freedom Commission on Mental Health Report
    (2003): about 1 in 5 American adults (44 million people) experience a
    mental disorder in a given year and 28 percent of adults meet the full
    criteria for a mental or addictive disorder.

       SUBSTANCE ABUSE, MENTAL HEALTH SERVICES ADMINISTRATION CENTER FOR
                             MENTAL HEALTH SERVICES

    Mental and Behavioral Health Services on Campus Program
        Funding in the amount of $5 million for fiscal year 2006 is
    requested for the newly established Mental and Behavioral Health
    Services on Campus Program, which is part of the Garrett-Lee-Smith
    Memorial Act that provides support for youth suicide early intervention
    and prevention programs, technical assistance centers for suicide
    prevention, and mental and behavioral services on campuses. The program
    also helps identify the best means, strategies and solutions for
    addressing the mental and behavioral health needs of our college aged
    youth.
        The Mental and Behavioral Health Services on Campus program
    received $1.5 million from fiscal year 2005 funds. The requested
    increased funding for $5 million in fiscal year 2006 will help ensure
    that SAMSHA administrators will be able to implement the program in a
    way that best addresses the needs that exist on college campuses.
    Academic failure on our college campuses, which is often associated
    with mental or behavioral problems, not only results in personal loss,
    but loss in federal investment (student financial assistance), as well.
    In the most severe cases, unaddressed psychological problems can lead
    to depression and even suicide--a loss that can never be measured.

    Minority AIDS Initiative
        The estimated number of AIDS cases from 1999 to 2003 has increased
    for racial and ethnic minorities, including African Americans, Latino/
    as, Asian Pacific/Islanders and American Indians/Alaska Natives. Many
    persons with HIV/AIDS have mental and/or substance abuse disorders.
    While treatment can enhance overall health and well-being, racial and
    ethnic minorities have less access to, and lower utilization of, mental
    health and substance abuse services. Accordingly, APA recommends an
    additional $5 million, for a total of $15 million, for the Minority
    AIDS Initiative to provide culturally competent and accessible mental
    health and substance abuse services to persons of color living with
    HIV/AIDS.

                     CENTER FOR SUBSTANCE ABUSE PREVENTION

    Rapid HIV Testing
        Each year, 25 to 30 percent of HIV-infected people who come to
    public clinics for HIV testing do not return a week later to receive
    their test results. With the rapid HIV test, results are available in
    about 20 minutes. Greater availability of this test can increase
    overall HIV testing and reduce the number of people--an estimated
    225,000 Americans--who are unaware of their HIV infection. APA strongly
    supports the Rapid HIV Testing Initiative to train mental health and
    substance abuse service providers on rapid HIV testing and prevention
    counseling and urges an additional $4.8 million, for a total of $9.6
    million, for fiscal year 2006. Mental health treatment services for
    individuals testing positive should also be provided as a critical
    component of rapid HIV testing.

     CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) NATIONAL CENTER FOR
                         INJURY PREVENTION AND CONTROL

    Suicide prevention
        An increase of $5 million over the fiscal year 2005 appropriation
    for suicide prevention activities will allow CDC to support the
    evaluation of suicide prevention planning, programs, and communication
    efforts to change knowledge and attitudes and to reduce suicidal
    behavior. These evaluation efforts will support communities to identify
    promising and effective suicide prevention strategies that follow the
    public health model and build community resilience.

    National Violent Death Reporting System (NVDRS)
        An increase of $10 million over the fiscal year 2005 appropriation
    for the NVDRS will allow approximately 20 additional states to be
    funded to gather and share state-level data about violent deaths. This
    state-based system collects data from medical examiners, coroners,
    police, crime labs, and death certificates to understand the
    circumstances surrounding violent deaths. The information can be used
    to develop, inform, and evaluate violence prevention programs.

         NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH (NIOSH)

        APA recommends an overall increase of $40 million over the fiscal
    year 2005 appropriation for NIOSH. As the only federal agency for
    occupational safety and health research and prevention, NIOSH provides
    national and international leadership to prevent work-related illness,
    injury, and death by gathering information, conducting scientific
    research, and translating the knowledge gained into products and
    services.

                          U.S. DEPARTMENT OF EDUCATION

    Institute for Education Sciences
        Support for research is particularly critical at the Institute of
    Education Sciences as it seeks to translate scientifically based
    research findings into classroom practice. To support the highest
    quality cognitive, developmental, and educational science, we would
    encourage IES to hold a field-initiated studies competition in the next
    fiscal year to encourage innovative research driven by scientific
    opportunities.
        APA appreciates the opportunity to present appropriations
    recommendations for the written record, and encourages members of the
    Committee to contact our Public Policy Office at (202) 336-6062 with
    questions or concerns about this statement.
                                     ______

            Prepared Statement of the American Psychological Society

                           SUMMARY OF RECOMMENDATIONS

      --As a member of the Ad Hoc Group for Medical Research Funding, APS
            recommends $30 billion for NIH in fiscal year 2006.
      --APS requests Committee support for increased behavioral and social
            science research and training at NIH in order to: better meet
            the Nation's health needs, many of which are behavioral in
            nature; realize the exciting scientific opportunities in
            behavioral and social science research, and; accommodate the
            changing nature of science, in which new fields and new
            frontiers of inquiry are rapidly emerging.
      --Committee support is requested for specific behavioral science
            activities at a number of individual institutes. This statement
            provides examples to illustrate the exciting and important
            behavioral and social science work being supported at NIH.
        Mr. Chairman, Members of the Committee: The American Psychological
    Society is a nonprofit organization dedicated to the promotion,
    protection, and advancement of the interests of scientifically oriented
    psychology in research, application, teaching, and the improvement of
    human welfare. Our 16,000 members are scientists and educators at the
    Nation's universities and colleges.
        On behalf of our members, I would like to thank you for your
    leadership in the bipartisan effort to double NIH budget. As a result,
    NIH has experienced a period of unparalleled growth in the past 5
    years, and the progress achieved as a result of research funded by NIH
    will lead us into a new era of discovery and innovation. Unfortunately,
    that progress is threatened by the Administration's request for fiscal
    year 2006, which at only .7 percent (or $196 million) over fiscal year
    2005 will not even cover the costs of inflation, never mind sustain and
    advance the nation's investment in NIH. As a member of the Ad Hoc Group
    for Medical Research Funding, APS recommends $30 billion for NIH in
    fiscal year 2006, an increase of 6 percent over fiscal year 2005
    funding levels. This increase would help provide a stable base of
    funding for the Nation's public health research enterprise and allow
    NIH to continue its important scientific pursuits.
        Within the NIH budget, APS is particularly focused upon the
    behavioral and social science research activities of NIH.
    the importance of behavioral research in addressing the nation's health
        In any realistic picture of our Nation's health, a core finding is
    that behavior is central to many, maybe to most of our Nation's leading
    health concerns: heart disease; stroke; lung disease and certain
    cancers; obesity; AIDS, suicide; teen pregnancy, drug abuse and
    addiction, depression and other mental illnesses; neurological
    disorders; alcoholism; violence; injuries and accidents--all have large
    behavioral components. Further, nearly 40 percent of premature deaths
    in the United States can be attributed to smoking, physical inactivity,
    poor diet, or alcohol misuse according to the Centers for Disease
    Control and Prevention.
        None of the conditions or diseases described above can be fully
    understood without an awareness of the behavioral and psychological
    factors involved in causing, treating and preventing them. For example,
    before you address how to change attitudes and behaviors around AIDS,
    you need to know how attitudes develop and change in the first place.
    Or, before you can change decisions about any risky behavior, you need
    to know how judgments and decisions are made on a range of topics.
    Similarly, before you address memory decline in the elderly, you need
    to know the basics of learning and memory and how that changes with
    age. And before you address the complexity of the interactions among
    genetics, the brain, and schizophrenia, you need to know the basics of
    cognition, emotion, culture, behavioral aspects of neuroscience, and
    behavioral genetics.
        APS members include thousands of scientists who, with NIH support,
    conduct basic, applied, and clinical research related to physical and
    mental health at our Nation's leading universities and colleges.
    Virtually every institute at NIH supports some amount of psychological
    science. Examples include: The connections between the brain and
    behavior; research into how children grow and develop; management of
    debilitating chronic conditions such as diabetes and arthritis as well
    as mental disorders; and the behavioral aspects of smoking and drug and
    alcohol abuse, so that science may find ways for people to escape
    addiction.
        NIH Director Dr. Elias Zerhouni, has expressed strong support for
    behavioral science at NIH, and sees this research as critical to our
    Nation's health. ``We are aware of the challenge in social and
    behavioral science. It's going to be front and center,'' he has stated.
    He went on to add, ``The bill for the nation will be unbearable in
    health and social costs without recognition of the role of behavior.''
    However, to date, behavioral research has not received the recognition
    or support needed to reverse the effects of behavior-based health
    problems in this Nation.
        APS asks that you continue to help make behavioral research more of
    a priority at NIH, both by providing maximum funding for those
    institutes where behavioral science is a core activity, by encouraging
    NIH to advance a model of health that includes behavior in deciding its
    scientific priorities, and by encouraging the establishment of a stable
    infrastructure to support basic behavioral science research at NIH.
        basic behavioral science research needs a stable infrastructure
        Twenty-four of the 27 institutes at NIH fund behavioral science
    research, and seven institutes commit over $100 million to this
    enterprise. Six institutes commit over 20 percent of their resources to
    behavioral science research. However, most of these institutes do not
    fund research into the fundamental behavioral processes that underlie
    the diseases and conditions that constitute some of the most vexing
    health problems facing us today. Traditionally, such basic behavioral
    research has been supported by the National Institute of Mental Health
    (NIMH). NIMH, for any number of historical reasons, has been the home
    for far more basic behavioral science than any other institute. Many
    basic behavioral and social questions were being supported by NIMH,
    even if their answers also could be applied to other institutes.
    Recently, NIMH has begun to aggressively reduce its support for many
    areas of the most basic behavioral research, saying that, like many
    other Institutes, it too is disease specific and must focus its energy
    on battling mental illness through translational and clinical research.
    This means that previously funded areas now are not being supported.
        NIMH is to be commended for promoting the transfer of knowledge
    into application for mental illness. But this is happening at the
    expense of critical basic behavioral research. Without progress in our
    understanding of fundamental behavioral processes, there will not be a
    sufficient body of knowledge to translate into application. Until other
    institutes begin to support larger amounts of basic behavioral science
    research connected to their respective missions, it is essential that
    NIMH's programs of research in behavioral phenomena such as cognition,
    emotion, psychopathology, perception, development, and others continue
    to flourish. APS asks the Committee to encourage NIMH's continued
    efforts to strengthen the ties between basic and clinical behavioral
    research, and to encourage NIMH's basic behavioral science portfolio in
    order to ensure continued progress in our understanding of the causes,
    treatment and prevention of mental illness and the promotion of mental
    health.

      NIGMS SHOULD SUPPORT BASIC BEHAVIORAL SCIENCE RESEARCH AND TRAINING

        Answering basic social and behavioral science questions is central
    to the overall NIH mission. The recent change at NIMH regarding basic
    behavioral research illustrates the problem of depending too much on
    non-structural support at any one agency for fundamental behavioral and
    social science research. Basic behavioral and social science needs a
    dependable structure of its own.
        The most appropriate location is the National Institute of General
    Medical Sciences (NIGMS), also known as NIH's ``basic research
    institute''. NIGMS already has a mandate to support basic behavioral
    research and training, but that mandate has not been fulfilled in part
    because NIMH already was serving that function.
        Since fiscal year 1999, this Committee has repeatedly issued report
    language urging NIGMS to fund basic behavioral research and training,
    saying, for example: ``The Committee is concerned that NIGMS does not
    support behavioral science research training. As the only Institute
    mandated to support research not targeted to specific diseases or
    disorders, there is a range of basic behavioral research and training
    that NIGMS could be supporting. The Committee urges NIGMS, in
    consultation with the Office of Behavioral and Social Sciences, to
    develop a plan for pursuing the most promising research topics in this
    area.'' [Senate fiscal year 2000 Appropriations Report 106-166, Senate
    fiscal year 2001 Appropriations Report 107-293, Senate fiscal year 2002
    Appropriations Report 107-84, Senate fiscal year 2003 Appropriations
    Report 107-216, Senate fiscal year 2004 Appropriations Report 108-82]
        Two years ago, Senators Specter, Inouye, and Harkin, engaged in a
    colloquy on the Senate floor expressing the Committee's strong support
    for basic behavioral research and training, and expressing their
    concern that NIH had not responded to this matter after many years of
    report language. Since then, NIH commissioned a task force to study the
    matter and report back to the Director's Advisory Committee. The panel
    formally recommended the establishment of a secure and stable home for
    basic behavioral science research and training at an NIH institute,
    and, in particular, suggested that an institute such as NIGMS should be
    that home, as this Committee has recommended for years.
        NIGMS is on record saying except for a few fields of inquiry,
    behavioral studies largely fall outside of its research mission, and
    are instead deemed to be within the missions of other institutes at the
    National Institutes of Health. And APS believes this line of thinking
    may still hold true within NIGMS. However, NIGMS' statutory mandate
    encompasses ``general or basic medical sciences and related natural or
    behavioral sciences [emphasis added] which have significance for two or
    more other national research institutes'' (TITLE 42, CHAPTER 6A,
    SUBCHAPTER III, Part C, subpart 11, Sec. 285k).
        Basic behavioral research in the cognitive, psychological and
    social processes underlying substance abuse and addiction (significance
    for NIDA, NIAAA, NCI and NHLBI), obesity (significance for NIDDK,
    NHLBI, and NICHD) and the connections between the brain and behavior
    (significance for NIMH, NINDS, and NHGRI) just to name a few, all are
    within the NIGMS mission. Given the statutory mandate, the
    recommendations of a recent Director's advisory council's task force,
    the strong Congressional interest, the scientific imperative, and most
    important, the health needs of the Nation, APS asks the Committee to
    direct NIGMS to develop a plan for establishing a basic behavioral
    science research and training program at NIGMS.
    nih needs a comprehensive behavioral science research training strategy
        The outcomes of science are unpredictable. Yet there is one aspect
    of science where the time and money invested is guaranteed to pay off:
    the training of our future scientists. We know that if we provide
    support now for a young investigator, we will have a well-trained,
    highly-qualified scientist as a result. This is a serious issue in
    behavioral science at NIH, where the demand for behavioral science
    investigators at NCI, NIMH, and other institutes outpaces the current
    supply of behavioral science researchers. In order to meet the future
    needs of research in health and behavior, NIH must have a comprehensive
    training strategy in place today, one that focuses on training young
    investigators in the core disciplines of behavioral and social science
    research as well as in multidisciplinary perspectives.
        APS is hopeful that NIH will take a closer look at forthcoming
    recommendations from a congressionally mandated National Academy of
    Sciences (NAS) study of research personnel needs with regard to the
    National Research Service Awards (NRSAs). It is anticipated that this
    study will be transmitted to Congress and NIH in the near future. When
    NAS conducted this study in 2000, NIH selectively implemented NAS's
    recommendations and ignored important findings with regard to the need
    for increased training, if at all. This Committee has taken note of the
    behavioral science recommendations from this study in the past, and has
    supported increasing NRSA awards as a mechanism to increase behavioral
    science research training. APS asks the Committee to developments
    closely.
        More generally, APS asks the Committee to support the development
    of a comprehensive training strategy for behavioral and social science
    research at NIH. This strategy should include all training mechanisms,
    and should be balanced between interdisciplinary research and
    traditional core disciplines in the behavioral sciences.

                      BEHAVIORAL SCIENCE AT KEY INSTITUTES

        In the remainder of my testimony, I would like to highlight
    examples of the cutting edge behavioral science research being
    supported by individual institutes.
    National Institute of Mental Health (NIMH)
        NIMH is funding behavioral research ranging from neural information
    processing to social psychology decision-making. Ultimately, this
    investment will help researchers understand and improve the way people
    think, plan, and make choices about their future as it relates to
    everything from chronic mental illness to AIDS. For example, one NIMH
    study is aimed at identifying how people understand the near future
    versus the distant future with the hopes of relating study findings to
    HIV prevention. By investigating how temporal distance from future
    events influences judgments and decisions regarding those events,
    researchers hope to identify the advantages and disadvantages of
    decision-making at different points in time.
        An NIMH-funded project is examining the operation of attention at
    two coarsely defined stages of processing: visual perception and visual
    working memory. By comparing ``memory-intensive'' tasks in which
    working memory is overloaded but the perceptual demands are minimal
    with ``perception-intensive'' tasks in which memory is not overloaded
    but the perceptual demands are great, researchers expect to see
    attention operate at different stages in these tasks. By developing
    methods to isolate and assess perceptual-level and working memory-level
    property mechanisms, researchers will be able to more easily identify
    attentional mechanisms compromised in a given disorder. This program of
    research will have important long-term implications for psychological/
    psychiatric disorders in which attention is compromised, such as
    attention deficit disorder, many anxiety disorders, even schizophrenia.
        Similarly, the NIMH project titled ``Executive Processes-Behavioral
    and Neuroimaging Study'' will help scientists better understand the
    brain mechanisms responsible for so-called ``executive'' brain
    functions, such as the ability to stay focused, to multi-task, and to
    respond with action. Studying these executive processes, which play a
    central role in cognition, could influence how we look at behavioral
    and psychological functioning, from the changes that occur over the
    life span to early diagnosis and treatment of dementia and other
    conditions involving reduced cognitive capacities.

    National Institute on Drug Abuse (NIDA)
        By supporting a comprehensive research portfolio that stretches
    across basic neuroscience, behavior, and genetics, the National
    Institute on Drug Abuse (NIDA) is leading the Nation to a better
    understanding and treatment of drug abuse. APS applauds NIDA for
    strengthening its efforts to study adolescent brain development to
    examine the influence drug exposure has on behavioral, psychological,
    and physiological development. New research supported by NIDA reveals
    that drug addiction is a ``developmental disease'' that often starts
    during the early developmental stages in adolescence, an age at which 3
    million 12-17 year olds reported using illicit drugs last year. If we
    can better understand the effects structural brain changes have on
    functions like thinking, decision-making, sensation and perception we
    will be able to better develop targeted and more likely effective
    prevention strategies from the brain development perspective. APS asks
    this Committee to support this and other critical behavioral science
    research at NIDA, and to increase NIDA's budget in proportion to the
    overall increase at NIH in order to reduce the health, social and
    economic burden resulting from drug abuse and addiction in this Nation.

    National Institute on Alcohol Abuse and Alcoholism (NIAAA)
        The National Institute on Alcohol Abuse and Alcoholism (NIAAA)
    works to examine the biological, chemical and behavioral factors
    associated with alcohol abuse and consumption, the third highest cause
    of preventable death in the United States according to the Centers for
    Disease Control and Prevention. Over time, NIAAA has broadened its
    behavioral science portfolio to understand the underlying psychological
    and cognitive processes that lead people to drink, and the impact of
    chronic alcohol abuse on those processes. Today, the institute is
    stepping up its efforts via its Improving Effectiveness of Treatment
    initiative to move beyond what we understand about today's behavior
    therapies and to further understand the mechanisms that determine how
    and why alcohol-related behavior changes. And since these changes are
    influenced by neurobiological, psychological and social factors, this
    new and exciting research includes multiple levels of research to
    ensure an integrated understanding to improve behavior strategies. APS
    asks this Committee to support NIAAA's behavioral science research
    efforts, and to increase NIAAA's budget in proportion to the overall
    increase at NIH in order to reduce the health, social and economic
    burden resulting from alcohol abuse and alcohol dependence.

    National Cancer Institute (NCI)
        The National Cancer Institute (NCI) is an agency that continues to
    make enormous advances in the behavioral sciences to achieve effective
    cancer prevention and control. Since its Behavioral Research Program
    was launched in 1997, NCI has funded comprehensive behavioral science
    research programs ranging from basic behavioral science to research on
    the development, testing and dissemination of disease prevention and
    health promotion interventions in areas such as tobacco use, diet, and
    even sun protection. APS applauds NCI's foresight to conduct
    transdisciplinary research within the program's five branches of
    Tobacco Control, Cancer Communications, Health Disparities, Energy
    Balance, and Cancer Survivorship because it set forward a new path for
    science--and APS believes disciplines are only made stronger when
    complimented by others. Take for example the agency's Centers for
    Transdisciplinary Research on Energetics and Cancer within the Energy
    Balance branch. This initiative brings together NCI's investment in
    diet, weight and physical activity research priorities by bringing
    together scientists from multiple disciplines to carry out projects
    ranging from the biology and genetics of energy balance to behavioral,
    sociocultural and environmental influences on nutrition, physical
    activity, weight, energy balance and energy transferred to or expended
    in life processes. In addition to training established scientists, this
    investment fosters collaboration among transdisciplinary teams. APS
    asks Congress to support NCI's behavioral science research and training
    initiatives and to encourage other institutes to use these programs as
    models.

    National Institute on Aging (NIA)
        APS is particularly pleased with NIA's dedication to behavioral
    research through the Behavioral and Social Research (BSR) Program--and
    its 3 branches of individual behavior, population and social processes
    and research resources and development--that supports basic social and
    behavioral research and research training by studying the dynamic
    interplay between individuals' aging; their changing biomedical,
    social, and physical environments; and multilevel interactions among
    psychological, physiological, social, and cultural levels. Agency-
    conducted research like that of the Behavioral and Imaging Approaches
    to Implicit Memory in Aging study will ultimately make a major
    contribution to our understanding of age-related changes in memory. As
    researchers carefully integrate behavioral and neuroimaging studies to
    broaden and deepen current understanding of age-related changes in
    implicit memory, they are evaluating decision accuracy in both young
    and elderly subjects to assess the neural substrates supporting
    encoding and retrieval of implicit memory. APS asks the Committee to
    support NIA's behavioral science research efforts and to increase NIA's
    budget in proportion to the overall increase at NIH in order to
    continue its high quality research to improve the health and wellbeing
    of older Americans.

    Office of Behavioral and Social Sciences Research (OBSSR)
        I'm pleased to report that psychological scientist David Abrams,
    from Brown University, has been appointed as the Director of the Office
    of Behavioral and Social Sciences Research at NIH. We ask the Committee
    to join us in welcoming Dr. Abrams to this position, and to support
    OBSSR in its efforts to achieve a strengthened behavioral science
    research enterprise at NIH.
        It's not possible to highlight all of the worthy behavioral science
    research programs at NIH. In addition to those reviewed in this
    statement, many other institutes play a key role in NIH behavioral
    science research enterprise. These include the National Heart, Lung,
    and Blood Institute, the National Institute of Neurological Disorders
    and Stroke, the National Institute of Diabetes and Digestive and Kidney
    Diseases, the National Institute of Nursing Research, and the National
    Institute for Human Genome Research. Behavioral science is a central
    part of the mission of these institutes, and their behavioral science
    programs deserve the Committee's strongest possible support.
                                     ______

            Prepared Statement of the American Society of Hematology

        Chairman Specter and members of the Subcommittee, the American
    Society of Hematology (ASH) thanks you for the opportunity to submit
    written testimony on the fiscal year 2006 Departments of Labor, Health
    and Human Services, and Education Appropriations Bill. In addition, ASH
    sincerely thanks the Subcommittee for its support of biomedical
    research.
        The Society represents nearly 14,000 clinicians and scientists
    committed to the study and treatment of blood and blood-related
    diseases. These diseases encompass malignant disorders such as
    leukemia, lymphoma, and myeloma; non-malignant conditions including
    anemia, thrombosis, and bleeding disorders; and congenital disorders
    such as sickle cell anemia, thalassemia, and hemophilia. In addition,
    hematologists have been pioneers in the fields of bone marrow
    transplantation, gene therapy, and the development of many drugs for
    the prevention and treatment of heart attacks and strokes.
        Hematologists treat a diverse group of patients. For example,
    anemia is a condition that has enormous consequences in the quality-of-
    life and functioning of the elderly; sickle cell disease is an
    inherited blood disorder that primarily affects African Americans. The
    hematological cancers--leukemia, lymphoma, and myeloma--strike men and
    woman of all ages; in 2005, nearly 115,000 Americans will be diagnosed
    with and more than 53,000 will die from these cancers.
        The study of blood and its disorders involves a number of NIH
    Institutes, including the National Heart, Lung and Blood Institute
    (NHLBI), the National Cancer Institute (NCI), the National Institute of
    Diabetes, Digestive and Kidney Diseases (NIDDK), and the National
    Institute on Aging (NIA). The Society supports the leadership of these
    Institutes and commends them for their vision and responsible research
    portfolio management.
        The Society's requests this year focus on translating basic
    scientific findings into improved treatments for patients with serious
    blood diseases. New comprehensive approaches to clinical research
    funding will advance our understanding of how to treat these and other
    diseases, enable patients to participate in high quality clinical
    protocols, and attract and train much-needed clinicians and clinical
    researchers to the field of hematology.

                       FISCAL YEAR 2006 FUNDING REQUESTS

    NIH Funding
        ASH fully supports the Ad Hoc Group for Medical Research Funding
    recommendation of $30 billion for NIH in fiscal year 2006. This 6
    percent increase represents an important step in maintaining NIH's
    commitment to medical research funding so that the progress made during
    the doubling years is not eroded. Research programs are not spigots
    that you can turn on and off without compromising their effectiveness.
    Innovative scientific teams working in sophisticated labs cannot be
    sustained without some stability in medical research funding from year
    to year. It is critical that the US maintain its commitment to medical
    research.
        For fiscal year 2006, the Bush Administration proposed $28.845
    billion, a $196 million or 0.7 percent increase over last year. This is
    the third consecutive year that the President's Budget request for NIH
    has not kept pace with medical inflation. Only continued, sustained
    investment in life-saving medical science today will provide cures and
    therapies for tomorrow. A proposed NIH budget along the lines of
    President Bush's recommendation is effectively a cut in funding; it
    doesn't keep up with the cost of medical inflation.
        Moreover, NIH budgets in the range proposed by the Bush
    Administration will force NIH to drop paylines substantially below the
    33rd percentile--where they are generally considered unhealthy for the
    biomedical research enterprise. Estimated paylines for most NIH
    Institutes in fiscal year 2006 are less than the 18th percentile. Low
    paylines create an atmosphere of hopelessness for even established
    investigators and little incentive for young researchers to take the
    chance that their grant would receive funding. More funding at NIH
    would provide the Institutes the opportunity to raise their paylines
    and fund more qualified and innovative research.
        In addition, there needs to be a highly-trained scientific
    workforce for NIH to meet its research objectives. Training the next
    generation of biomedical researchers has traditionally been the
    responsibility of NIH. Under the President's fiscal year 2006 Budget
    proposal, NIH will support almost 400 fewer full time training
    positions than last year. Without funding for the next generation of
    physician scientists, the biomedical research enterprise will not be
    prepared for future efforts.
        The Society is proud that NIH-sponsored research in hematology has
    led to important discoveries and generated new treatments and
    pharmaceutical products with broad applicability to human diseases. We
    have all benefited from past investments in NIH research. Recent
    advances include the incredibly effective hematologic drug Gleevec--a
    breakthrough in treating chronic myelogenous leukemia--that is one of
    the first drugs of its kind to be approved that targets specific
    molecules in cancer cells, leaving healthy cells unharmed. Moreover,
    ASH has always emphasized the synergy that is vital to successful
    scientific work. Basic research on the blood has aided physicians who
    treat patients with heart disease, strokes, end-stage renal disease,
    cancer and AIDS. As a result of this cross-fertilization, the Society
    remains firmly committed to broad-based support for biomedical research
    and to the existing peer-review process as the best way to identify and
    prioritize scientific grants.
        In fiscal year 2006, ASH also urges the Subcommittee to recognize
    the following areas of hematology research that have shown impressive
    progress and offer the potential of future advances:

                Coordination of the Issues Common to the Hemoglobinopathies
        Sickle cell anemia and thalassemia are inherited blood disorders
    caused by mutations in the genes for the hemoglobin molecule--the
    protein in red blood cells that carries oxygen to all parts of the
    body--and affect the normal functioning of hemoglobin in our blood.
    These conditions cause many problems including moderate to severe
    anemia, chronic pain, iron overload with its associated diabetes, liver
    and heart failure, enlarged spleen, bone weakness, pulmonary
    hypertension, and stroke. Although these disorders share many common
    issues, their research programs at NHLBI are organized into two
    parallel structures that could possibly benefit from the expertise of
    researchers focused on the other disorder. ASH believes there is an
    opportunity to determine the science and management issues common to
    the hemoglobinopathies and identify areas of scientific collaboration
    and promising new research directions in sickle cell anemia and
    thalassemia.

                Expansion of Research Activities in the Underlying Causes
                        of Thrombosis at NHLBI and NIA
        Venous and arterial thrombosis (blood clots) are serious conditions
    that can lead to heart attacks, strokes, limb loss, and respiratory
    dysfunction. Vascular biology research provides the foundation for
    understanding the underlying causes of atherosclerosis, angiogenesis,
    inflammation, and thrombosis. Greater understanding of vascular biology
    will lead to more knowledge about the prevention of thrombosis, which
    has implications into the further research of heart disease, stroke,
    recurrent fetal loss, complications associated with sickle cell anemia
    and diabetes, as well as the interruption of the blood supply to tumors
    and cancers.
        Recent research disclosed that deep vein thrombosis affects up to 2
    million Americans annually. Overall, thrombosis has sharply increased
    rates in the elderly and causes significant mortality and morbidity.
    With an expanding elderly population, thrombosis could become an even
    more serious health care problem. Although age is a known and important
    risk factor for thrombosis, there are other major research questions
    that need to be investigated in order to improve its diagnosis and
    treatment, such as the underlying causes of thrombosis. ASH believes
    that new research initiatives in the underlying causes of thrombosis
    will be helpful for improving the diagnosis and treatment of this
    potentially fatal complication of many diseases.

                Strengthening of Support for Clinical and Translational
                        Blood Cancer Research
        In 2005, nearly 115,000 Americans will be diagnosed with a
    hematologic malignancy, such as leukemia, lymphoma, and multiple
    myeloma. Moreover, more than 53,000 Americans will die from these
    cancers, compared to 40,870 for breast cancer, 30,350 for prostate
    cancer, and 56,290 for colon and rectum cancer. The blood cancers
    strike individuals of all ages, races, and each gender, and serve as
    valuable prototypes for the development of therapies for all types of
    malignant disorders. The Society hopes to work with NCI to strengthen
    its support for translational and clinical blood cancer research and
    use all available mechanisms to support blood cancer research by
    improving treatments and rapidly moving research advances from the
    laboratory bench to the patient's bedside.

                Expansion of Research Opportunities in Erythroid
                        Differentiation, Oxidant Injury, and Metabolomics
        High quality hematology research in iron metabolism, gene
    regulation, and stem cell plasticity is currently being funded by
    NIDDK. ASH hopes to work with the Institute to continue advancing
    research in these areas and set new priorities in cutting edge
    hematology topics, such as erythroid differentiation, oxidant injury,
    and metabolomics.

    Funding for the Sickle Cell Treatment Act (Public Law 108-357)
        Sickle Cell Disease (SCD) is an inherited blood disorder that is a
    major health problem in the United States. More than 2.5 million
    Americans, mostly African-Americans, have the sickle cell trait. SCD
    occurs in approximately 1 in 300 African-American newborns each year.
    The average life span for a patient with this devastating disease is 45
    years. While we continue to make progress with treatments, patients
    suffer debilitating pain and dangerous problems such as blood clots and
    strokes.
        As part of fiscal year 2005 Appropriations legislation, Congress
    provided $200,000 for the Health Resources and Services Administration
    to set up a demonstration program for sickle cell disease health
    centers and establish the National Coordinating Center to collect
    sickle cell disease-related data as authorized in the Sickle Cell
    Treatment Act (Public Law 108-357).
        For fiscal year 2006, ASH requests $10 million to continue to build
    this program by creating 40 Health Centers across the United States
    that would provide education, treatment (i.e., genetic counseling and
    testing), and continuity of care for individuals with sickle cell
    disease. In addition, this support would train health professionals at
    the 40 centers as well as establish a National Coordinating Center to
    collect, monitor and distribute information on best practices for the
    prevention and treatment of sickle cell disease. This recommendation
    has bipartisan, bicameral support as well as the backing of the
    Congressional Black Caucus and many other health, children's, church,
    union and African-American groups.
        ASH believes that the centers created through the Sickle Cell
    Treatment Act will improve the lives of SCD patients through disease
    management programs to help them live longer, healthier lives while
    funding research to find a comprehensive cure and providing community
    education about this disease and its treatment options.

            CONGRESSIONAL OVERSIGHT OF THE NIH PUBLIC ACCESS POLICY

       The Society remains concerned about the impact of the NIH Public
    Access Policy on the agency's budget, researchers, and not-for-profit
    journals. ASH requests that the Subcommittee continue to be engaged in
    the oversight of the policy's implementation. Moreover, the Society
    urges the Subcommittee to call for an analysis of the financial impact
    of the policy on the NIH budget and individual research grants.

                                   CONCLUSION

        This is an exciting time to be engaged in biomedical research and
    the Society is proud that ASH members are participating in so many
    innovative studies. ASH praises the NIH leadership for the excellent
    stewardship of the hematology research portfolio at NCI, NHLBI, NIDDK,
    and NIA. The opportunities in hematology research are immense,
    particularly in translational research. Partnerships and cooperative
    ventures involving multiple academic centers are necessary for clinical
    research projects to succeed and need special attention from NIH. When
    properly conceived and implemented, ASH believes these studies will
    lead to improved therapies for patients with debilitating and deadly
    blood disorders. The Society sincerely hopes that the Subcommittee will
    continue its longstanding support of biomedical research and will find
    the means to fund NIH at $30 billion in fiscal year 2006.
        In addition, ASH requests that the Subcommittee provide $10 million
    for the Sickle Cell Treatment Act (Public Law 108-357) in fiscal year
    2006. This support will create a network of centers across the United
    States for the education, treatment, and continuity of care for
    individuals with sickle cell disease, a major health care problem.
        Thank you again for the opportunity to submit testimony. Please
    contact Jeff Coughlin, ASH Government Affairs Manager, at (202) 776-
    0544 or jcoughlin@hematology.org if you have any questions or need
    further information on hematology research, fiscal year 2006 NIH
    funding, and support for the Sickle Cell Treatment Act.
                                     ______

          Prepared Statement of the American Society for Microbiology

        The American Society for Microbiology (ASM), representing 43,000
    members in the microbiological sciences, is pleased to provide a
    statement on the fiscal year 2006 funding for the Centers for Disease
    Control and Prevention (CDC). Although the fiscal year 2006 budget
    request includes important funding for influenza vaccine, childhood
    immunizations, global disease detection, and the Strategic National
    Stockpile, the ASM is concerned about the proposed budget reduction of
    $491 million for CDC at a time when new health challenges, including a
    possible influenza pandemic, threaten public health. The 2003 Institute
    of Medicine (IOM) report, Microbial Threats to Health, warns that the
    magnitude and urgency of microbial threats demand renewed concern and
    commitment. The IOM report emphasizes the importance of strong CDC
    programs including greater global capacity for responding to infectious
    disease outbreaks, better case reporting by health care providers and
    laboratories, and expanded efforts related to antimicrobial resistance.
        With people at risk from a broad range of health threats, our
    public health system will not be able to respond adequately without
    appropriate resources for public health programs. The ASM, therefore,
    recommends an increase of 8 percent in the fiscal year 2006 budget for
    the CDC. CDC's importance to safeguarding public health, both
    nationally and globally, is now unprecedented, but the level of funding
    for CDC is not keeping pace with its growing responsibilities to
    address new health threats. Infectious disease public health needs have
    been and will continue to increase and CDC's funding must remain strong
    to address them.

                        CDC INFECTIOUS DISEASE PROGRAMS

        The CDC recently reorganized programs to better adapt to changing
    health threats. The Infectious Diseases Coordinating Center oversees
    three major programs, the National Immunization Program, the National
    Center for Infectious Diseases, and the National Center for HIV/AIDS,
    Sexually Transmitted Diseases and Tuberculosis Prevention. The
    President's budget includes $1.7 billion related to domestic prevention
    and control of infectious diseases through these programs.

                                   INFLUENZA

        The National Center for Infectious Diseases is responsible for
    measuring progress in global influenza surveillance and detection to
    prepare for a pandemic influenza outbreak. Funding for pandemic
    influenza preparedness is appropriated through the Department of Health
    and Human Service's (DHHS) Public Health and Social Services Emergency
    Fund (PHSSEF). The budget proposes $120 million for the expansion of
    year-round vaccine production capacity, a priority in the DHHS's draft
    Pandemic Influenza Response and Preparedness Plan. A significant
    investment will be required to enhance vaccine capacity to address the
    threat of pandemic influenza by developing a newer generation of
    influenza vaccine that can be quickly produced and deployed to
    strengthen the public heath infrastructure on state and local levels,
    and to ensure that needed vaccines, antivirals and antibiotics are
    readily available.

                                    HIV/AIDS

        Under the CDC reorganization, programs focused on HIV/AIDS,
    sexually transmitted diseases (STDs), and tuberculosis are managed
    through the National Center for HIV, STD, and TB Prevention (NCHSTP).
    The budget proposes $956 million, $658 million of which is focused on
    prevention of these infectious diseases. Despite CDC efforts over the
    past two decades, the number of new HIV infection cases each year
    continues to remain high and the number of Americans living with HIV/
    AIDS is increasing. In fiscal year 2003, CDC launched a different U.S.
    initiative, based on new rapid testing techniques for immediate patient
    results, designed to better prevent infections through earlier
    notification and to help identify the estimated 180,000 to 280,000
    people not aware of their HIV-positive status.

                                 GLOBAL HEALTH

        The agency's recent reorganization also coordinated programs under
    the Office of Global Health (OGH) to track and prevent the
    international spread of diseases like measles, polio, and HIV/AIDS. The
    overarching goals are to recognize outbreaks faster, wherever in the
    world they occur, and to better control and prevent further outbreaks.
    Global disease detection mandates steady expansion of surveillance
    systems worldwide, as trade and travel allow rapid spread of previously
    unknown or unanticipated pathogens. Clinical and public health
    laboratory capacity must be strengthened together with epidemiologic
    and communications capabilities. The World Health Organization goal of
    eradicating polio by 2005 has suffered some setbacks recently, with
    wild poliovirus spreading in some African countries during 2003 and
    2004. But last year, cases of the disease declined by nearly 50 percent
    in India, Pakistan, and Afghanistan. Since the WHO global initiative
    began in 1988, CDC and others have invested more than $3 billion in the
    polio campaign. An estimated 250,000 lives have been saved and 5
    million cases of childhood paralysis prevented. The CDC also partners
    with other federal agencies in the Global AIDS Program and in the
    President's Emergency Plan for AIDS Relief. In fiscal year 2004, nearly
    2 million HIV laboratory tests and 275,000 tuberculosis infection
    laboratory tests were conducted under auspices of the Global AIDS
    Program. In addition, antiretroviral drug therapy was provided for
    nearly 19,000 AIDS patients in nine countries. By the end of 2003, the
    active spread of measles had been stopped in the Western Hemisphere.
    That year the CDC and its partners vaccinated more than 115 million
    children worldwide. Unfortunately measles persists as one of the
    world's leading child killers with an estimated 30 million cases and
    700,000 deaths each year.

                            ANTIMICROBIAL RESISTANCE

        Overuse of antimicrobials seriously increases the prevalence of
    pathogens resistant to commonly prescribed drugs. Antimicrobial
    resistance is considered one of the pressing issues faced by the CDC
    and other public health institutions. The 2003 Annual Report of the
    Antimicrobial Resistance Interagency Task Force reported that the
    number of cases of invasive pneumococcal disease in children in seven
    geographic areas declined by 75 percent in 2002 due to widespread use
    of pneumococcal vaccine, thereby reducing the use of antimicrobials
    which may become resistant. In fiscal year 2004, the CDC inaugurated a
    national media campaign about antibiotic resistance, to educate both
    patients and health care providers about the serious ramifications of
    overprescribing antibiotics. Also in fiscal year 2004, extramural
    grants were awarded for applied research in the estimate of economic
    costs for antimicrobial resistant human pathogens of public health
    importance. The purpose of the grant program is to obtain information
    that might impact and improve the current methods of preventing the
    emergence and spread of antimicrobial resistance. ASM supports
    sufficient budgetary increases in such prevention programs. The return
    on investment creates enormous health and economic benefits to the
    American public.

                                 IMMUNIZATIONS

        The CDC's immunization program would receive $2.1 billion under the
    proposed fiscal year 2006 budget, to support the two primary goals of
    the program: at least 90 percent of all 2-year-olds to receive the
    recommended vaccines, and assurances of an adequate annual influenza
    vaccine supply. Investments in immunization programs are proven cost-
    savers. For example, every dollar spent on measles-mumps-rubella
    vaccine saves an estimated $23 in health-care costs. Fiscal year 2006
    funds would flow through the Vaccines for Children program and the
    Section 317 program, the former to provide vaccinations to children
    otherwise underserved in the health care system, the latter to
    subsidize state immunization efforts. As part of the overall CDC
    immunization focus, $197 million is requested for influenza-related
    activities, representing a nine-fold increase over fiscal year 2001
    appropriations. Funds would further expand the pediatric vaccine
    stockpile initiated last year, purchase additional doses of influenza
    vaccines for the general public, and encourage greater vaccine
    production for next winter's flu season. The fiscal year 2006 emphasis
    on immunization activities is a prudent use of federal funds needed to
    protect the public.

                                  SURVEILLANCE

        DNA technology provides some of the notable cutting-edge science
    upon which CDC testing and surveillance programs are built and
    operated. The PulseNet system, which tracks foodborne illness
    outbreaks, is one particularly extensive use of such technology. These
    illnesses affect more than 76 million Americans each year; periodic
    outbreaks often are widely publicized in the national media. One
    example is the 2004 outbreak of salmonellosis among more than 500
    people across five states, which CDC epidemiologists tied to
    contaminated restaurant tomatoes. Another is a multi-state incident of
    hepatitis A infecting more than 1,000 people after they ingested
    imported green onions. Similar surveillance systems now exist in
    Europe, Pacific Rim countries, and Latin America. The CDC's
    Tuberculosis Genotyping Program, initiated in fiscal year 2004, also
    fingerprints the genetic profiles of pathogens, enabling case
    investigators to assess very quickly how and where the bacterium is
    spreading. It already has described outbreaks in several states,
    permitting rapid deployment of preventive measures.

                           BIOTERRORISM PREPAREDNESS

        Defenses against possible bioterrorist attacks are a collaborative
    initiative among federal, state, and local agencies and authorities.
    The CDC is largely responsible for sufficient supplies of
    countermeasures such as vaccines and portable treatment units. The
    Administration proposes an increase of $56 million for bioterrorism
    preparedness activities at the CDC, for a total of $1.6 billion in
    fiscal year 2006. Six hundred million is proposed for further enhancing
    the Strategic National Stockpile (SNS). Specifically, the Medical
    Contingency Station project will be enhanced and increased funding will
    also help to pay for BioShield acquisitions and the purchase of
    additional anthrax antibiotics for the SNS. The CDC maintains the
    capacity to transport SNS materials and personnel to any location
    within the United States within 12 hours. During fiscal year 2004, the
    CDC nearly tripled the amount of medical countermeasures against
    anthrax, now capable of treating 30 million people.
        Since 2001, the CDC has recognized the importance of anti-
    bioterrorism capabilities at the state and local levels, where attacks
    are most likely to occur. About $4.5 billion has been invested in CDC
    programs to assure state and local preparedness. The agency's
    Laboratory Response Network (LRN) now includes 134 reference labs in
    all states, up from 91 in 2001, nearly all capable of detecting agents
    of anthrax, tularemia and smallpox. Five veterinary diagnostic
    laboratories are now part of the system, recognizing the importance of
    animal-to-human transmission of disease pathogens. More than 8,800
    laboratory personnel have been trained for bioterrorism emergencies
    under CDC auspices. During fiscal year 2004, CDC invested about $846
    million to improve the ability of 62 state, local, and territorial
    health departments to respond to terrorism, infectious disease
    outbreaks, and other public health crises. The CDC funded the Cities
    Readiness Initiative, to boost delivery of medicines and other supplies
    during large-scale emergencies. The current proposed budget for fiscal
    year 2006 however, decreases support for state and local capacity. A
    report released this March by New York University concludes that
    bioterrorism-related training and equipping of local response personnel
    like paramedics have been seriously neglected, an example of yet unmet
    needs.

                            BUILDINGS AND FACILITIES

        Since 2001, the CDC has initiated or completed construction of more
    than 2.7 million square feet of laboratory and administrative space,
    replacing badly deteriorating buildings that were unsafe and
    inadequate. This year will mark the completion in Atlanta of a new
    Infectious Disease Laboratory, the Scientific Communications Center,
    the headquarters building with an Emergency Operations Center to
    coordinate quick responses, and the Environmental Toxicology
    Laboratory. The fiscal year 2006 request includes $22.5 million to
    complete a replacement Vector Borne Infectious Diseases lab in Fort
    Collins, Colorado and an additional $7.5 million to fund miscellaneous
    repairs and improvements. CDC's master plan for its buildings and
    facilities includes additional building renovations that are currently
    on hold, with hope to be funded in the near future. ASM applauds
    expenditures in recent years to replace the former CDC facilities in
    such poor condition and supports the completion of the master plan when
    funds can be allocated.
        The ASM appreciates the opportunity to provide written testimony
    and would be pleased to assist the Subcommittee as it considers its
    appropriation for the CDC for fiscal year 2006.
                                     ______

          Prepared Statement of the American Society for Microbiology

        The American Society for Microbiology (ASM), the largest single
    life science society with over 43,000 members, is pleased to submit a
    statement on the fiscal year 2006 appropriation for the National
    Institutes of Health (NIH). The ASM appreciates the strong support that
    the Congress has provided for NIH supported biomedical research.
    Congress's investment in NIH has paid tremendous dividends in terms of
    human health improvements. We can expect progress against disease to
    continue because of recent scientific advances and new opportunities
    for applications of research knowledge gained from basic research
    discoveries. The challenge of infectious diseases, cancer, diabetes and
    other chronic diseases will continue to increase, thus, strong support
    for NIH is needed.
        The ASM recommends a 6 percent increase in the budget for NIH in
    fiscal year 2006 and believes this increase would improve the pace of
    scientific investigation and the translation of science into new and
    better approaches to prevent, diagnose and treat diseases. A funding
    increase of this magnitude would allow NIH to take fuller advantage of
    innovative tools and technologies and the many extraordinary research
    achievements that have been made during the recent past. It would help
    to respond to urgent disease threats and realize more of the important
    medical treatment and public health goals that loom on the near
    horizon.
        The ASM considers a 6 percent increase justified for NIH if it is
    to continue current programs and deal with new and pressing needs,
    including the threat from pandemic influenza, other emerging infectious
    diseases such as the recent and unexpected outbreak of SARS, the AIDS
    pandemic, a myriad of infectious and chronic diseases that continue to
    take a human toll worldwide and biodefense initiatives.
        Since fiscal year 2003, the NIH budget has flattened, and at less
    than 1 percent, the proposed fiscal year 2006 budget increase will
    result in difficult funding decisions for research programs. Because
    the budget request for NIH falls below the current biomedical rate of
    inflation, which is about 3.5 percent, biomedical research will face a
    slowdown in the pace of scientific progress. This static state in
    funding comes at a rare time with unprecedented opportunities for major
    advances in human health and also at the very time that our nation's
    competitors are significantly increasing their investments in research.
    Their investments are based on the demonstrated positive impact of
    biotechnology and biomedical research on economic development. The
    European Union has set a goal of becoming the most competitive
    knowledge based economy in the world by 2010. Without increased
    investment in federally funded research in the United States, we stand
    to diminish the growth of U.S. technology.

                          BASIC RESEARCH AND TRAINING

       The ASM emphasizes the importance of providing increased support
    for basic research and the training and participation of young
    investigators in biomedical fields. Basic research and human ingenuity
    provide the underpinning of new knowledge that is necessary for
    successful medical breakthroughs. Basic research drives scientific
    creativity and productivity, making increased funding for investigator
    initiated research project grants a particularly critical issue when
    making funding decisions. Under the proposed fiscal year 2006 budget
    for NIH, the total number of research project grants (RPGs) supported
    falls below that of fiscal year 2005 by over 400 and no inflationary
    increases are provided for direct, recurring costs in noncompeting
    RPGs. The ASM recommends increased funding for NIH to ensure a
    continuum of high quality research project grants and scientist
    training programs to keep biomedical research in the future as vigorous
    as it is today.
        Specifically, ASM draws attention to the fact that scientific
    knowledge of microbes and their role in life and in the environment is
    key to new discoveries that will benefit human health. For example, the
    study of microbes resulted in the discovery that DNA is the genetic
    material of life and was responsible for the molecular revolution that
    has transformed biology. Research into basic life processes of bacteria
    is a critical underpinning of cellular studies that contribute to
    progress in the life sciences. Research on bacteria is urgent because
    more bacteria are becoming resistant to antibiotics, raising the
    specter of untreatable diseases. NIH should increase support for basic
    microbiology research and training and review research portfolios of
    the National Institute of General Medical Sciences (NIGMS), which
    provides support for fundamental research, and coordinate with other
    agencies such as the National Science Foundation (NSF) and the
    Department of Energy (DOE) to ensure that scientific opportunities in
    important areas of basic bacteriology physiology and genetics research
    are receiving adequate attention. The ASM recommends that NIH take
    steps such as workshops, requests for proposals and training grants to
    increase the infrastructure in this important area of science.

                              INFECTIOUS DISEASES

        Over the past 10 years, new and emerging microbial threats have
    continued to challenge the research community as well as the public
    health infrastructure. Despite scientific and medical advances,
    infectious diseases persist as the third leading cause of death in the
    United States and the second leading cause of death worldwide. A recent
    report from the Institute of Medicine on microbial threats to public
    health concluded that a comprehensive infectious disease research
    agenda is essential for successful anti-disease campaigns. The basic
    and applied research supported by the National Institute of Allergy and
    Infectious Diseases (NIAID) is essential to responding to infectious
    disease public health challenges. Unfortunately, the budget for the
    NIAID would increase by only 1.3 percent in the request for fiscal year
    2006, far less than the amount needed to maintain or accelerate NIAID
    supported work to combat a myriad of infectious diseases.
        Influenza is a familiar infectious disease threat with the proven
    potential for decimating pandemics. Influenza develops in about 20
    percent of U.S. citizens each year and an estimated 36,000 die annually
    from complications of influenza in the United States, with 250,000 to
    500,000 deaths worldwide. In the United States influenza and pneumonia
    remain the leading infectious cause of mortality and are ranked seventh
    among all causes of death. Influenza viruses steadily mutate and new
    strains periodically move from animal hosts to humans. World attention
    is drawn to outbreaks of avian influenza in Southeast Asia with about
    55 infected persons and 42 deaths since January 2004. The current
    strain of H5N1 influenza could acquire characteristics that permit
    transmission among humans which could lead to a worldwide influenza
    pandemic. The 1918 influenza pandemic killed at least 20 million people
    and pandemic avian influenza could kill millions of people. The NIH
    Influenza Genomics Project conducts rapid sequencing of the complete
    genomes of thousands of avian and human influenza viruses and newly
    emerging ones and will study the molecular basis of how new strains of
    influenza virus emerge and characteristics that contribute to
    virulence. Research is being done to develop a live attenuated vaccine
    candidate against each of 15 isolated hemagglutinin proteins that may
    speed the development of a vaccine against a potential pandemic strain.
    Using reverse genetics technology, a genetically engineered vaccine
    candidate against H5N1 was developed in weeks. This technology was also
    used to identify a genetic mutation in a H5N1 viral gene that makes the
    virus more lethal.
        In late 2002, Severe Acute Respiratory Syndrome (SARS) became the
    first severe newly emergent infectious disease of the 21st century, but
    was rapidly characterized and contained. Because of air travel by its
    earliest victims, SARS reached five countries within 24 hours and more
    than 30 countries on 6 continents within 6 months of the initial
    diagnosed case. Nearly 8,000 persons became ill and international
    travel and trade were greatly affected. The global cost of SARS has
    been estimated at about $80 billion. NIAID funded research in
    collaboration with the Centers for Disease Control and Prevention (CDC)
    demonstrated that SARS is a viral disease and a new coronavirus was
    identified quickly as the causative agent. By May of 2003, an
    international collaboration of researchers had decoded the genetic
    sequence of the virus to develop a candidate vaccine that in November
    2004 entered early phase tests in humans. Less than 2 years separated
    the discovery that SARS is a new infectious disease and the beginning
    of vaccine testing in humans, a process that traditionally can take
    decades. Results came quickly because of research and public health
    cooperation, NIAID resources and new molecular biology techniques.
    Research and technology developed during past disease outbreaks
    facilitate NIAID responses to unique or sporadic challenges like SARS,
    West Nile virus, Ebola virus, and bovine spongiform encephalopathy.
        Research yields major insights into the pathogenic mechanisms of
    established diseases such as HIV/AIDS, tuberculosis and malaria. An
    estimated 40 million people worldwide are living with HIV/AIDS. NIAID
    research has made possible critical discoveries about the basic biology
    of HIV and the immune response to HIV infection which has led to the
    development of therapies that suppress the growth of the virus.
    Approximately 20 antiretroviral medications that target HIV have been
    developed and approved by the Food and Drug Administration. More
    scientific research is needed on the virus to identify additional
    targets for therapeutic interventions and vaccines. Despite the fact
    that tuberculosis (TB) is one of the oldest infectious diseases known,
    the global incidence rate is still increasing. More than one third of
    the world is latently infected with TB. Every day there are 5,000
    deaths due to TB. A big part of the problem is the increasing number of
    patients with the deadly combination of TB and HIV. The only available
    medicines to treat and diagnose TB are from another era. Rapid
    development of new tools is greatly needed to address the growing
    problems of multi-drug resistant TB. Malaria is one of the major
    killers of humans in the world with an estimated 300 million acute
    illnesses each year and more than 1 million deaths. Both tuberculosis
    and malaria pathogens are increasingly resistant to commonly used
    antimicrobial drugs. Genomic and postgenomic techniques are being
    applied to identify key molecular pathways that could be exploited to
    develop TB interventions and vaccines. The complete genomic sequence of
    the malaria vector and parasite were completed in 2002, providing
    powerful tools to further characterize the genes and proteins involved
    in the life cycle of the malaria parasite. NIAID supported programs in
    basic and applied areas are contributing to knowledge that is needed to
    design new vaccines, therapeutics and diagnostics against these
    formidable infectious diseases that exact a terrible social, economic
    and human toll globally.
        The NIAID research portfolio is challenged as never before to
    address new and emerging infectious diseases and those that have
    affected humans for thousands of years but are still a public health
    threat. NIAID supports important research on the hepatitis viruses
    which cause liver inflammation and tissue damage and can cause chronic
    infections. There are more than 25 identified sexually transmitted
    infections (STIs) that affect more than 15 million people in the United
    States. STIs can lead to infertility, complications in pregnancy,
    cervical cancer, low birth weight, congenital/perinatal infections and
    other chronic conditions and are of critical global and national health
    priority because of their impact on women and infants. NIAID basic and
    clinical research studies on mechanisms of pathogenesis of STIs and
    prevention strategies for the control of these infections are
    essential. Bacterial and viral infections of the gastrointestinal tract
    often lead to diarrheal disease and to chronic conditions such as
    ulcers and stomach cancer. In the United States, diarrhea is the second
    most common infectious illness and diarrheal diseases account for 15 to
    34 percent of deaths in some countries. Infection with Helicobacter
    pylori is a major risk factor for developing peptic ulcer disease,
    stomach cancer and primary gastric B cell lymphoma. NIAID supports
    research to understand, prevent and treat enteric diseases through a
    variety of initiatives. NIAID also sponsors research on West Nile
    Virus, which first emerged in 1999 in New York City, other insect-borne
    diseases such as Lyme Disease and fungal diseases that can cause severe
    systemic infections.

                              BIODEFENSE RESEARCH

        The NIH is responsible for the implementation of the strategic plan
    for biodefense research. The NIH biodefense budget, proposed at $1.7
    billion for fiscal year 2006, is part of the budget for NIAID, the lead
    agency at NIH for infectious diseases and immunology research. Research
    is the backbone of the NIAID biodefense efforts and includes genomics
    and studies of pathogenesis and host defense, microbial physiology and
    animal disease models. Sustained funding by the Administration and
    Congress over the past few years is making possible significant
    progress evidenced by over 60 NIAID biodefense initiatives now in
    place.
        Following the September 11, 2001 terrorist attack in the United
    States and terrorist events using biological agents, awareness about
    the potential of bioterrorism and the vulnerability of people to a
    bioterrorism event prompted the U.S. Government to pursue a range of
    programs and capabilities to prepare for future emergencies (Homeland
    Security Presidential Directive 10). Among these was increased funding
    for research and development of medical countermeasures within the
    Department of Health and Human Services to enable the country to mount
    a successful medical and public health response to a biological attack
    on the civilian population should such a terrible event occur. In 2002
    the ASM testified before Congress that pathogenic microbes pose a
    threat to national security whether they occur naturally or are
    released in a bioterrorism attack. Biodefense research is part of the
    continuum of biomedical research aimed at protecting the nation and the
    world against infectious diseases. The ASM supports having federal
    biomedical and infectious disease research efforts related to civilian
    human health prioritized and conducted by and at the direction of the
    DHHS and NIH.
        In early 2002, the NIAID convened a panel of experts, the Blue
    Ribbon Panel on Bioterrorism and Its Implications for Biomedical
    Research, to provide guidance on the future biodefense research agenda,
    research resources, facilities and scientific personnel. The NIAID
    developed research priorities and goals for potential agents of
    bioterrorism with particular emphasis on the ``Category A'' agents
    considered by the CDC and NIH as the worst currently recognized
    potential bioterror threats. The NIAID developed the NIAID Strategic
    Plan for Biodefense Research, The NIAID Biodefense Research Agenda for
    CDC Category A Agents, and the NIAID Biodefense Research Agenda for
    Category B and C Priority Pathogens. Approximately 60 NIAID initiatives
    were funded in fiscal years 2002-2004, including funding for a network
    of 8 nationwide multidisciplinary Regional Centers of Excellence (RCE)
    for Biodefense and Emerging Infectious Diseases Research, 2 National
    Biocontainment Laboratories (NBLs), and 9 Regional Biocontainment
    Laboratories (RBLs) to provide secure space for the expanded civilian
    biodefense research program. The genomes of the biological agents
    listed as posing the most severe threats have been sequenced; new
    animal models have been developed to test promising drugs and
    repositories have been established to catalog reagents and specimens.
    NIAID is sponsoring basic research to understand structure, biology and
    mechanisms by which potential bioweapons cause disease, studies to
    elucidate how the human immune system responds to dangerous pathogens
    and technology to translate basic research into medical countermeasures
    to detect, prevent and treat diseases caused by potential biological
    weapons.
        Advances in biodefense research are outlined in the NIAID
    Biodefense Research Agenda for CDC Category A Agents Progress Report
    and the NIAID Biodefense Research Agenda for Category B and C Priority
    Pathogens Progress Report. NIAID supported biodefense research is
    conducted through collaborataive efforts with academic institutions and
    public/private partnerships and scientific communications are open,
    facilitating scientific and medical progress against infectious
    diseases. NIAID anticipates that the large investment mandated by the
    government in civilian biodefense research will advance scientific
    knowledge that will have positive spin offs for other diseases.
                                     ______

              Prepared Statement of the American Thoracic Society

                        SUMMARY: FUNDING RECOMMENDATIONS
                            [In millions of dollars]
    ------------------------------------------------------------------------
                             Agency                               Amount
    ------------------------------------------------------------------------
    National Institutes of Health...........................        30,000.0
        National Heart, Lung and Blood Institute............         3,117.0
        National Institute of Allergy and Infectious Disease         4,667.0
        National Institute of Environmental Health Sciences.           680.0
        Fogarty International Center........................            71.5
        National Institute of Nursing Research..............           146.0
    Centers for Disease Control and Prevention..............         8,500.0
        National Institute for Occupational Safety and                 326.0
         Health.............................................
        Environmental Health: Asthma Activities.............            70.0
        Tuberculosis Control Programs.......................           215.0
    ------------------------------------------------------------------------

        The American Thoracic Society (ATS) is pleased to submit our
    recommendations for programs in the Labor Health and Human Services and
    Education Appropriations Subcommittee purview.
        The American Thoracic Society, founded in 1905, is an independently
    incorporated, international education and scientific society that
    focuses on respiratory and critical care medicine. For 100 years, the
    ATS has continued to play a leadership role in scientific and clinical
    expertise in diagnosis, treatment, cure and prevention of respiratory
    diseases. With approximately 13,500 members who help prevent and fight
    respiratory disease around the globe, through research, education,
    patient care and advocacy, the Society's long-range goal is to decrease
    morbidity and mortality from respiratory disorders and life-threatening
    acute illnesses.

                            LUNG DISEASE IN AMERICA

        Lung disease in America is a serious problem. Each year, an
    estimated 342,000 Americans die of lung disease. Lung disease is
    responsible for one in every seven deaths, making it America's number
    three cause of death. More than 35 million Americans suffer from a
    chronic lung disease. In 2005, lung diseases cost the U.S. economy an
    estimated $139.6 billion in direct and indirect costs, a total of 5.9
    percent of the U.S. economy.
        Lung diseases represent a spectrum of chronic and acute conditions
    that interfere with the lung's ability to extract oxygen from the
    atmosphere, protect against environmental or biological challenges and
    regulate a number of metabolic processes. Lung diseases include chronic
    obstructive pulmonary disease, lung cancer, tuberculosis, influenza,
    sleep disordered breathing, pediatric lung disorders, occupational lung
    disease, sarcoidosis, asthma and severe acute respiratory syndrome
    (SARS).
        The ATS is pleased that the Subcommittee provided increases in the
    National Institutes of Health (NIH) and the Centers for Disease Control
    and Prevention (CDC) budget last fiscal year. However, we are extremely
    concerned with the president's fiscal year 2006 budget that proposes a
    mere 0.5 percent increase for NIH and significant cuts for CDC. We ask
    that this Subcommittee recommend a 6 percent increase for NIH and an
    8.1 percent increase for the CDC. In order to stem the devastating
    effects of lung disease, research funding must continue to grow to
    sustain the medical breakthroughs made in recent years. There are three
    lung diseases that illustrate the need for further investment in
    research and public health programs: Chronic Obstructive Pulmonary
    Disease, pediatric lung disease, specifically asthma and tuberculosis.

                                      COPD

        Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading
    cause of death in the United States and the third leading cause of
    death worldwide. Yet, COPD remains relatively unknown to most
    Americans. COPD is the term used to describe the airflow obstruction
    associated mainly with emphysema and chronic bronchitis and is a
    growing health problem.
        While the exact prevalence of COPD is not well defined, it affects
    tens of millions of Americans and can be an extremely debilitating
    condition. It is estimated that 11.2 million patients have COPD while
    an additional 13 million Americans are unaware that they have this life
    threatening disease.
        According to the National Heart, Lung and Blood Institute (NHLBI),
    COPD cost the U.S. economy an estimated $37.2 billion in 2004.
    Unfortunately, NHLBI spends about $44,000 a year on COPD research. We
    recommend the Subcommittee encourage NHLBI to devote additional
    resources to finding improved treatments and a cure for COPD.
        Medical treatments exist to relieve symptoms and slow the
    progression of the disease. Today, COPD is treatable but not curable.
    Fortunately, promising research is on the horizon for COPD patients.
    Despite these leads, the ATS feels that research resources committed to
    COPD are not commensurate with the impact COPD has on the United States
    and the world. Clearly more needs to be done to make Americans aware of
    COPD, its causes and symptoms. We were pleased to participate in an
    NHLBI-sponsored workshop to formulate strategies toward implementing a
    National COPD Education and Prevention Program. As this effort
    continues, we encourage the NHLBI to maintain its partnership with the
    patient and physician community in the next stages in the development
    of the National COPD Education and Prevention Program.
        While additional resources are needed at NIH to conduct COPD
    research, CDC has a role to play as well. The ATS encourages the CDC to
    add COPD-based questions to future CDC health surveys, including the
    National Health and Nutrition Evaluation Survey (NHANES), the National
    Health Information Survey (NHIS) and the Behavioral Risk Factor
    Surveillance Survey (BRFSS). By collecting information on the
    prevalence of COPD, researchers and public health professionals will be
    better able to understand and control the disease.

                             PEDIATRIC LUNG DISEASE

        Lung disease affects people of all ages. The ATS is pleased to
    report that infant death rates for various lung diseases have declined
    for the past ten years. However, of the seven leading causes of infant
    mortality, four are lung diseases or have a lung disease component. In
    2002, lung diseases accounted for 21 percent of all deaths under one
    year of age. It is also widely believed that many of the precursors of
    adult respiratory disease start in childhood. The ATS encourages the
    NHLBI to continue with its research efforts to study lung development
    and pediatric lung diseases.
        The pediatric origins of chronic lung disease extend back to early
    childhood factors. For example, many children with respiratory illness
    are growing into adults with COPD. In addition, it is estimated that
    close to 20.3 million people suffer from asthma, including an estimated
    6.1 million children. While some children appear to outgrow their
    asthma when they reach adulthood, 75 percent will require life-long
    treatment and monitoring of their condition. Asthma is the third
    leading cause of hospitalization among children under the age of 15 and
    is the leading cause of chronic illness among children.
        The ATS feels that the NIH and the CDC must play a leadership role
    in the ways to assist those with asthma. National statistical estimates
    show that asthma is a growing problem in the United States. However, we
    do not have accurate data that provide regional and local information
    on the prevalence of asthma. To develop a targeted public health
    strategy to respond intelligently to asthma, we need locality-specific
    data. CDC should take the lead in collecting and analyzing this data.
        Last year, Congress provided approximately $32 million for the CDC
    to conduct asthma programs. We recommend that CDC be provided $70
    million in fiscal year 2006 to expand programs and establish grants to
    community organizations for screening, treatment, education and
    prevention of childhood asthma.

                                  TUBERCULOSIS

        Tuberculosis (TB) is a global public health crisis that remains a
    concern for the United States. Tuberculosis is an airborne infection
    caused by a bacterium, Mycobacterium tuberculosis. Tuberculosis
    primarily affects the lungs but can also affect other parts of the
    body, such as the brain, kidneys or spine. The statistics for TB are
    alarming. Globally, one-third of the world's population is infected
    with the TB germ, 8-10 million active cases develop each year and 2-3
    million people die of tuberculosis annually. It is estimated that 10-15
    million Americans have latent tuberculosis. Tuberculosis is the leading
    cause of death for people with HIV/AIDS.
        While we are pleased that CDC has reported 12 straight years of
    decline in United States. TB rates, we remain concerned that TB rates
    in African Americans remain high and the TB rates in foreign-born
    Americans is growing. In addition, there has also been an increase in
    the number of TB cases among people with HIV/AIDS, prisoners, the
    homeless and certain immigrant communities.
        Upon review of this information, many have concluded that a cycle
    of neglect has begun, reminiscent of a previous resurgence in the early
    1980's. The ATS, in collaboration with the National Coalition for
    Elimination of Tuberculosis, recommends an increase of $105 million for
    TB control in fiscal year 2006 to allow the CDC undertake an
    unprecedented initiative, Intensified Support and Activities to
    Accelerate Control (ISAAC), to enhance, maximize and target resources
    to sustain the momentum of the past decade and accelerate the control
    and elimination of tuberculosis. ISAAC targets tuberculosis in African
    Americans, tuberculosis along the United States-Mexico border, allows
    for universal genotyping of all culture positive TB cases, and expands
    clinical trials for new tools for the diagnosis and treatment of
    tuberculosis.
        In the efforts to eliminate tuberculosis, it is important to note
    that in 2004 foreign-born residents accounted for nearly 54 percent of
    U.S. tuberculosis cases. The CDC is working to enhance screening of
    immigrants and refugees overseas, test recent arrivals from countries
    that have high TB rates, and cooperate with authorities to control
    tuberculosis along the United States-Mexico border.
        The NIH also has a prominent role to play in the elimination of
    tuberculosis. Currently there is no highly effective vaccine to prevent
    TB transmission. However, the recent sequencing of the TB genome and
    other research advances have put the goal of an effective TB vaccine
    within reach. The National Institute of Allergy and Infectious Disease
    has developed a Blueprint for Tuberculosis Vaccine Development. We
    encourage the Subcommittee to fully fund the TB vaccine blueprint. We
    also encourage the NIH to continue efforts to develop drugs to combat
    multi-drug resistant tuberculosis a serious emerging public health
    threat.
        It is clear that efforts to eliminate tuberculosis must continue.
    From recent TB outbreaks in Fort Wayne, IN and Chesapeake, VA to the
    hundreds of people being tested for tuberculosis in Houston, TX and
    Santa Barbara, CA, tuberculosis is still a problem in the United States
    today.

                           PHYSICIAN WORKFORCE SUPPLY

        As the number of people diagnosed with lung diseases rises, we need
    to ask, who will be treating lung disease patients in the future? The
    ATS is concerned about the supply of physicians in the United States. A
    recent study published in the Journal of the American Medical
    Association predicts that there will be an acute shortage of physicians
    trained to treat patients with critical care illness and lung disease
    starting in 2007.\1\ While the study focuses on supply of pulmonary/
    critical care physicians, what is driving the shortage is the
    predicated increase in demand for physician services caused by the
    aging of the U.S. population.
    ---------------------------------------------------------------------------
        \1\ D. Angus, et al. Current and Project Workforce Requirements for
    Care of the Critically Ill and Patients with Pulmonary Disease: Can We
    Meet the Requirements of an Aging Population? JAMA 2000; 284:2762-2770.
    ---------------------------------------------------------------------------
        We are pleased that the Bureau of Workforce Analysis at Health
    Resources and Services Administration (HRSA) has taken an interest in
    this issue and will soon be releasing a study on pulmonary/critical
    care physician supply in the United States. We believe the HRSA study
    will confirm an existing shortage of pulmonary and critical care
    physicians. Should the HRSA study confirm a shortage of physicians,
    Congress will then need to take action to address the shortage before
    it reaches a crisis. Potential steps Congress could take include:
    increasing existing caps on training positions for pulmonary/critical
    care, expanding the J-1 visa waiver program, increasing class sizes in
    medical schools, and expanding loan forgiveness and accelerated
    deductions of interests on loans for students enrolled in critical care
    training programs.

                    LUNG-DISEASE OPPORTUNITIES AND ADVANCES

        Pulmonary researchers have made significant advances in lung
    disease research. The following are identified areas of lung disease
    research that the NHBLI has said it will be exploring in the next year:
      --HIV-Related Pulmonary Complications. As mentioned earlier, the rate
            of persons with HIV who are also contracting TB are steadily
            growing. We applaud the NHLBI for its research on the roles of
            co-infections, immune factors and genetic predisposition in the
            pathogenesis of HIV-related pulmonary disease.
      --COPD and lung cancer research. Nearly a quarter of a million
            Americans die each year of either COPD or lung cancer. NHLBI
            hopes to address the gap in knowledge that a common
            pathogenetic mechanism may be involved as a risk factor for
            COPD and lung cancer. The research will focus on a search for
            the similarities of the cellular and molecular mechanisms that
            lead to COPD and lung cancer. This new research could have
            important implications for the prevention and management of
            both diseases.
      --Sleep Apnea or Sleep Disordered Breathing (SDB). SDB is a medical
            condition associated with upper airway obstruction and
            cessation of breathing that leads to repeated episodes of
            asphyxia during the night. SDB is very prevalent in the U.S.
            population with conservative estimates set at 2 percent to 3
            percent of all children, 5 percent of middle age adults, and in
            excess of 15 percent of the aged population. The major health-
            related implications and morbid consequences of SDB include the
            neurocognitive and cardiovascular morbidities, depression,
            hypertension, increased frequency of myocardial infarction and
            stroke, and increased frequency of motor vehicle accidents due
            to the increased sleepiness induced by the disruption of sleep
            in SDB patients. Both the frequency of SDB and its consequences
            are anticipated to increase in the next decades due to the
            aging of the overall U.S. population and the ongoing epidemic
            of obesity that afflicts our country. The ATS supports the need
            for more research into the causes, diagnosis and treatment of
            SDB.
        In conclusion, lung disease is a growing problem in the United
    States. It is this country's third leading cause of death, responsible
    for one in seven deaths. The lung disease death rate continues to
    climb. Overall, lung disease and breathing problems constitute the
    number one killer of babies under the age of one year. Worldwide,
    tuberculosis kills 3 million people each year, more people than any
    other single infectious agent. The level of support this Subcommittee
    approves for lung disease programs should reflect the urgency
    illustrated by these numbers.
                                     ______

     Prepared Statement of the Centers for Disease Control and Prevention
                                (CDC) Coalition

        The CDC Coalition is a nonpartisan association of more than 100
    groups committed to strengthening our nation's prevention programs. Our
    mission is to assure that health promotion and disease prevention are
    given top priority in federal funding, to support a funding level for
    the Centers for Disease Control and Prevention (CDC) that enables it to
    carry out its prevention mission, and to assure an adequate translation
    of new research into effective state and local programs. Coalition
    member groups represent millions of public health workers, researchers,
    educators, and citizens served by CDC programs. We are grateful for the
    opportunity to present our views to the Subcommittee.
        It is time to support CDC as an agency--not just the individual
    programs that it funds. In the best professional judgment of the CDC
    Coalition--given the challenges and burdens of chronic disease,
    terrorism and disaster preparedness, new and re-emerging infectious
    diseases and our many unmet public health needs and missed prevention
    opportunities--the agency will require funding of $8.65 billion to
    support its mission for fiscal year 2006.
        The CDC Coalition is pleased with the support the Subcommittee has
    given to CDC programs over the years, including your recognition of the
    need to fund chronic disease prevention, infectious disease
    preparedness, and environmental health programs. By translating
    research findings into effective intervention efforts in the field, the
    agency has been a key source of funding for many of our state and local
    programs that aim to improve the health of communities. Perhaps more
    importantly, federal funding through CDC provides the foundation for
    our state and local public health departments, supporting a trained
    workforce, laboratory capacity and public health education
    communications systems.
        CDC also serves as the command center for our nation's public
    health defense system against emerging and reemerging infectious
    diseases. From anthrax to West Nile to smallpox to SARS, the Centers
    for Disease Control and Prevention is the nation's--and the world's--
    expert resource and response center, coordinating communications and
    action and serving as the laboratory reference center. States and
    communities rely on CDC for accurate information and direction in a
    crisis or outbreak.
        In fiscal year 2002, Congress appropriated $7.7 billion for CDC. In
    fiscal years 2003, 2004 and 2005, Congress appropriated $7.1 billion,
    $7.2 billion, and $8.0 billion, respectively. Now the President's
    proposed budget for the agency in fiscal year 2006 is $7.5 billion--a
    $500 million cut from last year's funding, and $200 million below the
    fiscal year 2002 funding level. We are moving in the wrong direction.
    Public health is being asked to do more, not less. As far as we can
    tell, in light of the current workload placed on the public health
    service--in addition to the threat of emerging diseases such as the
    avian flu--it simply does not make any sense to cut the budget for CDC
    at a time when the threats to public health are so great. Funding
    public health outbreak by outbreak is not an effective way to ensure
    either preparedness or accountability.
        Until we are committed to a strong public health system, every
    crisis will force trade offs. For instance, the Administration's recent
    reprogramming request to make up for the vaccine shortage with money
    originally appropriated by Congress for chronic disease prevention
    programs (COPP and the Preventive Health and Health Services Block
    Grant) and bioterror preparedness funds is the most recent concrete
    example of attention to one disease coming at the expense of another.
        CDC serves as the lead agency for bioterrorism preparedness and
    must receive sustained support for its preparedness programs in order
    for our nation to meet future challenges. In the best professional
    judgment of CDC Coalition members, given the challenges of terrorism
    and disaster preparedness, and our many unmet public health needs and
    missed prevention opportunities, the agency will require at least level
    funding to adequately fulfill its mission for fiscal year 2006.
        We are concerned that the President's budget proposes cutting the
    state and local capacity grants for terrorism by almost $130 million,
    and eliminating the anthrax preparedness program. We encourage the
    Subcommittee to restore these cuts to ensure that our local communities
    can be prepared in the event of an act of terrorism.
        Heart disease remains the nation's number one killer. In 2002,
    696,947 people died of heart disease (51 percent of them women),
    accounting for 29 percent of all U.S. deaths. Stroke is the third
    leading cause of death after heart disease and cancer and a leading
    cause of serious, long-term disability. In 2002, stroke killed 162,672
    people (62 percent of them women), accounting for about 1 of every 15
    deaths. In 1998, the U.S. Congress provided funding for CDC to initiate
    a national, state-based heart disease and stroke prevention program
    with funding for eight states. Currently, 32 states and the District of
    Columbia are funded, 21 as capacity building programs and 12 as basic
    implementation programs. The CDC Coalition recommends $55.6 million for
    the Heart Disease and Stroke Prevention Program.
        The CDC carries out crucial work to reduce the incidence, morbidity
    and mortality of cancer through prevention, early detection, treatment,
    rehabilitation, and palliation. Cancer is the second leading cause of
    death in the United States. In 2004, about 1.4 million new cases of
    cancer will be diagnosed, and more than 563,700 Americans--about 1,500
    people a day--will die of the disease. The financial cost of cancer is
    also significant. According to the National Institutes of Health, in
    2003, the overall cost for cancer in the United States was $189.5
    billion: $64.2 billion for direct medical expenses, $16.3 billion for
    lost worker productivity due to illness, and $109 billion for lost
    worker productivity due to premature death. Among the ways they are
    fighting cancer, the CDC funds programs to detect colorectal, ovarian,
    prostate, skin, breast and cervical cancers, as well as maintain a
    cancer registry to track cancer incidence. The CDC coalition recommends
    $385 million for the Cancer Prevention and Control activities of the
    CDC.
        Nearly 16 million Americans have diabetes, including over 5 million
    who don't know it. During 1980-2002, the number of people with diabetes
    in the United States more than doubled, from 5.8 million to 13.3
    million. Although more than 18 million Americans have diabetes, 5.2
    million cases are undiagnosed. Each year, 12,000-24,000 people with
    diabetes become blind, more than 42,800 develop kidney failure, and
    about 82,000 have leg, foot, or toe amputations. Preventive care such
    as routine eye and foot examinations, self-monitoring of blood glucose,
    and glycemic control could reduce these numbers. Without additional
    funds, most states will not be able to create programs based on these
    new data. States also will continue to need CDC funding for diabetes
    control programs that seek to reduce the complications associated with
    diabetes. The CDC Coalition recommends $150 million for CDC's diabetes
    prevention efforts.
        Over the last 25 years, obesity rates have doubled among United
    States adults and children, and tripled in teens. Obesity, diet and
    inactivity are cross-cutting risk factors that contribute significantly
    to heart disease, cancer, stroke and diabetes. The CDC funds programs
    to encourage the consumption of fruits and vegetables, to get
    sufficient exercise, and to develop other habits of healthy nutrition
    and activity. The CDC Coalition recommends $70 million for CDC's
    Division of Nutrition and Physical Activity.
        Arthritis and chronic joint symptoms affect nearly 70 million
    Americans, or about one of every three adults, making it one of the
    most prevalent diseases in the United States. As the population ages,
    this number will increase dramatically. The CDC Coalition recommends
    $25 million for the arthritis programs of the CDC.
        More than 400,000 people die prematurely every year due to tobacco
    use. The CDC's tobacco control efforts seek to prevent tobacco addition
    in the first place, as well as help those who want to quit with ways to
    do so. The CDC Coalition recommends $145 million for the CDC's tobacco
    control programs.
        Each day 4,400 young people try their first cigarette. At the same
    time, daily participation in high school physical education classes
    dropped from 42 percent in 1991 to 32 percent in 2001. Almost 80
    percent of young people do not eat the recommended number of servings
    of fruits and vegetables, while nearly 30 percent of young people are
    overweight or at risk of becoming overweight. And every year, almost
    800,000 adolescents become pregnant and about 3 million become infected
    with a sexually transmitted disease. School health programs are one of
    the most efficient means of correcting these problems, shaping our
    nation's future health, education, and social well-being. CDC's
    Adolescent and School Health program supports coordinated school health
    programs that reduce disease risk factors. In 2003, CDC supported 22
    state-coordinated school health programs. The CDC Coalition recommends
    $82.4 million for school health programs.
        The President's budget proposes the elimination of the Childhood
    Obesity Prevention Program (COPP), also referred to as the VERB or CDC
    Youth Media campaign. The success of the COPP program shows that over
    30 percent of the target audience, children ages 9 to 10 years old,
    increased their physical activity as a direct result of the VERB media
    campaign. This type of success warrants continued funding to empower
    our children to respond to the growing concerns of the obesity epidemic
    and improve the health of this nation. We encourage the Subcommittee to
    restore the cuts and fund the COPP program at $70 million.
        Public health programs delivered at the local level should be
    flexible to respond to local needs. Within an otherwise-categorical
    funding construct, the Preventive Health and Health Services Block
    Grant is the only source of flexible dollars for states and localities
    to address their unique public health needs. The track record of
    positive public health outcomes from Prevention Block Grant programs is
    strong, yet so many requests go unfunded. However, the President's
    budget proposes the elimination of the Preventive Health and Health
    Services Block Grant. As states use their Prevention Block Grant
    dollars to address high priority needs such as emerging and chronic
    diseases, child safety seat programs, suicide prevention, smoke
    detector distribution and fire safety programs, adult immunization,
    oral health, worksite wellness, infectious disease outbreaks, food
    safety, emergency medical services, safe drinking water, and
    surveillance needs--we can scarcely understand why the Prevention Block
    Grant should be eliminated. In fact, the Prevention Block Grant has
    been flat funded since fiscal year 2000. We encourage the Subcommittee
    to restore the cuts and fund the Prevention Block Grant at $132
    million.
        Much of CDC's work in chronic disease prevention and health
    promotion, and in other programs areas, is guided by its prevention
    research activities. Prevention research considers the factors
    associated with illness, disability, and injury, such as lifestyles or
    exposure to environmental toxins, and the best ways to address these
    factors and thereby promote health. By answering these questions,
    prevention research links biomedical research, which focuses on human
    physiology and disease treatment, to policies and public health
    interventions that promote wellness and reduce the need for treatment.
        CDC provides national leadership in helping control the HIV
    epidemic by working with community, state, national, and international
    partners in surveillance, research, prevention and evaluation
    activities. These activities are critically important, as CDC estimates
    that between 800,000 and 900,000 Americans currently are living with
    HIV. Also, the number of people living with AIDS is increasing, as
    effective new drug therapies are keeping HIV-infected persons healthy
    longer and dramatically reducing the death rate. Prevention of HIV
    transmission is our best defense against the AIDS epidemic that has
    already killed over 400,000 U.S. citizens and is devastating the
    populations of nations around the globe, and CDC's HIV prevention
    efforts must be expanded.
        Elimination of tuberculosis and sexually transmitted diseases
    (STDs), especially syphilis, is now within our grasp. These welcome
    opportunities, if adequately funded now, will save millions in annual
    health care costs in the future. Untreated STDs contribute to infant
    mortality, infertility, and cervical cancer. State and local STD
    control programs depend heavily on CDC funding for their operational
    support.
        CDC conducts the National Health and Nutrition Examination Survey
    (NHANES), the only national source of objective health data to provide
    accurate estimates of diagnosed and undiagnosed medical conditions in
    the population. NHANES is a unique collaboration between CDC, the
    National Institutes of Health (NIH), and others to obtain data for
    biomedical research, public health, tracking of health indicators, and
    policy development. Through physical examinations, clinical and
    laboratory tests, and interviews, NHANES assesses the health status of
    adults and children in the United States. Mobile exam centers travel
    throughout the country to collect data on chronic conditions,
    nutritional status, medical risk factors (e.g., high cholesterol level,
    obesity, high blood pressure), dental health, vision, illicit drug use,
    blood lead levels, food safety, and other factors that are not possible
    to assess by use of interviews alone. Findings from this survey are
    essential for determining rates of major diseases and health conditions
    and developing public health policies and prevention interventions.
        We must address the growing disparity in the health of racial and
    ethnic minorities. CDC's REACH 2010 Demonstration Program, Racial and
    Ethnic Approaches to Community Health (REACH), helps states address
    these serious disparities in infant mortality, breast and cervical
    cancer, cardiovascular disease, diabetes, HIV/AIDS and immunizations.
    The CDC Coalition recommends $50 million for the REACH program.
        The CDC Coalition is requesting a $5 million increase, for an
    appropriation of $46 million for Steps to a HealthierUS (STEPS)
    program. Additional resources will allow for the creation of programs
    in more states. Furthermore, while the President's budget request
    includes $1.5 million to support the YMCA Pioneering Healthier
    Communities initiative, $3 million is needed to fully fund and continue
    to expand this important effort. This would enable the funding 20 NEW
    Pioneering Healthier Community projects with one-time start up grants;
    provide funding for a conference in 2005 to train these community
    leadership teams, and establish an office within the Centers for
    Disease Control and Prevention that would assist YMCAs, non-profits and
    local/state health departments in initiating, evaluating and sustaining
    healthy community change efforts.
        CDC oversees immunization programs for children, adolescents and
    adults, and is a global partner in the ongoing effort to eradicate
    polio worldwide. The value of adult immunization programs to improve
    length and quality of life, and to save health care costs, is realized
    through a number of CDC programs, but there is much work to be done and
    a need for sound funding to achieve our goals. Influenza vaccination
    levels remain low for adults. Levels are substantially lower for
    pneumococcal vaccination. Significant racial and ethnic disparities in
    vaccination levels persist among the elderly. Childhood immunization
    programs at CDC also need a funding boost, to ensure sufficient
    purchase and delivery of the recently-approved varicella and
    pneumococcal vaccines. In addition, developing functional immunization
    registries in all states will be less costly in the long run than
    maintaining the incomplete systems currently in place.
        Injury at work remains a leading cause of death and disability
    among U.S. workers. During the period from 1980 through 1995, at least
    93,338 workers in the United States died as a result of injuries
    suffered on the job, for an average of about 16 deaths per day. The
    Bureau of Labor Statistics (Department of Labor) has identified 5,915
    workplace deaths from acute traumatic injury in 2000. BLS also
    estimates that 5.7 million injuries to workers occurred in 1997 alone;
    while NIOSH estimates that about 3.6 million occupational injuries were
    serious enough to be treated in hospital emergency rooms in 1998. The
    injury prevention and workforce protection initiatives of NIOSH need
    continued support.
        Of the 4 million babies born each year in the United States, 3
    percent are born with one or more birth defects. Birth defects are the
    leading cause of infant mortality, accounting for more than 20 percent
    of all infant deaths. Children with birth defects who survive often
    experience lifelong physical and mental disabilities. An estimated 54
    million people in the United States currently live with a disability,
    and 17 percent of children under the age of 18 have a developmental
    disability. Direct and indirect costs associated with disability exceed
    $300 billion.
        Created by the Children's Health Act of 2000 (Public Law 106-310),
    the National Center on Birth Defects and Developmental Disabilities
    (NCBDDD) at CDC conducts programs to protect and improve the health of
    children and adults by preventing birth defects and developmental
    disabilities; promoting optimal child development and health and
    wellness among children and adults with disabilities. We encourage the
    Subcommittee to provide at least $135 million in fiscal year 2006
    funding for the NCBDDD. This would be a modest increase of $10 million
    and would further surveillance, research and prevention activities
    related to birth defects and developmental disabilities and improve the
    lives of those living with disabilities.
        We also encourage the Subcommittee to provide $10 million for CDC's
    Environmental Public Health Services Branch to revitalize environmental
    public health services at the national, state and local level. As with
    the public health workforce, the environmental health workforce is
    declining. Furthermore, the agencies that carry out these services are
    fragmented and their resources are stretched. These services are the
    backbone of public health and are essential to protecting and ensuring
    the health and well being of the American public from threats
    associated with West Nile virus, terrorism, E. coli and lead in
    drinking water.
        We appreciate the Subcommittee's hard work in advocating for CDC
    programs in a climate of competing priorities. We encourage you to
    consider our request for $8.65 billion for CDC in fiscal year 2006.
    Members of the CDC Coalition are grateful for this opportunity to
    present our views to the Subcommittee.
                                     ______

        Prepared Statement of the Charcot-Marie-Tooth Association (CMTA)

        I want to thank the Subcommittee for this opportunity to share
    information about Charcot-Marie-Tooth (CMT) disorder and to express
    support for expanded CMT research funded by the National Institutes of
    Health (NIH).

                               BACKGROUND ON CMT

        CMT is the most common inherited neurological disorder, affecting
    approximately 125,000 Americans. The disease affects people across
    their lifespan and is found world wide in all races and ethnic groups.
    Unlike muscular dystrophy, which strikes the muscles, CMT adversely
    affects the nerves that control the muscles. Individuals afflicted with
    CMT slowly lose normal use of their feet and legs and hands and arms as
    nerves to the extremities degenerate. The muscles in the extremities
    weaken due to the loss of stimulation by the affected nerves, and there
    is often a loss of sensory nerve function.
        Even though there are different types of CMT, CMT is largely
    inherited in an autosomal pattern, meaning when one parent has the
    disease (either the father or the mother), there is a 50 percent chance
    it will be passed onto each child. The degree of severity can vary
    greatly from patient to patient, even within the same family. A child
    may or may not be more severely disabled than his or her parent. In
    most cases, CMT does not affect life expectancy; however, in certain
    forms the disease is more severe: debilitating children so that they
    require wheelchairs and even resulting in premature death. There are
    currently no effective treatments--although physical therapy,
    occupational therapy, and moderate physical activity are beneficial.

                             STATUS OF CMT RESEARCH

        CMT was described over 100 years ago; yet, it has only been in the
    last 10 years that rapid advances in our understanding of CMT have
    occurred. We now know there are at least 30 different genetic causes of
    CMT, and the genetic location of many more types are known.
    Identification of the known CMT genes has led to the development of
    diagnostic tests, enabling many people to receive a firm diagnosis and
    evaluate risk to other family members. Despite identifying more genes
    associated with CMT, we are just beginning to understand how the genes,
    when abnormal, cause CMT.
        To elucidate the complexities surrounding CMT, the CMTA funded the
    CMT North American Database, which is housed at Indiana University.
    Simply put, the database is a standardized collection of data about a
    large number of people with all types of CMT that includes detailed
    information about a person's medical, genetic, and family histories.
    Having a central repository of standardized information of CMT patients
    will accelerate the pace of CMT research, by providing detailed
    information about large numbers of uniformly evaluated patients to
    qualified researchers. Information contained in the database should
    provide a more accurate picture of the range of disability caused by
    the various types and sub-types of CMT. The database will also be a
    rich resource to tap when drugs or other CMT treatments become
    available for testing.
        In addition to the database, for several years, CMTA has funded a
    quality research program including the sponsorship of many fellowships
    and national and international meetings. Ongoing studies are
    investigating the molecular basis of various forms of CMT, the
    molecular biology of molecules known to cause CMT, relationships
    between CMT and other neurodegenerative diseases such as ALS, and the
    development of rational clinical therapies to potentially treat CMT.
    The National Institutes of Health (NIH), in particular, the National
    Institute of Neurological Disorders and Stroke (NINDS), has co-funded
    several of these activities.

               CMT RESEARCH AND THE NATIONAL INSTITUTES OF HEALTH

        Despite providing modest support for a handful of successfully
    competed applications, NIH has not launched a coordinated effort to
    stimulate more CMT research opportunities nor invested sufficient
    resources. In fact, according to the NINDS, from fiscal year 2002 to
    fiscal year 2005, funding for CMT research at NINDS declined in real
    terms, even as total NIH dollars and funding of neuropathy research
    increased.
        We are pleased the report that the House and Senate Appropriations
    Subcommittees on Labor, Health and Human Services, and Education
    requested on CMT research at NIH last year has contributed to the
    understanding of relevant trans-NIH activities. Moreover, we are
    encouraged by NIH's announcement that it is beginning to plan a
    workshop on peripheral neuropathies, but believe that such a workshop
    should focus intensively on CMT so that it will result in outcomes
    which will be directly relevant to CMT research and could lead to a
    relevant program announcement or request for applications on CMT,
    specifically.
        We are confident the Subcommittee's continued interest in CMT
    research will help the NIH and CMT field work together to identify
    potential future research opportunities that could be incorporated into
    existing trans-NIH initiatives, such as the Blueprint for
    Neurosciences, or developed from the upcoming scientific workshop into
    a request for applications or program announcement.
        Unlike many other areas of research, CMT did not experience a
    largess of funding during the NIH doubling period. In spite of this
    fact, in recent years, researchers made substantial progress towards
    understanding CMT. Yet, additional advances in the field will be
    hampered without additional resources from the NIH. This support would
    not only benefit CMT. Data from CMT research has the potential to
    translate into direct benefits for research into other
    neurodegenerative disorders, such as ALS and MS, which devastate
    hundreds of thousands of Americans. Therefore, by increasing its
    support for CMT, NIH will also be facilitating research into other
    neurodegenerative diseases.

                            FISCAL YEAR 2006 REQUEST

        CMTA believes the Administration's request for the NIH in fiscal
    year 2006 is inadequate. Providing NIH with less than a one percent
    increase, as proposed, would fund the agency well below the rate of
    biomedical research inflation index (3.5 percent) and limit the
    agency's ability to invest in emerging areas of sciences, such as CMT,
    that are in dire need of an infusion of federal support. We urge the
    Subcommittee to increase funding for the NIH in fiscal year 2006.
    Moreover, we urge the Subcommittee to continue to express an interest
    in CMT and work with NIH to ensure that any workshop on peripheral
    neuropathies is intensively focused on CMT so that it will result in
    outcomes which will be directly relevant to CMT research and could lead
    to a relevant program announcement or request for applications on CMT,
    specifically. We encourage and strongly support any such program
    announcement or request for applications on CMT.
        Once again, I thank the Subcommittee for expressing its interest in
    CMT and for this opportunity to testify.
                                     ______

          Prepared Statement of the Coalition for American Trauma Care

        The Coalition for American Trauma Care is pleased to provide you
    with its recommendations for fiscal year 2006 appropriations for public
    health programs that support trauma care, trauma care research, and
    injury prevention.
        The Coalition for American Trauma Care is a nonprofit association
    of national health and professional organizations that seeks to improve
    care for the seriously injured patient through improved delivery of
    trauma care services, research and rehabilitation activities. The
    Coalition also supports efforts to prevent injury from occurring.
        Injury is one of the most important public health problems facing
    the United States today. It is the leading cause of death for Americans
    from age 1 through age 44. More than 145,000 people die each year from
    injury, 88,000 from unintentional injury such as car crashes, fires,
    and falls, and 56,000 from violence-related causes. Over 85 children
    and young adults die from injuries in the United States every day
    translating into 30,000 deaths annually. Injury is also the most
    frequent cause of disability. Millions of Americans are non-fatally
    injured each year leaving many temporarily disabled and some
    permanently disabled with severe head, spinal cord, and extremity
    injuries. Because injury so often strikes the young, injury is also the
    leading cause of years of lost work productivity and, at an estimated
    $224 billion in lifetime costs each year, trauma is our nation's most
    costly disease.
        Attention to injury was never more important in the wake of the
    September 11, 2001 attacks. Particularly concerning is our failure, as
    a nation, to fully implement organized systems of trauma care in every
    state and region which numerous studies have demonstrated are essential
    to saving the lives of those who are severely injured. The Health
    Resources and Services Administration's (HRSA) completed analysis of a
    2002 survey of the states that shows only eight states had
    comprehensive trauma systems, 12 states did not have even rudimentary
    elements of a trauma system and the remaining states are were in
    various stages of incomplete development. And yet a new Harris Poll,
    commissioned in November, 2004 to learn about the American public's
    views of and support for trauma systems found that:
      --Almost everyone recognizes the importance of having a trauma system
            in their state.
      --Large majorities feel that having a trauma system in place is as
            important as, or more important than, having State police or
            HAZMAT teams.
      --About two in three Americans would be extremely or very concerned
            if they learned that the trauma system in their state did not
            meet recognized standards.
      --Americans are willing to spend their own money to have trauma
            centers and trauma systems in place in their states.
      --Generally, Americans have high expectations of their states' trauma
            centers and systems when it comes to handling natural disasters
            or terrorist attacks.
        Trauma Care Systems.--The Coalition is opposed to the elimination
    of this program in the President's fiscal year 2006 budget request and
    urges you to provide $12 million in fiscal year 2006 for HRSA's Trauma-
    EMS systems program. This is the amount provided in Senate authorizing
    legislation (S. 265) adopted unanimously by the Senate HELP Committee
    on February 9. The Trauma-EMS program was funded at $3.0 million in
    fiscal year 2001, and $3.5 million for fiscal year 2002-2005. Fully 80
    percent of the appropriated dollars, as authorized, is provided for
    state grants to further trauma system development. States receive 100
    percent federal funding in the first grant year and must provide a 2:1
    state to federal match in Year 2, and a 3:1 match in Year 3. States may
    do this through in-kind assets. Thus, this seriously under-funded
    program provides both critical federal leadership and leverages scarce
    state resources.
        The program has been making steady progress toward the goal of
    extending and strengthening organized systems of trauma care across the
    nation. In receiving grants from fiscal year 2002-2004 states had to
    assure:
        1. A lead agency for the state trauma system.
        2. Identification of a state-level trauma system manager.
        3. A multidisciplinary statewide trauma stakeholder group.
        4. Completion of the 2002 National Assessment (with fiscal year
    2001 funding).
        5. A statewide trauma system plan.
        After these components were in place (or for those states with
    advanced trauma systems), the program funded additional state-specific
    trauma system projects.
        A follow-up assessment of state progress in trauma system
    development is being planned for fiscal year 2005.
        National Center for Injury Prevention and Control.--The Coalition
    supports $168 million in funding in fiscal year 2006 for the National
    Center for Injury Prevention and Control which is currently funded at
    $138 million. While the Coalition remains a strong supporter of the
    National Center for Injury Prevention and Control, members would like
    to see more balance in support for unintentional injuries. Significant
    increases in the NCIPC in recent years have largely been earmarked for
    violence prevention--an important focus for NCIPC after disturbing
    incidents in public schools around the country. However, unintentional
    injury remains the leading killer of children and young adults and
    NCIPC's efforts to translate what works into communities should receive
    increased funding. These efforts help prevent, for example, the 20,000
    head injuries that occur every year by encouraging the use of bicycle
    helmets, and reduce burn-related injuries through smoke detector
    implementation programs. The Coalition is also disappointed that as the
    funding base for the National Center for Injury Control and Prevention
    has grown, the relative amount of funding for acute care research and
    demonstration has diminished.
        Traumatic Brain Injury (TBI).--Traumatic brain injury is a leading
    cause of trauma-related disability. Brain injury is a silent epidemic
    that compounds every year, but about which still little is known. The
    Coalition is opposed to the proposed elimination of this important
    program in the President's fiscal year 2006 budget request and urges
    you to provide a total of $30 million for the Traumatic Brain Injury
    (TBI) Act, reauthorized as part of the Children's Health Act of 2000
    (Public Law 106-310), as follows: $8.715 million for CDC for
    surveillance--the legislation directs the CDC to build upon its work
    with state registries to collect information to help improve service
    delivery to people who have sustained a TBI and to expand monitoring of
    the incidence and prevalence of TBI to include all age groups and
    individuals in institutional settings. In 2003, the CDC launched the
    first phase of the National Information Center for TBI (NCITBI)--a
    ``one call'' national information center that provides persons with
    brain injury and their circles of support toll-free information on
    State-specific resources and linkage to services. The CDC has also been
    directed to monitor the incidence, outcomes and services needs of
    people who sustain injuries, including TBI, during mass casualty
    events. The Coalition also supports $15.193 million for the HRSA TBI
    State Grant Program--this Program was established to improve access to
    health and other services for individuals with TBI and their families
    by awarding competitive grants to States and Territories; and $6
    million for HRSA Protection and Advocacy Services for persons with TBI.
    In addition, the Coalition requests that you include report language to
    ensure that the National Institutes on Neurological Disorders and
    Stroke (NINDS) within NIH increases core funding to $2 million for each
    of its six Centers and that NINDS dedicate $1.0 million for funding a
    new coordinating and administrative network for the six Centers. We
    also request that NINDS dedicate funding to establish a new category of
    training grants to incentivize individuals to pursue careers in TBI
    bench science research. NINDS currently funds six bench science
    research centers at $1.0 million each. These six Centers represent
    groups of renowned basic and clinical physician-scientists working
    collaboratively on translational research programs who have developed
    the clinically-relevant laboratory models that will serve as the
    foundation for future research--it is imperative that we invest in the
    infrastructure that is now in place.
        Children's EMS.--The Coalition is opposed to the proposed
    elimination of this program in the President's fiscal year 2006 budget
    request and urges you to provide $20 million in fiscal year 2006, which
    maintains the fiscal year 2005 funding level. While children currently
    account for up to 30 percent of all emergency department visits and 10
    percent of ambulance runs annually, many facilities lack the
    specialized equipment needed to care for children. Moreover, many
    emergency personnel do not have the necessary education or training to
    provide optimal care to children. In order to assist local communities
    in providing the best emergency care to children the Children's EMS
    program needs to continue and continue at the fiscal year 2005 funding
    level.
        Preventive Health/Health Services Block Grant (PHHS).--The
    Coalition is opposed to the proposed elimination of this program in the
    President's fiscal year 2006 budget supports an fiscal year 2006
    funding level of $132 million, which maintains the same funding level
    as provided in fiscal year 2005. The Coalition rejects the President's
    request to eliminate this program because it is duplicative of other
    activities within the CDC. The PHHS Block Grant provides flexible
    funding to states to allow them to address specific health problems
    identified under the Healthy People 2010 assessment process. The
    funding allows states to take innovative approaches to address
    significant health issues and complements, not duplicates, some of
    CDC's other program activities. In addition, the PHHS Block Grant is
    the largest single source of federal funding for support basic state
    Emergency Medical Services' (EMS) infrastructure--the first line of
    defense against death and disability resulting from severe injury.
        The Coalition for American Trauma Care is disappointed by the
    President's fiscal year 2006 budget which proposes elimination of all
    funding for four programs specifically designed to build infrastructure
    to ensure that trauma and emergency medical services are available and
    appropriate to need: HRSA's Trauma-EMS systems program; HRSA's
    Traumatic Brain Injury program; HRSA's Children's EMS program and CDC's
    Preventive Health and Health Services Block Grant. If these cuts were
    enacted, the results would be devastating for emergency care in the
    United States for everyone and particularly for children and those who
    have suffered head injury. The burden of injury in America has been
    well documented by numerous IOM reports and injury facts speak for
    themselves: injury is the leading cause of death and disability for
    children and adults up to age 44. While much more can and needs to be
    done to prevent injury from occurring at all, we will never be able to
    eliminate it entirely. Cutting these programs will not lessen the
    injury burden in America; on the contrary, it will significantly
    increase the burden of death, disability and direct and indirect health
    care costs. We need to increase our investment in these program areas,
    not reduce our commitment.
        The Coalition greatly appreciates the support the Subcommittee has
    provided to trauma related programs in the past and looks forward to
    working with the Subcommittee in the coming weeks and months.
                                     ______

             Prepared Statement of the Coalition for Health Funding

        The Coalition for Health Funding is pleased to provide the
    Subcommittee with testimony recommending fiscal year 2006 funding
    levels for the agencies and programs of the U.S. Public Health Service.
    Since 1970, the Coalition's member organizations, representing 40
    million health care professionals, researchers, lay volunteers,
    patients and families, have been advocating for sufficient resources
    for PHS agencies and programs to meet the changing health challenges
    confronting the American people. The Coalition for Health Funding is
    the nation's oldest, most broadly based alliance focused on the breadth
    of discretionary health spending. One of the important principles that
    unites the Coalition's members is that the health needs of the nation's
    population must be addressed by strong, sustained support for a
    continuum of activities that includes biomedical, behavioral and health
    services research; community-based disease prevention and health
    promotion; health care services for vulnerable and medically
    underserved populations; ensuring a safe and effective food and drug
    supply; and education of a health professions workforce in adequate
    numbers to address the breadth of need.
        The Coalition for Health Funding believes the Bush Administration,
    and Congress, are missing an important opportunity to improve the
    health of all Americans by not making a stronger investment in the
    agencies and programs of the U.S. Public Health Service. Federal
    spending for public health is low compared to other health spending,
    amounting to three percent of total health care spending according to
    the Centers for Medicare and Medicaid, and yet an investment in public
    health has the potential to slow unsustainable growth in mandatory
    costs, reduce lost productivity at work, school and home, and
    strengthen every citizen's contribution for a healthy, economically
    strong America. Mounting evidence-based studies
    (www.thecommunityguide.org; www.aspe.hhs.gov/health/prevention/
    prevention.pdf; www.modelprograms.samhsa.gov) demonstrating the
    effectiveness of prevention, early intervention, access to basic health
    care services and associated cost-savings support investing in public
    health programs and activities. Instead, over the past two fiscal years
    we have seen an erosion of resources, beginning with the budget phase,
    with flat-funding, or cuts in funding, effected for many programs
    during the Committee phase of the appropriations process followed by
    across-the-board cuts in the omnibus bills for all health programs. The
    President's fiscal year 2006 budget request takes these reductions
    considerably further by proposing to cut funding for the seven major
    public health agencies by $1.1 billion below fiscal year 2005 levels, a
    cut of 2.2 percent as the accompanying table shows.
        The Coalition for Health Funding urges the Subcommittee on Labor,
    Health and Human Services and Education to reject the President's
    proposal to reduce the nation's investment in public health and instead
    join 425 health organizations that, in letter dated February 1, 2005,
    urged the President and Congress to make an investment in public health
    of $3.5 billion over fiscal year 2005 levels. As that letter states:

        ``The health of all Americans is at risk from an unprecedented
    range of threats, including: chronic diseases and disabilities,
    infectious and food borne illnesses, biological and chemical terrorism,
    mental disorders and substance abuse, catastrophic injuries, and a
    shortage of healthcare providers and trained public health workers.
        ``Our nation's public health system will not be able to respond
    adequately to these threats without additional resources for the
    continuum of medical research, prevention, treatment and training
    programs. We urge you to increase discretionary funding for public
    health through the Function 550 budget allocation in fiscal year 2006
    by $3.5 billion. This investment is critical to improving the health,
    safety and security of our nation.''

        The following is a partial list of the Coalition's fiscal year 2006
    recommendations for specific U.S. Public Health Service agencies. The
    Coalition developed these recommendations working with eight other
    health coalitions with a more targeted focus on one agency, or major
    activities within a particular agency. The table that follows provides
    the Coalition's recommendations for all the major public health
    agencies.

                      NATIONAL INSTITUTES OF HEALTH (NIH)

        The Coalition supports $30.1 billion in fiscal year 2006 for the
    National Institutes of Health, a 6 percent increase over the fiscal
    year 2005 funding level, to provide sufficient resources to sustain the
    momentum of the recently completed campaign to double the nation's
    investment in the promising research supported and conducted by the
    NIH. The President's request to provide $28.6 billion, or a .5 percent
    increase over fiscal year 2005, is inadequate to fully reap the
    research opportunities that the doubling campaign have made available.
    NIH is engaging the next generation of biomedical research to integrate
    and aggregate basic research, computational capabilities, and clinical
    evidence into new cures. Transforming America's health for the 21st
    century will require a longstanding commitment from our country and its
    leaders. The pace and intensity of this transformation is critical.
    Health improvements will only be possible if the medical research
    enterprise runs smoothly. Recent discoveries NIH supported research has
    made possible include: lifestyle intervention can reduce the onset of
    Type II diabetes as occurred in 58 percent of those at risk in a recent
    trial; islet cell transplantation has reduced the need for insulin for
    250 individuals with juvenile diabetes; low-cost diuretics are as
    effective as newer, costlier drugs in lowering high blood pressure that
    affects one in four Americans, potentially saving money and enhancing
    compliance; newer antidepressant medications are more targeted to
    specific brain function resulting in fewer side effects and enhanced
    compliance; great advances in understanding the genetic factors in
    Alzheimer's Disease holds promise for treatment for the growing number
    of Americans afflicted with this devastating disease; new vaccines have
    been developed against Haemophilus influenzae type b, pneumococcal
    disease, Hepatitis A and B and a new Ebola vaccine is currently in
    trial.
        Scientific discoveries are the result of a series of incremental
    steps that pave the way for future breakthroughs. This process needs
    sustained support. A funding increase of only .5 percent will delay
    important initiatives leading to earlier, more targeted diagnoses; more
    targeted, effective treatment options; and more comprehensive, cost-
    effective prevention strategies.

                CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)

        The Coalition for Health Funding recommends an overall funding
    level of $8.65 billion for CDC in fiscal year 2006. This amount is $616
    million more than the fiscal year 2005 funding level and $1.1 billion
    more the President's request for fiscal year 2006. The Coalition
    believes this is the amount needed to enable CDC to carry out its vital
    mission of disease prevention and health promotion.
        The Coalition opposes the President's request to cut $130 million
    from State and Local Preparedness grants and shift the funds to the
    Strategic National Stockpile (SNS) to purchase vaccines and terrorism
    countermeasures and fund a new $50 million Mass Casualty Initiative.
    Any SNS purchases and new federal terrorism initiatives, if deemed
    warranted, should be funded from new resources and not at the expense
    of State and Local Preparedness. State and Local health departments are
    in the third year of expanded funding for terrorism preparedness. The
    effect of a 14 percent cut will seriously jeopardize momentum in
    addressing critical capacity needs. Funding should be restored, at
    least, to fiscal year 2005 levels and the commitment to rebuilding the
    nation's neglected public health infrastructure resumed and sustained.
        The Coalition also opposes the proposed elimination of funding for
    the Preventive Health and Health Services Block Grant. This funding
    provides the only source of flexible funding to state health
    departments to help them meet Healthy People 2010 goals. The funding is
    often used in innovative ways which complement, not duplicate, other
    disease-specific categorical programs. It is also the only source of
    funding for many states to monitor well-contamination in poor rural
    areas. And it helps states cope with unexpected challenges such as
    emerging infectious diseases like West Nile Virus and the health
    consequences of disasters. Taken together, the proposed cut in the
    State and Local Bioterrorism grant program coupled with the elimination
    of the Preventive Block Grant seriously undermines funding for building
    State and Local public health capacity, a major Congressional goal
    expressed in legislation the year before (Public Law 106-505) and the
    year after (Public Law 107-188) the attacks of September 11, 2001.
        The Coalition is displeased that most of the rest of the programs
    and activities conducted by the CDC are proposed for flat funding in
    the President's budget. This is especially egregious for chronic
    disease programs at a time when the nation faces an epidemic of obesity
    and the ensuing increase in diabetes, heart disease, kidney disease,
    cancer, arthritis and other costly diseases. There should be a major
    national investment in finding ways to address this problem. The VERB
    program, eliminated in the President's budget, provides a model for
    reaching young adolescents; it should be replicated.
        Similarly, there is insufficient funding provided for infectious
    disease programs, most of which are flat-funded. The United States is
    still only partially prepared for diseases such as West Nile virus and
    pandemic flu, and has not committed funds to combat antimicrobial
    resistance commensurate with the scope and severity this problem
    presents in the United States. There are 40,000 new HIV infections each
    year which means the United States burden of HIV/AIDS is growing, not
    stagnant. The President's budget request does include increases for the
    National Immunization Program (+$50 million), but the Coalition
    supports an increase of $282 million in order to meet the national goal
    of vaccinating 90 percent of children and adults.
        Finally, the Coalition is, overall, deeply disappointed that the
    President's budget request cuts funding for the CDC, the nation's
    leading disease prevention/health promotion agency, by more than 6
    percent, instead of investing in this agency's potential for saving
    health care costs.

              HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)

        The Coalition for Health Funding recommends an overall funding
    level of $7.5 billion for HRSA in fiscal year 2006. This amount is $691
    million, or 10 percent, more than the fiscal year 2005 funding level,
    and is $1.5 billion more than the President's request. This is the
    amount that the Coalition believes is needed to provide adequate
    resources for the important programs that HRSA administers that address
    access to needed medical and health care services for medically
    underserved populations.
        The Coalition is pleased that the President has requested a
    significant 17 percent increase for Community Health Centers (CHC) for
    a total of $2.038 billion. These centers provide basic health care
    services for those who are medically underserved in both rural and
    inner city communities across the nation. With the number of uninsured
    rising, CHCs are more important than ever.
        There are many other areas in the HRSA budget that the President
    proposes to cut deeply that the Coalition opposes. Chief among these is
    the elimination of the Title VII Health Professions Education programs.
    These programs are beginning to document formally what their supporters
    have long known: that they have a solid track record in recruiting and
    training the kind of health professionals that practice in, and stay
    in, medically underserved areas. Graduates of these programs are 3-10
    times more likely to practice in underserved areas and are 2-5 times
    more likely to be minorities. The Title VII programs also have a solid
    track record in training needed health professionals in short supply
    including pharmacists, allied health professionals, dentists, a range
    of public health practitioners, psychologists, and physician
    assistants. These shortages will become worse as increasing numbers of
    the nation's healthcare workforce begin to retire and the babyboom
    generation requires increased care as it ages.
        The Coalition also opposes the elimination of five other programs:
    Community Access Program, an innovative program of coordinated service
    delivery to the uninsured that does not duplicate other available
    programs; the Trauma-EMS program which fosters statewide trauma system
    development to provide appropriate emergency response for seriously
    injured individuals--an important terrorism readiness component; the
    Children's EMS program which builds appropriate emergency response
    capacity for children; the Traumatic Brain Injury program which helps
    brain-injured individuals become successful community participants; the
    universal newborn screening program which ensures that all states
    screen infants for a core set of screening tests for genetic,
    metabolic, hormonal, or functional conditions many of which can be
    treated if detected and disability averted. The Coalition also opposes
    the $115 million cut to a number of rural programs, and the $101
    million cut to the Children's Hospitals Graduate Medical Education
    program.
        Also disturbing is the proposed level funding for many other
    programs. This includes the Nursing Education programs despite
    considerable documentation of the nursing shortage crisis. It also
    includes the Ryan White CARE Act programs at a time when the United
    States is experiencing 40,000 new HIV infections per year. The
    President's request for Ryan White programs, when compared to fiscal
    year 2005 levels, provides level funding for all titles except for the
    AIDS Drug Assistance Program which receives a $10 million increase--not
    enough to eliminate waiting lists for the life-saving drugs. The
    Maternal and Child Health Block Grant is a critical safety net program
    for poor women and special needs children. Flat-funding actually cuts
    services at a time when there is an upsurge in the number of families
    needing TANF assistance. Family Planning services, which support 4,600
    clinics across the United States that provide comprehensive services
    including screening for cancer, HIV, and other diseases as well as
    contraception and teen pregnancy prevention, are another critical
    safety net service that needs increased resources.
        Overall, the President proposes to cut existing HRSA programs by
    $838 million, or over 12 percent, at a time when the numbers of
    uninsured individuals and families is rising and they are turning to
    federally funded programs for assistance and care.

           SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

        The Coalition for Health Funding recommends an overall funding
    level of $3.5 billion for SAMHSA in fiscal year 2006. This amount is
    $262 million, or 8 percent, more than the fiscal year 2005 funding
    level, and $316 million more than the President's budget request, which
    includes a 54 million cut for SAMHSA programs.
        The Coalition is pleased that, for the third year, the President
    requests an increase for substance abuse treatment, although
    substantially less at $25 million than the last two years. However,
    once again, the increase comes at the expense of prevention which is
    slated for a $15 million cut. Substance abuse is a significant and very
    costly national problem involving an estimated 21.6 million Americans--
    over 9 percent of the population--and needs investment in both
    treatment and prevention. SAMHSA has developed a set of evidence-based
    model prevention programs that community-based organizations need help
    in implementing. On the treatment side, of the 1 million Americans who
    express a need for substance abuse treatment in a regularly conducted
    household survey, 273,000 (26 percent) report they made an effort to
    obtain treatment, but were unable to do so. Clearly, a stronger
    investment--which the President has championed--needs to be made to
    provide treatment when it is sought.
        The Coalition is very disappointed that the President's budget cuts
    mental health program funding at SAMHSA by $64 million. There is no
    additional investment made in response to the findings and
    recommendations of the President's New Freedom Commission on Mental
    Health, the first such commission in over 25 years. The Commission
    advised the President that youth with mental and emotional problems
    face enormous access barriers and that an alarming 80 percent of youth
    in juvenile detention facilities have mental disorders. Yet the
    President's budget cuts the Jail Diversion program in half and the
    successful Youth Violence Prevention program by $27 million. These cuts
    should not be accepted in the aftermath of the Red Lake school massacre
    in Minnesota.
        The Coalition sincerely appreciates this opportunity to provide its
    fiscal year 2006 funding recommendations to the Subcommittee for the
    agencies and programs of the U.S. Public Health Service. The
    Coalition's recommendations for all of the public health agencies are
    provided in the accompanying table. The Coalition, and its member
    organizations, look forward to working with the Subcommittee in the
    weeks ahead to improve the health of all Americans.

                                                        COALITION FOR HEALTH FUNDING 2006 RECOMMENDATIONS
                                                                      [Dollars in millions]
    --------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                    President's    Percent
                                                                                       dollar    President's                      Dolllar         Percent
                                                                       President's    request       request         CHF       difference CHF  difference CHF
                            Agency                           Fiscal      request    fiscal year  fiscal year  recommendation  recommendation  recommendation
                                                            year 2005  fiscal year     2006-        2006-       fiscal year     fiscal year     fiscal year
                                                                           2006     fiscal year  fiscal year       2006         2006-fiscal     2006-fiscal
                                                                                        2005         2005                        year 2005       year 2005
    --------------------------------------------------------------------------------------------------------------------------------------------------------
    NIH \1\..............................................     $28,444      $28,590        +$146         +0.5       $30,150         +$1,706            +6.0
    CDC \2\..............................................       8,034        7,543         -491         -6.1         8,650            +616            +7.7
    HRSA \1\.............................................       6,809        5,972         -837        -12.3         7,500            +691           +10.0
    SAMHSA \1\...........................................       3,269        3,215          -54         -1.6         3,531            +262            +8.0
    AHRQ.................................................         319          319  ...........  ...........           443            +124           +38.0
    FDA \1\..............................................       1,450        1,500          +50         +3.4         1,566            +116            +8.0
    IHS \1\..............................................       2,985        3,048          +63         +2.1         3,218            +232            +7.8
                                                          --------------------------------------------------------------------------------------------------
          Totals.........................................      51,310       50,187       -1,123         -2.2        55,058          +3,747           +6.8
    --------------------------------------------------------------------------------------------------------------------------------------------------------
    \1\ Reflects Total Budget Authority.
    \2\ Reflects Total Program Level.

                                     ______

      Prepared Statement of the Crohn's and Colitis Foundation of America

                  SUMMARY OF FISCAL YEAR 2006 RECOMMENDATIONS

        (1) A 6 percent increase for the National Institute of Diabetes,
    and Digestive and Kidney Diseases, and the National Institute of
    Allergy and Infectious Diseases and a corresponding increase for
    Inflammatory Bowel Disease Research at both institutes.
        (2) $1.5 Million for the National Inflammatory Bowel Disease
    Epidemiological Program at the Centers for Disease Control and
    Prevention.
        (3) $25 million for CDC's National Colorectal Cancer Screening
    Awareness Program.

                                  INTRODUCTION

        Mr. Chairman, thank you very much for the opportunity to present
    the views of the Crohn's and Colitis Foundation of America (CCFA). I am
    Rodger DeRose, President and Chief Executive Officer of CCFA and I am
    honored to represent the people of this country who suffer from Crohn's
    disease and ulcerative colitis.
        Crohn's disease and ulcerative colitis are chronic disorders of the
    gastrointestinal tract which represent a leading cause of morbidity
    from digestive illness. Because they behave similarly, these disorders
    are collectively known as inflammatory bowel disease (IBD). IBD can
    cause severe diarrhea, abdominal pain, fever, and rectal bleeding.
    Moreover, IBD related complications can include; arthritis,
    osteoporosis, anemia, liver disease, and colon cancer. Crohn's disease
    and ulcerative colitis are not fatal, but they can be devastating. We
    do not know their cause, and there is no medical cure.
        CCFA is a non-profit, voluntary organization dedicated to finding a
    cure for Crohn's disease and ulcerative colitis. Throughout its 38-year
    history, CCFA has sponsored basic and clinical research of the highest
    quality. The Foundation also offers a wide range of educational
    programs for patients and healthcare professionals, and provides
    support services to assist people in coping with these chronic
    intestinal diseases.
        We are extremely grateful Mr. Chairman, for your support of IBD
    related programs in the fiscal year 2005 Labor-HHS bill. Your
    leadership is making a tremendous difference in the lives of the
    patients and families that we serve.

                      RECOMMENDATIONS FOR FISCAL YEAR 2005

    (1) National Institutes of Health
        CCFA has developed highly successful research partnerships with the
    NIH. We are particularly proud of our longstanding collaborations with
    the National Institute of Diabetes and Digestive and Kidney Diseases
    (NIDDK) which sponsors the majority of IBD research at NIH, and the
    National Institute of Allergy and Infectious Diseases (NIAID).
        In 2001, a team of investigators from NIDDK, CCFA, and the private
    industry announced that they had identified the first gene for Crohn's
    disease. This historic breakthrough opens up exciting new pathways of
    research focused on the development of improved therapies for Crohn's
    disease patients. The research which led to the discovery of the gene
    would not have been possible without the strong support that Congress
    has provided to the NIDDK in recent years.
        Some of the most promising IBD research supported by the NIH has
    focused on translating findings from studies conducted on animal models
    to humans with IBD. These animal models have enabled researchers to
    form the current hypothesis that Crohn's disease and ulcerative colitis
    are caused by a malfunctioning immune system, wherein components of the
    patient's immune system overreact to normal intestinal bacteria. We
    know that people are susceptible to this malfunction because of their
    genetic makeup but further research is necessary to determine which
    bacteria are responsible, how these bacteria interact with the
    intestine's immune system, and which immune system components are
    involved.
        Mr. Chairman, IBD patients and their families are pinning their
    hopes for a better life on medical advancements made through NIH
    sponsored research. For this reason, CCFA recommends a 6 percent
    increase for NIDDK, NIAID, and NIH overall in fiscal year 2006.
    Moreover, CCFA encourages the subcommittee to increase IBD research
    funding within NIDDK and NIAID at the same rate as NIH overall.
    (2) Centers for Disease Control and Prevention
                IBD Epidemiology Program
        Mr. Chairman, CCFA estimates that ``up to one million'' people in
    the United States suffer from IBD. Unfortunately, we do not have an
    exact number; due to the complicated nature of those diseases, patients
    may remain undiagnosed or misdiagnosed for several years.
        One of CCFA's main public policy objectives has been the
    establishment of a nationwide IBD epidemiological program in
    partnership with the Centers for Disease Control and Prevention.
        We are extremely grateful for your leadership in providing $750,000
    within CDC's National Center for Chronic Disease Prevention and Health
    Promotion for this much needed project in the fiscal year 2005 Labor-
    HHS bill. This program, which was initially funded through private
    support provided to CDC from our Foundation, will further our
    understanding of both the prevalence of IBD in the United States, and
    the demographic characteristics of this unique patient population.
        The cultivation of patient demographic information is critically
    important to our biomedical research efforts given that environmental
    factors are believed to play a major role in the development and
    progression of IBD. If we are able to generate an accurate analysis of
    the geographic makeup of the IBD patient population, it will provide us
    with invaluable clues about the potential causes of IBD.
        CDC, in partnership with our scientific experts, are making
    significant progress on the epidemiology study. Phase one of the study
    has been completed and is being prepared for publication this summer.
    Plans are currently underway to expand the study to other key areas of
    investigation. For fiscal year 2006, CCFA respectfully requests an
    appropriation of $1.5 million for the continuation of the epidemiology
    study within the National Center for Chronic Disease Prevention and
    Health Promotion.
                Colorectal Cancer Prevention
        Finally Mr. Chairman, in addition to coping with either Crohn's
    disease or ulcerative colitis, many IBD patients are at high risk for
    developing colorectal cancer. As you may know, colorectal cancer is the
    third most commonly diagnosed cancer for both men and women in the
    United States and the second leading cause of cancer-related deaths.
    Because people who have suffered from IBD for more than 8 years are
    susceptible to this disease, CCFA has a long history of actively
    promoting the benefits of colorectal cancer screening.
        Although colorectal cancer is almost entirely curable when detected
    early, studies have shown a tremendous need to: (1) inform the public
    about the availability and advisability of screening and (2) educate
    healthcare providers about screening guidelines. CDC's National
    Colorectal Cancer Roundtable is actively working to address these
    challenges by partnering with organizations like CCFA to implement a
    national public awareness campaign emphasizing the importance of
    screening and early detection. Moreover, CDC's ``Screen for Life''
    awareness campaign is actively promoting the importance of colorectal
    cancer screening via television, radio and print media. CCFA encourages
    the subcommittee to provide CDC with $25 million in fiscal year 2006 to
    support its colorectal cancer prevention activities.
        Once again, Mr. Chairman, thank you for the opportunity to present
    the views of Crohn's and Colitis Foundation of America. We look forward
    to continuing to work with you on these important issues.
                                     ______

     Prepared Statement of the Developmental Disabilities Research Centers
                                  Association

        Mr. Chairman, on behalf of the Developmental Disabilities Research
    Centers Association (DDRCA), I thank you for this opportunity to share
    with you and your Committee, some of the exciting achievements that are
    happening in the world of developmental disabilities and mental
    retardation research. I am Steven F. Warren, Director of the Kansas
    Mental Retardation and Developmental Disabilities Research Center at
    the University of Kansas and Chair of the Developmental Disabilities
    Research Centers Association. First, let me tell you a little about our
    Association.
        The DDRCA is a national resource that grew out of Congress' mandate
    in 1963 to establish ``centers of excellence'' in mental retardation
    and developmental disabilities research. With funding from the National
    Institute of Child Health and Human Development, our 20 member Centers
    represent the nation's first sustained and integrated effort to prevent
    and treat disabilities through biomedical and behavioral research.
    Today, we are the world's largest concentration of scientific expertise
    in the fields of intellectual and developmental disabilities. We
    believe that our Centers, and the network they form, substantially
    foster communication, innovation, and excellence in research. We work
    collaboratively on a number of research projects, and together with the
    Society for Developmental Pediatrics, produce the quarterly
    publication, ``Mental Retardation and Developmental Disabilities
    Research Reviews.'' Each edition highlights the exciting new research
    on a developmental disability.
        Our research Centers are located within premier research intensive
    universities and often are affiliated with major medical centers which
    provide academic, scientific and often clinical expertise as well as
    institutional support. Collectively, our work represents a
    multidisciplinary, vigorous, and innovative research program directed
    at understanding, treating and eventually substantially reducing the
    incidence of developmental disabilities including mental retardation.
    Additionally, our investigators are engaged in a very important
    mission--training the next generation of scientific investigators and
    clinicians in this area of great importance to America's children and
    families.
        Although a significant portion of the research portfolios at the
    Centers consists of fundamental studies that are directed at
    understanding the biological and behavioral processes in animal models
    and human subjects, each Center directs considerable attention toward
    seeking solutions to practical issues and problems. Our connection to
    the University Centers for Excellence in Developmental Disabilities
    (UCEDDs) is critical in relating our research to practice. The scope of
    the research conducted at the Centers encompasses every known major
    dimension of mental retardation.
        Over the last three decades there has been a huge payoff in the
    federal investment in the Developmental Disabilities Research Centers.
    Many disorders that cause intellectual disabilities can be prevented or
    treated to improve developmental outcomes. The Centers' scientific
    achievements have helped improve quality of life for individuals and
    families affected by disabilities. Among the most exciting aspects of
    this research is the work that is getting close to understanding the
    fundamental biological mechanisms that contribute to many of these
    disabilities with development of interventional strategies. I am
    pleased to share some examples with you.
        Brain Imaging Technologies.--We are all familiar now with magnetic
    resonance imaging or MRI technology. Many of us have experienced this
    technology as it has been used increasingly over the past 12 years as a
    way for physicians to see increasingly higher resolution images of the
    brain as well as to measure local brain activity and metabolism.
    Functional magnetic resonance imaging (fMRI) provides a way to examine
    brain processing during complex behavior such as thinking and reading.
    Signal abnormalities associated with several diseases and syndromes
    that dramatically affect behavior and cognition have been
    characterized, including fragile X syndrome, Rett syndrome, Turner
    syndrome, Tourette syndrome and neurofibromatosis.
        At the Kennedy Krieger Institute (KKI), the Mental Retardation
    Developmental Disability Research Center at Johns Hopkins University in
    Baltimore, MD., they have utilized functional brain imaging to
    establish a link between the lowering of vocabulary in children with
    neurofibromatosis (NF-1) and enlargement of the cerebrum. More detailed
    imaging techniques called spectroscopy imaging was then used to locate
    the specific regions of the brain that linked with the loss of
    vocabulary and cognitive functioning. A similar type of cerebral
    enlargement was discovered in autistic children by investigators at the
    University of North Carolina Mental Retardation Research Center.
    Understanding the processes of increased rates of brain growth will
    help lead researchers to finding preventive measures to stop the
    results of loss of IQ or vocabulary in these children.
        Brain Growth and Development.--We are aware that the brain develops
    complex circuitry both under the guidance of internal genetic cues and
    in response to the brain's interaction with the outside world through
    activity and experiences ranging from simple sensation to complex
    behavioral interaction between the child and others. Developmental
    problems result when genetic errors occur either through the expression
    of an inherited copy of a deleterious gene, through chromosomal
    abnormalities or when environmental factors may modify the expression
    pattern of genes. In addition, the developing brain is particularly
    sensitive to exposure to environmental toxins such as alcohol or lead.
    These insights into brain development provide a foundation for
    prevention through biomedical and behavioral intervention. During the
    initial formation of the brain in the fetus and in early postnatal life
    of the child, new nerve cells are forming and each one must extend fine
    processes that migrate through the brain to their correct targets and
    then they must establish the right connections (synapses) and assemble
    those synapses into the functional networks of communication sites
    whereby each cell in our brain talks to the next and communicates with
    the outside world. Many developmental disorders such as neonatal
    seizures that occur due to the mislocation of the brain's nerve cells
    to abnormal sites (heterotopia) or due to the failure of synapses to
    form their proper structural arrangements through a refinement process
    such as fragile X syndrome, result from the failure of synaptic
    connections to properly form in the developing brain. In order to
    understand a brain that has developed abnormally, leading to mental
    retardation or other developmental disabilities, it is necessary to
    understand the normal processes that guide this development.
        At the Civitan International Research Center and Mental Retardation
    Research Center at the University of Alabama at Birmingham,
    investigators have discovered a new particle that forms in nerve cells
    during their earliest stages of development that brings together all of
    the necessary molecules to allow formation of a newborn synapse. At the
    University of North Carolina Mental Retardation research Center,
    investigators have determined the chemical pathways for regulating the
    migration of newborn neurons' in the developing brain. Several groups
    of investigators have determined how the fragile X gene product protein
    plays a role in the normal refinement of synapses in the normal
    developing brain and the consequences of interference with this
    protein's production in humans with fragile X syndrome and animal
    models. The functional consequences of this abnormal development
    include abnormally strong responses to sensory stimuli as determined by
    investigators from the University of Colorado Mental Retardation/
    Developmental Disabilities Research Center. This work is providing the
    scaffolding for designing strategies for specifically targeting early
    molecular events in the formation of the brain that may go awry in
    order to prevent or correct disorders of synaptic development.
        Language and Communication.--Language and communication are key
    aspects in a human's ability to function in society. Researchers now
    know that the first 48 months of life is an optimal period in brain
    development for language acquisition and therefore is a period when
    intervention can have the greatest impact on a child's overall
    communication ability. With this in mind, researchers are asking the
    question, ``Are there linkages between language impairments and various
    developmental disabilities or syndromes?''
        The Kansas Mental Retardation Developmental Disability Research
    Center asked a more specific question. ``Do some children with Specific
    Language Impairment (SLI) and children with some forms of autism share
    a genetic relationship?'' Research conducted in Kansas suggests that
    this may be the case. Children with SLI often show a particular grammar
    deficit, an inability to accurately mark tense in the sentences they
    produce. Research reveals that this deficit may even be inherited.
    Collaboration with researchers at the Shriver Center Mental Retardation
    Research Center in Massachusetts shows that children with autism were
    also found to exhibit this tense-marking deficit. On the other hand,
    collaboration with researchers at the University of Louisville in
    Kentucky demonstrated that children with William's syndrome do not show
    this deficit. Researchers at the University of Texas Health Sciences
    Center in Houston have found that in dyslexic children, remedial
    training is helpful and that this training results in changes in
    patterns of brain activation similar to those seen in proficient
    readers. This work will ultimately lead to better identification and
    effective interventions to limit the disability caused by these
    disorders.
        Early Identification and Intervention.--Researchers are learning
    that early intervention as well as early identification of a problem
    can lead to dramatically different life outcomes for a child and his/
    her family. At the Civitan International Research Center at the
    University of Alabama at Birmingham MRRC, investigators have begun
    using a dramatic new training regiment in children with cerebral palsy.
    This therapy termed pediatric constraint induced intensive therapy
    (PCIIT) involves limiting the child's use of the most affected limb
    with intensive training of the other limb over several weeks. Similar
    to its beneficial effect in adults who have experienced stroke, this
    therapy results in improved use of the trained limb. Investigators will
    evaluate whether this therapy in children results in similar massive
    functional reorganization of the brain as occurs in adult stroke
    patients. The Mental Retardation Research Center at the University of
    Washington in Seattle, has devoted a great deal of its research to
    early intervention studies. Behavioral scientists there have enhanced
    the ability to recognize autism in the first two years of life. The new
    neuropsychological and brain-imaging findings in autism indicate that
    the severity observed reflects different underlying neurobiological
    bases that can be readily identified; these findings may now help focus
    early intervention programs. Other investigators in this field have
    identified and characterized the unique peer interaction deficits
    experienced by a vast majority of young children with developmental
    disabilities. Researchers who study early intervention developed a
    methodology to evaluate parent/child interactions using feeding and
    teaching scales, a methodology that has been extremely useful in
    identifying problem areas for children who are at risk. Researchers at
    the Waisman Mental Retardation Research Center at the University of
    Wisconsin in Madison, Wisconsin, have developed a method using gene
    sequencing technology to determine if children suffer from a rare but
    progressive disorder in children that has profound effects on cognitive
    development, Alexander's disease. By comparing their results with gene
    analysis to those obtained with more conventional clinical and fMRI
    analysis, these investigators have determined that a more definitive
    early diagnosis can be made with modern genetic tests. This work is
    contributing to our ability to identify and treat developmental
    disorders earlier and more effectively.
        Genetics.--About 40 to 60 percent of known causes of moderate to
    severe mental retardation have genetic origins. Researchers are working
    on DNA probes designed to identify specific genes, to distinguish
    abnormal genes, and to identify genes responsible for specific
    disabilities such as Duchenne muscular dystrophy. Investigators have
    succeeded in mapping genes responsible for disabilities caused by
    enzyme defects, storage diseases, and other inborn errors of
    metabolism. Researchers have identified genes located on chromosome 21
    known to be associated with Down syndrome and Alzheimer's disease.
    Researchers at the Baylor College of Medicine Mental Retardation
    Research Center in Houston, TX have discovered an X chromosome-linked
    gene that is associated with a large percentage of patients with Rett
    syndrome a neurodevelopmental disorder that primarily affects infant
    girls (the leading cause of mental retardation in girls) causing loss
    of speech, purposeful hand movements, seizures, ataxia and apraxia,
    episodes of apnea (breath holding) and sometimes death. Utilizing a
    mouse model, investigators at Baylor are investigating which genes are
    silenced in Rett and the underlying biological consequences of this
    process on neural development and synaptic function. Mutations in the
    same gene that causes Rett syndrome can also lead to other
    developmental disorders including autism and mild mental retardation as
    well as bipolar disorders and schizophrenia. Researchers at the
    University of Kansas Institute for Child Development have determined
    that children with Prader-Willi syndrome (the most common known form of
    genetically caused obesity) who have a life threatening eating disorder
    also display obsessive compulsive disorder (OCD). Both of these
    disorders may be caused by a gene defect on chromosome 15 causing lack
    of inhibition of brain centers involved with OCD and other brain
    centers that regulate growth hormone.This work is giving investigators
    a rich source of animal models to precisely identify the mechanisms
    whereby genetic defects cause developmental disorders and is providing
    the potential therapeutic targets for correcting the consequences of
    these disorders in humans.
        While we have come a long way over the last 30 years, we still have
    far to go. With knowledge generated by the DDRCs, we will be able to:
      --Use brain imaging and genetic methods to better understand the
            causes of specific disabilities and design strategies for
            treatment.
      --Develop new therapies to prevent or reverse some of the symptoms of
            specific disabilities.
      --Better understand the process of brain cell development and
            enrichment through studying the interplay of the brain's own
            chemistry with a child's experiences.
      --Prevent many types of developmental disabilities by treating
            maternal infections and viruses transmitted to their infants.
      --Capitalize on the brain's natural ``plasticity'' to optimize brain
            development in children born with developmental disabilities
            through early intervention or by extending the period of brain
            development.
      --Design learning environments so all children have improved academic
            outcomes, including those with learning and intellectual
            disabilities.
      --Determine which child with a disability will respond best to which
            speech or communication learning approach.
      --Develop culturally competent psychological and medical assessment
            and treatment procedures for children born into minority
            families.
      --Prevent and treat atypical behavior among children and adults with
            disabilities who are especially prone to such difficulties,
            such as children with autism, fragile X syndrome, or Rett's
            syndrome.
      --Assist families in preparing their adult sons and daughters with
            disabilities for successful lives of their own and prepare
            older people with developmental disabilities for coping with
            the normal process of aging.
        To address our concerns, we respectfully ask the Committee to
    increase NIH funding to $30.067 billion for fiscal year 2006.
    Additionally, we ask that you increase funding for NICHD to the level
    of $1.34 billion for fiscal year 2006.
        Again, I thank you Mr. Chairman for taking time to learn about the
    DDRC network and the scope of work being conducted at these Centers
    across the nation. Together we believe that we are making strong
    headway in finding solutions to the many diseases and disabilities,
    which affect the children and adults of our society. With your
    continued support, and that of the Subcommittee, we can make great
    strides into the future.
                                     ______

         Prepared Statement of the Digestive Disease National Coalition

                  SUMMARY OF FISCAL YEAR 2006 RECOMMENDATIONS

      --Provide increased funding for the National Institutes of Health
            (NIH) at 6 percent for fiscal year 2006. Increase funding for
            the National Cancer Institute (NCI), the National Institute of
            Diabetes and Digestive and Kidney Diseases (NIDDK) and the
            National Institute of Allergy and Infectious Diseases by 6
            percent.
      --Continue focus on digestive disease research and education at NIH,
            including the areas of Inflammatory Bowel Disease (IBD),
            Hepatitis and other liver diseases, Irritable Bowel Syndrome
            (IBS), Colorectal Cancer, Endoscopic Research, Pancreatic
            Cancer, Celiac Disease, and Hemochromatosis.
      --$30 million for the Centers for Disease Control and Prevention's
            (CDC) Hepatitis Prevention and Control activities.
      --$25 million for the Center for Disease Control and Prevention's
            (CDC) Colorectal Cancer Screening and Prevention Program.
        Chairman Specter, thank you for the opportunity to again submit
    testimony to the Subcommittee. Founded in 1978, the Digestive Disease
    National Coalition (DDNC) is a voluntary health organization comprised
    of 27 professional societies and patient organizations concerned with
    the many diseases of the digestive tract. The Coalition has as its goal
    a desire to improve the health and the quality of life of the millions
    of Americans suffering from both acute and chronic digestive diseases.
        The DDNC promotes a strong federal investment in digestive disease
    research, patient care, disease prevention, and public awareness. The
    DDNC is a broad coalition of groups representing disorders such as
    Inflammatory Bowel Disease (IBD), Hepatitis and other liver diseases,
    Irritable Bowel Syndrome (IBS), Pancreatic Cancer, Ulcers, Pediatric
    and Adult Gastroesophageal Reflux Disease, Colorectal Cancer, Celiac
    Disease, and Hemochromatosis.
        Mr. Chairman, the social and economic impact of digestive disease
    is enormous and difficult to grasp. Digestive disorders afflict
    approximately 65 million Americans. This results in 50 million visits
    to physicians, over 10 million hospitalizations, collectively 230
    million days of restricted activity. The total cost associated with
    digestive diseases has been conservatively estimated at $60 billion a
    year.
        The DDNC would like to thank the subcommittee for its past support
    of digestive disease research and prevention programs at the National
    Institutes of Health (NIH) and the Centers for Disease Control and
    Prevention (CDC). With respect to the coming fiscal year the DDNC is
    recommending an increase of 6 percent ($1.7 billion) to $30.1 billion
    for the National Institutes of Health (NIH) and all of its Institutes.
        Specifically the DDNC recommends:
      --$5.1 billion for the National Cancer Institute (NCI).
      --$1.9 million for the National Institute of Diabetes and Digestive
            and Kidney Disease (NIDDK).
      --$4.66 billion for the National Institute of Allergy and Infectious
            Diseases (NIAID).
        We at the DDNC respectfully request that any increase for NIH does
    not come at the expense of other Public Health Service agencies.
        With the completed and the challenging budgetary constraints the
    Subcommittee currently operates under, the DDNC would like to highlight
    the research being accomplished by NIDDK which warrants the increase
    for NIH.

                           INFLAMMATORY BOWEL DISEASE

        In the United States today about 1 million people suffer from
    Crohn's disease and ulcerative colitis, collectively known as
    Inflammatory Bowel Disease (IBD). These are serious diseases that
    affect the gastrointestinal tract causing bleeding, diarrhea, abdominal
    pain, and fever. Complications arising from IBD can include anemia,
    ulcers of the skin, eye disease, colon cancer, liver disease,
    arthritis, and osteoporosis. Crohn's disease and ulcerative colitis are
    not usually fatal but can be devastating. The cause of IBD is still
    unknown, but research has led to great breakthroughs in therapy.
        In recent years researchers have made significant progress in the
    fight against IBD. In 1998, the FDA approved the first drug ever
    specifically to fight Crohn's disease, a remarkable milestone. The DDNC
    encourages the subcommittee to continue its support of IBD research at
    NIDDK and NIAID at a level commensurate with the overall increase for
    each institute. The DDNC would like to applaud the NIDDK for its strong
    commitment to IBD research through the Inflammatory Bowel Disease
    Genetics Research Consortium. The DDNC urges the Consortium will
    continue its work in IBD research. Given the recent advancements in
    treatment for these diseases and the increased risk that IBD patients
    have for developing colorectal cancer, the DDNC strongly believes that
    generating improved epidemiological information on the IBD population
    is essential if we are to provide patients with the best possible care.
    Therefore the DDNC and its member organization the Crohn's and Colitis
    Foundation of America encourage the CDC to initiate a nationwide IBD
    surveillance and epidemiological program in fiscal year 2006.

                    HEPATITIS C: A LOOMING THREAT TO HEALTH

        It is estimated that there are over 4 million Americans who have
    been infected with Hepatitis C of which over 2.7 million remain
    chronically infected. About 10,000 die each year and the Centers for
    Disease Control and Prevention (CDC) estimates that the death rate will
    more than triple by 2010 unless there is additional research,
    education, and more effective treatments and public health
    interventions. Hepatitis C infection is the largest single cause for
    liver transplantation and one of the principal causes of liver cancer
    and cirrhosis. There is currently no vaccine for hepatitis C, and
    treatment has limited success, making the infection among the most
    costly diseases in terms of health care costs, lost wages, and reduced
    productivity. Patients who are older at the time of infection, those
    who continually ingest alcohol, and those co-infected with HIV
    demonstrate accelerated progression to more advanced liver disease.
        The DDNC applauds all the work NIH and CDC have accomplished over
    the past year in the areas of hepatitis and liver disease. The DDNC
    urges that funding be focused on expanding the capability of state
    health departments, particularly to enhance resources available to the
    hepatitis C state coordinators. The DDNC also urges that CDC increase
    the number of cooperative agreements with coalition partners to develop
    and distribute health, education, communication and training materials
    about prevention, diagnosis and medical management for hepatitis A, B,
    and C.
        The DDNC supports $30 million for the CDC's Hepatitis Prevention
    and Control activities. The hepatitis division at CDC supports the
    hepatitis C prevention strategy and other cooperative nationwide
    activities aimed at prevention and awareness of hepatitis A, B, and C.
    The DDNC also urges the CDC's leadership and support for the National
    Viral Hepatitis Roundtable to establish a comprehensive approach among
    all stakeholders for viral hepatitis prevention, education, strategic
    coordination, and advocacy.

                          COLORECTAL CANCER PREVENTION

        Colorectal cancer is the third most commonly diagnosed cancer for
    both men and woman in the United States and the second leading cause of
    cancer-related deaths. Colorectal cancer affects men and women equally.
    Although colorectal cancer is preventable and curable when polyps are
    detected early, a General Accounting Office report issued in March 2000
    documented that less than 10 percent of Medicare beneficiaries have
    been screened for colorectal cancer. This report revealed a tremendous
    need to inform the public about the availability of screening and
    educate health care providers about colorectal cancer screening
    guidelines. In 2003, the New York City Department of Health has
    recommended colonoscopy for everyone over age 50 to prevent colorectal
    cancer.
        The DDNC recommends a funding level of $25 million for the CDC's
    Colorectal Cancer Screening and Prevention Program. This important
    program supports enhanced colorectal screening and public awareness
    activities throughout the United States. The DDNC also supports the
    continued development of the CDC-supported National Colorectal Cancer
    Roundtable, which provides a forum among organizations concerned with
    colorectal cancer to develop and implement consistent prevention,
    screening, and awareness strategies.

                               PANCREATIC CANCER

        In 2002, an estimated 28,300 people in the United States were found
    to have pancreatic cancer and approximately 28,200 died from the
    disease. Pancreatic cancer is the fifth leading cause of cancer death
    in men and women. Only 2 out of 10 patients will live 1 year after the
    cancer is found and only a very few will survive after 5 years.
    Although we do not know exactly what causes pancreatic cancer, several
    risk factors linked to the disease have been identified:
        (1) Age: Most people are over 60 years old when the cancer is
    found;
        (2) Sex: Men have pancreatic cancer more often than women
        (3) Race: African Americans are more likely to develop pancreatic
    cancer than are white or Asian Americans
        (4) Smoking
        (5) Diet: Increased red meats and fats
        (6) Diabetes
        The National Cancer Institute (NCI) has established a Pancreatic
    Cancer Progress Review Group charged with developing a detailed
    research agenda for the disease. The DDNC encourages the Subcommittee
    to provide an increase for pancreatic cancer research at a level
    commensurate with the overall percentage increase for NCI and NIDDK.

                         IRRITABLE BOWEL SYNDROME (IBS)

        IBS is a disorder that affects an estimated 35 million Americans.
    The medical community has been slow in recognizing IBS as a legitimate
    disease and the burden of illness associated with it. Patients often
    see several doctors before they are given an accurate diagnosis. Once a
    diagnosis of IBS is made, medical treatment is limited because the
    medical community still does not understand the pathophysiology of the
    underlying conditions.
        Living with IBS is a challenge, patients face a life of learning to
    manage a chronic illness that is accompanied by pain and unrelenting
    gastrointestinal symptoms. Trying to learn how to manage the symptoms
    is not easy. There is a loss of spontaneity when symptoms may intrude
    at any time. IBS is an unpredictable and fickle disease. A patient can
    wake up in the morning feeling fine and within a short time encounter
    abdominal cramping to the point of being doubled over in pain and
    unable to function.
        The unpredictable bowel symptoms may make it next to impossible to
    leave your home. It is difficult to ease the pain than may repeatedly
    occur periodically throughout the day. A patient can become reluctant
    to eat for fear that just eating a meal will trigger symptoms all over
    again. IBS has a broad and significant impact on a person's quality of
    life. It strikes individuals from all walks of life and results in a
    significant toll of human suffering and disability.
        While there is much we don't understand about the causes and
    treatment of IBS, we do know that IBS is a chronic complex of systems
    affecting as many as 1 in 5 adults. In addition:
        (1) It is reported more by women than men
        (2) It is the most common gastrointestinal diagnosis among
    gastroenterology practices in the United States
        (3) It is a leading cause of worker absenteeism in the United
    States
        (4) It costs the U.S. Health Care System an estimated $8 billion
    annually.
        Mr. Chairman, much more can still be done to address the needs of
    the nearly 35 million Americans suffering from irritable bowel syndrome
    and other functional gastrointestinal disorders.

                                 CELIAC DISEASE

        Celiac Disease is a life-long condition in which the body develops
    an allergy to gluten, a protein found in wheat, barley, and rye, which
    can result in damage to the small intestine. Celiac disease affects as
    many as two million Americans. Onset of the disease can occur at any
    age. The common symptoms of Celiac Disease include fatigue, anemia,
    chronic diarrhea or constipation, weight loss, and bone pain. The only
    treatment for celiac disease is strict adherence to a gluten-free diet.
    Undiagnosed and untreated celiac disease can lead to other disorders
    such as osteoporosis, infertility, neurological conditions, and in rare
    cases cancer. Persons with Celiac Disease often have other associated
    autoimmune disorders as well.

                          DIGESTIVE DISEASE COMMISSION

        In 1976, Congress enacted Public Law 94-562, which created a
    National Commission on Digestive Diseases. The Commission was charged
    with assessing the state of digestive diseases in the United States,
    identifying areas in which improvement in the management of digestive
    diseases can be accomplished and to create a long-range plan to
    recommend resources to effectively deal with such diseases. The
    Commission's subsequent report in 1979 laid the groundwork for
    significant progress in the area of digestive disease research.
        After almost 25 years, however, the burden of digestive diseases
    among the U.S. population remains substantial. The DDNC, therefore,
    calls upon Congress to establish a contemporary Digestive Diseases
    Commission to address the numerous digestive disorders that remain in
    today's diverse population.
        The Commission should be comprised of the nation's leading non-
    governmental scientists, physicians, and health professionals,
    including practicing clinical gastroenterologists and researchers
    studying in the field of digestive diseases. Congress should charge the
    Commission with the following:
        (1) Conducting a comprehensive study of the present state of
    knowledge of the incidence, duration, and morbidity of, and mortality
    rates resulting from, digestive diseases and of the social and economic
    impact of such diseases;
        (2) Evaluating the public and private facilities and resources
    (including trained personnel and research activities) for the
    diagnosis, prevention, and treatment of, and research in, such
    diseases; and
        (3) Identifying programs (including biological, behavioral,
    nutritional, environmental, and social programs) in which, and the
    means by which, improvement in the management of digestive diseases can
    be accomplished.
        The Commission also should develop and recommend a long-range plan
    for the use and organization of national resources to effectively deal
    with digestive diseases, related nutritional disorders and basic
    biological processes and mechanisms in nutrition which are related to
    digestive diseases. Finally, the Commission should recommend for each
    of the Institutes of the NIH whose activities are to be affected by the
    long-range plan estimates of the expenditures needed to carry out each
    Institute's part of the overall program.

                                   CONCLUSION

        The DDNC understand the challenging budgetary constraints and times
    we live in that is subcommittee is operating under, yet we hope you
    will carefully consider the tremendous benefits to be gained by
    supporting a strong research and education program at NIH and CDC.
    Millions of Americans are pinning their hopes for a better life, or
    even life itself, on digestive disease research conducted through the
    National Institutes of Health.
        Mr. Chairman, on behalf of the millions of digestive disease
    sufferers, we appreciate your consideration of the views of the
    Digestive Disease National Coalition. We look forward to working with
    you and your staff.

                      DIGESTIVE DISEASE NATIONAL COALITION

        The Digestive Disease National Coalition was founded 25 years ago.
    Since its inception, the goals of the coalition have remained the same:
    to work cooperatively to improve access to and the quality of digestive
    disease health care in order to promote the best possible medical
    outcome and quality of life for current and future patients with
    digestive diseases.
                                     ______

               Prepared Statement of the Doris Day Animal League

        The Doris Day Animal League represents 350,000 members and
    supporters nationwide who support a strong commitment by the federal
    government to research, development, standardization, validation and
    acceptance of non-animal and other alternative test methods. We are
    also submitting our testimony on behalf of People for the Ethical
    Treatment of Animals and the Animal Welfare Institute and their 800,000
    members and supporters. Thank you for the opportunity to present
    testimony relevant to the fiscal year 2006 budget request for the
    National Institute of Environmental Health Sciences for the Center for
    the Evaluation of Alternative Toxicological Test Methods (NICEATM) for
    the Interagency Coordinating Committee for the Validation of
    Alternative Test Methods (ICCVAM) activities for fiscal year 2006.
        In 2000, the passage of the ICCVAM Authorization Act into Public
    Law 106-545, created a new paradigm for the field of toxicology. It
    requires federal regulatory agencies to ensure that new and revised
    animal and alternative test methods be scientifically validated prior
    to recommending or requiring use by industry. An internationally agreed
    upon definition of validation is supported by the 15 federal regulatory
    and research agencies that compose the Interagency Coordinating
    Committee for the Validation of Alternative Methods (ICCVAM), including
    the EPA. The definition is: ``the process by which the reliability and
    relevance of a procedure are established for a specific use.''

                             FUNCTION OF THE ICCVAM

        The ICCVAM performs an invaluable function for regulatory agencies,
    industry, public health and animal protection organizations by
    assessing the validation of new, revised and alternative toxicological
    test methods that have interagency application. After appropriate
    independent peer review of the test method, the ICCVAM recommends the
    test to the federal regulatory agencies that regulated the particular
    endpoint the test measures. In turn, the federal agencies maintain
    their authority to incorporate the validated test methods as
    appropriate for the agencies' regulatory mandates. This streamlined
    approach to assessment of validation of new, revised and alternative
    test methods has reduced the regulator burden of individual agencies,
    provided a ``one-stop shop'' for industry, animal protection, public
    health and environmental advocates for consideration of methods and set
    uniform criteria for what constitutes a validated test methods. In
    addition, from the perspective of animal protection advocates, ICCVAM
    can served to appropriately assess test methods that can refine, reduce
    and replace the use of animals in toxicological testing. This function
    will provide credibility to the argument that scientifically validated
    alternative test methods, which refine, reduce of replace animals,
    should be expeditiously integrated into federal toxicological
    regulations, requirements and recommendations.

                               HISTORY OF ICCVAM

        The ICCVAM is currently composed of representatives from the
    relevant federal regulatory and research agencies. It was created from
    an initial mandate in the NIH Revitalization Act of 1993 for NIEHS to
    ``(a) establish criteria for the validation and regulatory acceptance
    of alternative testing methods, and (b) recommend a process through
    which scientifically validated alternative methods can be accepted for
    regulatory use.'' In 1994, NIEHS established the ad hoc ICCVAM to write
    a report that would recommend criteria and processes for validation and
    regulatory acceptance of toxicological testing methods that would be
    useful to federal agencies and the scientific community. Through a
    series of public meetings, interested stakeholders and agency
    representatives from all 14 regulatory and research agencies, developed
    the NIH Publication No. 97-3981, ``Validation and Regulatory Acceptance
    of Toxicological Test Methods.'' This report, and subsequent revisions,
    has become the sound science guide for consideration of new, revised
    and alternative test methods by the federal agencies and interested
    stakeholders.
        After publication of the report, the ad hoc ICCVAM moved to
    standing status under the NIEHS' NICEATM. Representatives from federal
    regulatory and research agencies and their programs have continued to
    meet, with advice from the NICEATM's Advisory Committee and independent
    peer review committees, to assess the validation of new, revised and
    alternative toxicological methods. Since then, several methods have
    undergone rigorous assessment and are deemed scientifically valid and
    acceptable. In addition, the ICCVAM is working to streamline assessment
    of methods from the European Union (EU) that have already been
    validated for use within the EU. The open public comment process, input
    by interested stakeholders and the continued commitment by the federal
    agencies has led to ICCVAM's success. It has resulted in a more
    coordinated review process for rigorous scientific assessment of the
    validation of new, revised and alternative test methods.

                           REQUEST FOR APPROPRIATIONS

        On December 19, 2000, the ``ICCVAM Authorization Act'' which makes
    the entity a permanent standing committee, was signed into Public Law
    No. 106-545. For several years, the NIEHS has provided between $1 and
    $2.6 million per fiscal year to the NICEATM for ICCVAM's activities. In
    order to ensure that federal regulatory agencies and their stakeholders
    benefit from the work of the ICCVAM, it is important to fund it at an
    appropriate level. I respectfully urge the Subcommittee to support
    increasing appropriations from within NIEHS' existing budget request
    for NICEATM for ICCVAM's activities to $3.6 million for fiscal year
    2006. This appropriation request includes all FTEs, funding for
    independent peer review assessment of test methods and meetings of the
    ICCVAM and other activities as deemed appropriate by the Director of
    the NIEHS.

                     REQUEST FOR COMMITTEE REPORT LANGUAGE

        The NIEHS should support the NICEATM/ICCVAM in creating a five-year
    roadmap for assertively setting goals to prioritize ending the use of
    antiquated animal tests for specific endpoints. While the stream of
    methods forwarded to the ICCVAM for assessment has remained relatively
    steady, it is imperative that the ICCVAM take a more proactive role in
    isolating areas where new methods development is on the verge of
    replacing animal tests. These areas should form a collective call by
    the federal agencies that compose ICCVAM to fund any necessary
    additional research, development, validation and validation assessment
    that is required to eliminate the animal methods. We also strongly urge
    the NICEATM/ICCVAM to closely coordinate research, development and
    validation efforts with its European counterpart, the European Centre
    for the Validation of Alternative Methods (ECVAM) to ensure the best
    use of available funds and sound science. This coordination should also
    reflect a willingness by the federal agencies comprising ICCVAM to more
    readily accept validated test methods proposed by the ECVAM to ensure
    industry has a uniform approach to worldwide chemical regulation.
        We also respectfully request the Subcommittee consider the
    following report language for the Senate Labor, Health and Human
    Services, Education and Related Agencies Appropriations bill:

        ``In order for the Interagency Coordinating Committee for the
    Validation of Alternative Methods (ICCVAM) to carry out its
    responsibilities under the ICCVAM Authorization Act of 2000, the
    Committee strongly urges the National Institute of Environmental Health
    Sciences (NIEHS) to strengthen the resources provided to ICCVAM for
    methods validation reviews in fiscal year 2006. ICCVAM and NIEHS
    activities must include up-front validation study design, execution and
    review to ensure that new and revised test methods, non-animal test
    methods, and alternative test methods (such as QSARs, mechanistic
    screens, high throughput assays, and toxicogenomics) are deemed
    scientifically valid before they are recommended or adopted for use by
    federal agencies or used in implementing the National Toxicology
    Program's (NTP) Road Map and Vision for NTP's toxicology program in the
    21st century.''

        Thank you for the opportunity to submit this request on behalf of
    our more than 1.1 million members and supporters.
                                     ______

         Prepared Statement of the Dystonia Medical Research Foundation

                  SUMMARY OF FISCAL YEAR 2006 RECOMMENDATIONS

        Provide increased funding for the National Institute of Health at 6
    percent for fiscal year 2006. Increase funding for the National
    Institute of Neurological Disorders and Stroke (NINDS), the National
    Institute of Deafness and other Communication Disorders (NIDCD), and
    the National Eye Institute (NEI) by 6 percent.

                    FISCAL YEAR 2006 RECOMMENDATIONS FOR NIH

      --NIH: $30.1 billion
      --NINDS: $1.63 billion
      --NEI: $709 million
      --NIDCD: $417.6 million
        Continue to accelerate funding for intramural and extramural
    dystonia research at NINDS.
        Provide funding for NINDS to conduct an epidemiological study and
    to increase public and professional awareness of dystonia.
        Continue to expand NIDCD's intramural and extramural research on
    dysphonia.
        Continue to expand NEI's intramural and extramural research on
    dystonia.
        Chairman Specter, thank you for the opportunity to submit testimony
    to the Subcommittee on behalf of the Dystonia Medical Research
    Foundation (DMRF). Dystonia has affected the lives of many Americans
    and we are thankful to be able to provide for you our recommendations
    for fiscal year 2006 federal funding with regards to dystonia research.
        Dystonia is a neurological disorder characterized by powerful and
    painful involuntary muscle spasms that causes the body to twist,
    repetitive jerking movements, and sustained postural deformities. There
    are several different variations of dystonia, including: focal
    dystonias which affect specific parts of the body, such as the arms,
    legs, neck, jaw, eyes, vocal cords; and generalized dystonia, affecting
    many parts of the body at the same time. Some forms of dystonia are
    genetic and others are caused by injury or illness. Dystonia does not
    affect a person's consciousness or intellect, but is a chronic and
    progressive movement disorder for which, at this time, there is no
    known cure. The Foundation estimates that some form of dystonia affects
    about 300,000 people in North America.
        Even though there is no known cure for dystonia, there are
    treatments to lessen the severity of the symptoms of the disease such
    as oral medications, botulinum toxin injections, and in some cases
    surgery. Having increased access to these medical therapies is becoming
    an increasing larger issue for the community as a whole.
        In the past few decades, dystonia researchers have made several
    exciting scientific advancements and have been able to rapidly turn
    laboratory and clinical research into diagnostic examinations and
    treatment procedures, directly benefiting those affected. Genetics, in
    particular, is opening up a new understanding into the cause and
    pathophysiology of the disorder. Thus far, 13 dystonia related genes or
    gene loci have been identified. In 1997, the DYT1 gene for childhood
    early onset dystonia was identified, and we now have a genetic test
    available to confirm diagnosis of this particular type of dystonia.
    Most recently, in 2002, the gene for myoclonus dystonia was identified.
    However the community is still without a diagnostic test and
    misdiagnosis still occurs too frequently.
        Deep brain stimulation is a surgical procedure that was originally
    developed to treat Parkinson's disease but is now being applied to
    severe cases of dystonia. Deep brain stimulation has drastically
    improved the lives of dozens of dystonia patients during the past few
    years. Individuals who were previously bedridden by muscle spasms and
    pain are able to walk without assistance, to speak clearly, to dress
    themselves, to get a driver's license, to date, to travel, and to live
    the life of an able-bodied person. Deep brain stimulation is currently
    used primarily to treat severe cases of generalized dystonia but its
    promising role in treating focal dystonias is being explored. Surgical
    interventions are a crucial and active area of dystonia research.

                        RESEARCH, AWARENESS, AND SUPPORT

        Now is an exciting time to be involved in dystonia research and
    awareness. Researchers are becoming more interested in movement
    disorders and dystonia at the National Institutes of Health (NIH), and
    research is yielding promising clues for better understanding and
    management of this disorder.
        One way the Dystonia Medical Research Foundation has advocated for
    more research on dystonia, is by funding ``seed'' grants to
    researchers. Thus far, the Dystonia Foundation has funded over 370
    grants, and 5 fellowships, totaling more than $18 million. Due to our
    advocacy there are a growing number of talented researchers dedicated
    to understanding the biochemistry of dystonia, genetic causes, new
    therapeutics and the necessity of an epidemiology study.
        Another primary goal of the Dystonia Foundation is education of
    both lay and medical audiences. The Foundation conducts regular medical
    workshops and patient symposiums to present, discuss, and disseminate
    comprehensive medical and research data on dystonia. In January 2001,
    NINDS co-sponsored a genetics and animal models meeting, designed to
    involve not only prominent researchers but inviting junior
    investigators to participate in the discussions. Additionally, in
    October 1996, the NIH was one of our co-sponsors for an international
    medical symposium, which featured 60 papers on dystonia and 125
    representatives from 24 countries. The Young Investigators Award
    Program and the Residency Program are in place to entice emerging
    medical professionals into the field of dystonia research and cultivate
    future dystonia experts.
        Since 1995, over 3,000 educational medical videos have been
    distributed to hospitals, medical and nursing schools, and at medical
    conventions. In addition to medical and coping publications, we have a
    children's video to educate families and increase public awareness of
    this devastating disorder in younger populations. Media awareness is
    conducted throughout the year, and especially during Dystonia Awareness
    Week, observed nationwide from October 14 through 20. Local volunteers
    have been successful in securing news stories on dystonia in local
    venues as well as national media shows such as Good Morning America,
    The Oprah Winfrey Show, and Maury Povich. Through his friendship with
    the mother of a dystonia patient, screen star Kirk Cameron has taken an
    interest in promoting dystonia awareness, and the Dystonia Foundation
    is in the process of investigating the possibility of a public service
    announcement and several appearances at fundraising events.
        The Dystonia Foundation has over 200 chapters, support groups, and
    area contacts across North America. In addition, there are 15
    international chairpersons whose mission is to promote awareness,
    children's advocacy, development, extension, Internet resources,
    leadership, medical education, and symposiums. Furthermore, patient
    symposiums are held internationally and regionally to provide the
    latest medical and coping information to dystonia patients and others
    interested in the disorder.

                 DYSTONIA AND THE NATIONAL INSTITUTES OF HEALTH

        The Dystonia Medical Research Foundation recommends an increase to
    $30.1 billion or 6 percent for NIH overall, and a 6 percent increase
    for NINDS, and NIDCD. We at DMRF request that this increase for NIH
    does not come at the expense of other Public Health Service agencies.
        We also urge the Subcommittee to recommend that NINDS provide the
    necessary funding for additional extramural research and a large-scale
    dystonia epidemiological study. There is also an imperative need for
    NINDS to increase its efforts to educate the public and medical
    community about dystonia through co-sponsorship of workshops and
    seminars. We also encourage the Subcommittee to support NIDCD in its
    efforts to revamp its strategic planning process by implementing a
    Strategic Planning Group which will help NIDCD as they: consider
    applications for high program priority; develop program announcements
    and requests for applications; and develop new research areas in the
    Intramural Research Program.
        The National Institute of Neurological Disorders and Stroke (NINDS)
    awarded seven grants in fiscal year 2004 for dystonia research in
    response to the Program Announcement, ``Studies into the Causes and
    Mechanisms of Dystonia'' (August 2002). In addition, the National
    Institute on Deafness and Other Communication Disorders (NIDCD) funded
    an eighth study on brainstem systems and their role in spasmodic
    dysphonia.
        DMRF also supports the many intramural researchers studying
    dystonia. Research includes: exploring improved clinical rating scales
    for dystonia, elevations of sensory motor training, utilizing botox as
    a possible treatment for focal hand dystonia, characterization of
    abnormalities in sensory regions of the brain, treatments for spasmodic
    dysphonia, anatomy imaging of the affect of dystonia on brain activity,
    and exploring the link between laryngitis and spasmodic dysphonia. The
    public awareness impact of pianist Leon Fleisher's treatment through
    the NIH intramural research program has had a tremendously positive
    impact.
        NINDS continues to work with dystonia research and voluntary
    disease groups in the community. In January 2004, NINDS sponsored a
    workshop at Emory University on the Pathology of Dystonia, and in
    October 2004, NINDS participated in a workshop to develop a strategic
    plan for a series of studies on the epidemiology of dystonia. NINDS
    also provided funding in September 2004 to a researcher affiliated with
    the Dystonia Medical Research Foundation (DMRF) to provide partial
    support for a multi-year series of workshops focused on evolving areas
    of research that are critical for the development of therapeutics.
        Dystonia is the third most common movement disorder after
    Parkinson's Disease and tremor, and effects many times more people than
    better known disorders such as Huntington's Disease, muscular dystrophy
    and ALS or Lou Gehrig's Disease. We ask that NINDS fund dystonia-
    specific extramural research at the same level that it supports
    research for other neurological movement disorders.

                                   CONCLUSION

        The ultimate goal of the Dystonia Foundation is a cure for
    dystonia. Until that goal is realized, we are hungry for knowledge
    about the nature of dystonia and for more effective treatments with
    fewer side effects. We have amassed many exceptional and diligent
    researchers; who are committed to our goal, and our top priority is
    funding their very important research. But the Foundation cannot do it
    alone. We need federal support though NIH, NINDS, NIDCD and NEI to
    continue to fund quality scientific research and eliminate this
    debilitating disease.
        Combine the thwarting of scientific progress with the decreased
    access to therapies and all the progress of the last few years could be
    wiped away. We ask that you aggressively support medical research,
    specifically for movement disorders and brain research. By doing so,
    you are doing a tremendous service for my family and myself and to the
    hundreds of thousands of people and families affected by dystonia.
        Thank you very much.

                    THE DYSTONIA MEDICAL RESEARCH FOUNDATION

        The Dystonia Medical Research Foundation was founded 25 years ago
    and has been a membership-driven organization since 1993. Since its
    inception, the goals of the Foundation have remained the same: to
    advance research for more effective treatments of dystonia and
    ultimately a cure; to promote awareness and education; and support the
    needs and well being of affected individuals and their families.
                                     ______

       Prepared Statement of the FacioScapuloHumeral Muscular Dystrophy
                   Society, Incorporated (FSH Society, Inc.)

        Mr. Chairman, it is a pleasure to submit this testimony to you
    today.
        My name is Daniel Paul Perez, of Lexington, Massachusetts, and I am
    testifying as President & CEO, of the FacioScapuloHumeral Muscular
    Dystrophy Society (FSH Society, Inc.) and as an individual who has
    lived with facioscapulohumeral muscular dystrophy (FSHD) for nearly 43
    years. FSHD is the third most prevalent form of muscle disease. It
    affects 1/20,000 people. For men, women, and children the major
    consequence of inheriting FSHD is a lifelong progressive and severe
    loss of all skeletal muscles. Most people are familiar with Duchenne
    muscular dystrophy (DMD) that affects boys. What they are not aware of
    is, that in any given moment, there are probably more individuals with
    FSHD alive than with Duchenne MD (14,800 vs. 11,000). Recently, the NIH
    identified significant gaps in FSHD and a preponderance of DMD research
    grants and reported that it only has five (5) active projects on
    facioscapulohumeral muscular dystrophy in its entire NIH wide
    portfolio.
        We have given testimony before the U.S. Congress every year since
    1994. We have submitted 26 written testimonies and 5 oral testimonies
    to the U.S. Senate and U.S. House Appropriations Subcommittees on
    Labor, Health, Human Services and Education and Related Agencies. We
    have had considerable report language written in the appropriations
    budget from the committees directed to the National Institutes of
    Health (NIH) with regard to improving the portfolio at the NIH in FSHD
    in nearly every year that we have come before you. In April 2000, prior
    to the passage of the ``Muscular Dystrophy CARE Act 2001'' law, we
    testified that Congressional directive on FSHD has been and is
    repeatedly ignored by the NIH. Since 2001, we have been working closely
    with the NIH on the MD CARE ACT 2001 law mandated research plan. Prior
    to all of the activity around the MD CARE Act 2001, we noted then that
    the NIH is seriously out of compliance with the previous four years of
    Congressional Directives. Incredibly, today in the calendar year 2005
    heading into the fiscal year 2006 the NIH still is out of compliance
    and has an anemic portfolio on FSHD. Going back in time, in 2000 we
    reported the NIH had not responded to the past and prior years of
    Report Language.
        The Report Language for 2000 has been responded to in an untimely
    manner and mainly ignored. The 2000 Report Language is as follows:
    ``The Committee is concerned that NIH has not responded to a previous
    request to develop a plan for enhancing NIH research into
    Facioscapulohumeral (FSH) disease. The Committee urges NIH to promptly
    convene a research planning conference and to establish a comprehensive
    portfolio into the causes, prevention, and treatment of FSH disease
    through all available mechanisms, as appropriate. The Director is
    requested to be prepared to testify on the status of this initiative at
    the fiscal year 2001 appropriations hearing.'' (House Report 3037, p.
    81 for NINDS, p. 97 for NIAMS.) The status of fiscal year 2000 Report
    Language is as follows: FSHD extramural research is almost non-
    existent. Intramural research on FSHD is non-existent at NIH.
        The Report Language for 1999 has been ignored and the status of the
    Report language for fiscal year 1999 is not done. The 1999 Report
    Language is as follows: ``The Committee encourages the Institute to
    continue and expand research efforts focused on aiding in the diagnosis
    and treatment of FSHD.'' (House Report, NINDS Section, p. 103), and,
    ``The Committee was pleased with the Institute's response to last
    year's request which encouraged NIH to stimulate research in the area
    of facioscapulohumeral disease (FSHD). However, the Committee notes
    that NIAMS has not responded in developing a plan for enhancing FSHD
    research, and has not addressed the question of whether an intramural
    program in this area would be beneficial. Therefore, the Committee
    urges NIH to conduct a research planning conference in the near future
    in order to explore scientific opportunities in FSHD research, both
    intramurally and extramurally.'' (House Report, NIAMS Section, p. 120-
    121.) The status of 1999 Report Language is as follows: FSHD extramural
    research is almost non-existent. Intramural research on FSHD is non-
    existent at NIH.
        The Report Language for 1998 has been ignored and the status of
    Report language for fiscal year 1998 is not done. The 1998 Report
    Language is as follows: ``The Committee has heard compelling testimony
    about facioscapulohumeral (FSH) disease, which causes progressive and
    severe loss of skeletal muscle. FSHD research includes aspects such as
    molecular genetics, neurological function and muscular dystrophy
    involving multiple NIH Institutes. The Committee encourages NIH to take
    steps to stimulate research in this area and requests NIH to develop a
    plan for enhancing NIH research into FSH disease (FSHD), including an
    assessment of whether an intramural research program in this area would
    be beneficial.'' (House Report, p. 101.) In 2005, the status of 1998
    Report Language is as follows: FSHD extramural research is almost non-
    existent. Intramural research on FSHD is non-existent at NIH.
        We have worked hard to be sure that our constituency understands
    and supports the doubling of the NIH budget and have been very
    successful in helping to grow the NIH budget from $10.326 billion to
    $28.649 billion. In the same period, we saw FSHD funding increase by
    about $1.3 million. This year we will spare you the heartache of our
    personal story and the pain and suffering our disease brings in its
    train. This year we simply would like you to ask the NIH ``Where did
    the money that Congress appropriated and further directed through
    appropriations report language go?''
        We formerly request a congressional investigation, hearing or some
    other Congressional action regarding the absolute failure of the NIH to
    increase funding in facioscapulohumeral muscular dystrophy (FSHD). We
    have been testifying and generating report language and laws for a
    dozen years and have done the yeoman's share in building the base for
    FSHD. Despite the specific directions from the Congress in report
    language as shown above and with a public law and a federal advisory
    committee on muscular dystrophy, the NIH has failed to follow through
    on improving FSHD research. Despite our active involvement with the
    NIH, the NIH has made the grant review process very secretive, has
    turned down opportunities to shed light on the grant decision making
    process and still has not responded to congressional letters and
    inquiries on the lack of facioscapulohumeral muscular dystrophy (FSHD)
    research in the NIH portfolio.
        I would like to illustrate what we have done at the FSH Society,
    Inc. to improve the funding and portfolio of muscular dystrophy (MD)
    and FSHD. The FSH Society (Society) has represented the FSHD community
    of researchers and clinicians by the following activities on the Hill,
    in the districts, and at the NIH. The FSH Society was the first on the
    Hill and at the NIH and before Parent Project Duchenne Muscular
    Dystrophy (PPDMD) and MDAUSA for many years since 1993. The Society has
    given nearly three dozen Congressional testimonies, in writing and in
    person, before the committee to support the doubling of the NIH budget
    and to encourage spending on muscular dystrophy. The Society has
    succeeded in achieving nearly a dozen sections of report language in
    appropriations reports. I have served on numerous NIH research and
    planning task forces. The Society has had countless hundreds of
    meetings with the Directors, Staff and program officers of the NIH
    NINDS, NIAMS, NICHD, NHGRI, ORD and the OD. I served on the five year
    long range planning meeting for the NIH NIAMS July 1999. I rewrote the
    MD CARE Act 2001 bills to include all muscular dystrophies, ages and
    genders, and to establish the Muscular Dystrophy Coordinating Committee
    (MDCC) federal advisory committee with public members, and to establish
    five national centers for MD not at the exclusion of the basic
    research, and much more. The Society has contributed to supporting two
    NIH funded FSHD research planning conferences (1997, 2000). I work
    closely and collaboratively with NIH program directors. I serve on the
    MDCC at the request of Secretary Tommy G. Thompson and Dr. Elias
    Zerhouni. I helped write the MDCC NIH research plan submitted to
    Congress in summer 2004. I continually encourage FSHD researchers to
    submit NIH grant applications for R01, R21, R03, P01, U54, K, T, F
    training and mentoring awards and Director's Pioneer Awards. The
    Society has given testimony before the Institute of Medicine (IOM) on
    improving the Center for Scientific Review (CSR) grant review process
    for FSHD. The FSH Society itself has funded $1.1 million in $30,000 a
    year fellowships to more than 2 dozen researchers in 5 years, leading
    to nearly 7 dozen publications in top tier journals. The FSH Society
    helps the NIH FSHD patient registry and existing Wellstone Cooperative
    Research Center's as a volunteer health agency.
        As a grant agency, the FSH Society has world renowned and leading
    clinicians and researchers peer reviewing applications, funding
    research, reviewing progress reports and preliminary data and ideas. We
    know and have comprehension on the quality of applicants and projects
    and data being submitted to you in the NIH grant applications for FSHD
    research. I have first hand knowledge of the research as well as our
    Nobel quality advisors. I can tell you that researchers of Wellstone,
    Nobel, and Howard Hughes stature working on FSHD have had applications
    on FSHD rejected by the NIH. However, their applications on other types
    of muscular dystrophy have been funded by the very same agency.
        Mr. Chairman, as you know, the National Institute of Child Health
    and Human Development (NICHD), the National Institute of Arthritis and
    Musculoskeletal Disorders (NIAMS), the National Institute of
    Neurological Disorders and Stroke (NINDS), and the National Human
    Genome Research Institute (NHGRI) are four of the National Institutes
    of Health (NIH) institutes called upon by the Muscular Dystrophy
    Community Assistance Research and Education Act of 2001 (MD CARE Act
    2001) to develop a research plan for muscular dystrophy (MD) research
    and education conducted through the National Institutes of Health.
    Certainly, other NIH institutes will be called into action where
    appropriate such as NHLBI, NEI, NIA, NIMH, NCRR, FIC, and OD.
        We rewrote the MD CARE Act 2001 bill from the Muscular Dystrophy
    Children's Assistance Research and Education Act 2001, covering only
    the childhood form of`Duchenne MD (DMD), to the Muscular Dystrophy
    Community Assistance Research and Education Act 2001 covering all forms
    of MD. We rewrote the bill to include all forms of muscular dystrophy
    affecting men, women, and girls in addition to boys because it was the
    right thing to do. Oddly, in 2004 Duchenne MD received a commanding
    portion of the muscular dystrophy funding and seven of the other
    muscular dystrophy types have little or no funding from the NIH.
        An analysis was presented at the December 2004 MD CARE Act mandated
    Muscular Dystrophy Coordinating Committee (MDCC) meeting of the 164
    grants in the NIH portfolio for future planning purposes related to the
    five sections of the muscular dystrophy research plan. Subsequent to
    the meeting, I requested the details of the 164 grants used for the
    December 1, 2004 discussion from Dr. John Porter (DHHS NIH NINDS), the
    Executive Secretary of the MDCC. It is has been communicated that this
    compilation was done for planning purposes. From discussions with Dr.
    Porter we understand that this view of grants differs from the muscular
    dystrophy portfolios as presented by the budget and NIH OCPL offices
    regarding the various institutes along coding parameters. The 164
    grants were assembled with a degree of scientific subjectivity and
    based on professional expertise and judgment. The December 2004 MDCC
    meeting yielded an analysis of a subjective grouping of the NIH wide
    164 muscular dystrophy grants. Eight were reported related to FSHD. At
    that time, the NIH identified that 8 out of 164 grants are on FSHD!
    Only eight out of 164 grants are for research on FSHD the third most
    prevalent dystrophy that affects men, women and children!
         The details of the data of the 164 grants as presented at the
    December 1, 2004 MDCC for the grants with funding start dates in 2004
    shows 35 grants funded for the 2004 year to that date. The count by
    dystrophy for calendar year 2004 is: 18 for Duchenne muscular dystrophy
    (DMD), 2 for Limb Girdle muscular dystrophy (LGMD), 1 for Myotonic
    muscular dystrophy (DM), 1 for facioscapulohumeral muscular dystrophy
    (FSHD), 7 for stem cell research, and 6 for other research. To re-
    iterate by dystrophy the total grants awarded in 2004 were: 18 for DMD,
    2 for LGMD, 1 for DM, and 1 for FSHD! The most recent year of funding
    data shows that the non-Duchenne muscular dystrophy group is not doing
    well in terms of numbers of grants and funding. We request a hearing
    that focuses on this issue with immediacy and attention to ameliorating
    this unequal growth. Oddly, there is an order of magnitude difference
    between Duchenne muscular dystrophy (DMD) and the entire complement of
    all other dystrophies.
        What has happened in facioscapulohumeral muscular dystrophy (FSHD)
    research in the five years since the MD CARE Act was signed and what
    has happened since the thirteen years since we first started asking NIH
    to invest and build the facioscapulohumeral muscular dystrophy
    portfolio? NIH has rejected nearly four dozen grant applications on
    facioscapulohumeral muscular dystrophy of R03, R21, R01, P01, U54, NIH
    Director Pioneer Award Nominations mechanisms and more. The funding
    track record speaks for itself. To date in fiscal year 2005 the NIH has
    rejected every FSHD application it has received. It is difficult to
    attract investigators to FSHD when there is no money made available for
    them and it becomes a downward spiral to attract new and promising
    investigators.
        Incredibly, the NIH NIAMS, NINDS, NICHD, NHGRI FSHD funding is
    still non existent. Since 2001, the overall NIH wide muscular dystrophy
    budget has increased from $21.0M to $42.2M in fiscal year 2006
    estimated and enacted. Since 2001, the FSHD budget has increased from
    $500,000 to $1.6M in fiscal year 2006 estimated.

               NATIONAL INSTITUTES OF HEALTH (NIH) MUSCULAR DYSTROPHY AND FSHD APPROPRIATIONS HISTORY \1\
                                                [In millions of dollars]
    ----------------------------------------------------------------------------------------------------------------
                                                    Total NIH    NIAMS      NINDS      NICHD      NHGRI     NIH wide
                      Fiscal year                     dollars   dollars    dollars    dollars    dollars    dollars
                                                      on MD      on MD      on MD      on MD      on MD     on FSHD
    ----------------------------------------------------------------------------------------------------------------
    2000..........................................       12.6        4.8        4.9        1.2  .........        0.4
    2001..........................................       21.0        9.2        8.2        0.5        0.3        0.5
    2002..........................................       27.6       11.1        9.8        0.6        2.3        1.3
    2003..........................................       39.1       15.5       13.2        4.5        2.1        1.5
    2004..........................................       38.7       15.0       14.8        3.8        0.3        2.2
    2005ES........................................       41.0       16.3       13.7        4.8        2.2        1.6
    2005EN........................................       42.2       15.2       16.6        5.0        0.3        1.6
    2006ES........................................       42.2       15.2       16.7        5.0        0.3        1.6
    ----------------------------------------------------------------------------------------------------------------
    \1\ Source: NIH/OD Budget Office & NIH OCPL.

        NIH NIAMS. The NIAMS is ostensibly the lead institute at the NIH on
    muscular dystrophy. After all of our efforts the NIH National Institute
    of Arthritis and Musculoskeletal Disorders (NIAMS) now has only one
    research contract that it is co-funding with NIH NINDS for FSHD for
    $186,233 per year? Not one single research grant for FSHD, the third
    most prevalent dystrophy! The total muscular dystrophy portfolio ending
    December 15, 2005 was 58 projects, including Wellstone Cooperative
    Research Centers (CRC) components for a total of $14,992,725.
        NIH NINDS. The NINDS is the second largest NIH contributor towards
    muscular dystrophy research funding. The NIH National Institute of
    Neurological Disorders and Stroke (NINDS) now has three research
    grants, one research contract, and one-quarter of a Wellstone CRC for
    FSHD for a total of $1,386,620 in fiscal year 2004. The total muscular
    dystrophy fiscal year 2004 portfolio reported February 1, 2005 was 39
    projects, including Wellstone CRC components for a total of
    $14,756,290.
        NIH NICHD. The NICHD is third largest NIH contributor towards
    muscular dystrophy research funding. The NIH National Institute of
    Child Health and Human Development (NICHD) does not have a single
    research grant or project directly focused or covering FSHD, which is
    the third most prevalent dystrophy that affects both boys and girls.
    The total muscular dystrophy fiscal year 2004 portfolio reported
    December 1, 2004 was 15 projects, including Wellstone CRC components
    for a total of $3,837,633.
        NIH NHGRI. The NHGRI is historically the fourth largest NIH
    contributor towards muscular dystrophy research funding. The NIH
    National Human Genome Research Institute (NHGRI) does not have a single
    research grant or project directly focused or covering FSHD. The total
    muscular dystrophy fiscal year 2004 portfolio reported on December 1,
    2004 was 1 project (Z01-HG000215-02), including Wellstone CRC
    components for a total of $281,396. The project is Hereditary Inclusion
    Body Myopathy (HIBM) and HIBM is not a type of muscular dystrophy.
        Astonishingly, the total NIH wide spending on muscular dystrophy
    decreased from $39.1 million (fiscal year 2003) to $38.7 million
    (fiscal year 2004). Something is wrong with this trend given the
    Appropriations Subcommittee's interest in this area and the efforts of
    the patient and research communities to shore up and improve muscular
    dystrophy research.

                             NATIONAL INSTITUTES OF HEALTH (NIH) APPROPRIATIONS HISTORY \1\
                                                  [Dollars in millions]
    ----------------------------------------------------------------------------------------------------------------
                                                       NIH         MD         MD        FSH        FSHD       FSHD
                      Fiscal year                    overall    research   percent    research   percent    percent
                                                     dollars    dollars     of NIH    dollars     of MD      of NIH
    ----------------------------------------------------------------------------------------------------------------
    2000..........................................    $17,821      $12.6      0.071       $0.4       3.18     0.0022
    2001..........................................     20,458       21.0      0.103        0.5       2.38     0.0024
    2002..........................................     23,296       27.6      0.118        1.3       4.71     0.0056
    2003..........................................     27,067       39.1      0.144        1.5       3.83     0.0055
    2004..........................................     27,887       38.7      0.139        2.2       5.67     0.0079
    2005E.........................................     28,495       41.0      0.144        1.6       3.90     0.0056
    2006E.........................................     28,640       42.2      0.147        1.6       3.79    0.0056
    ----------------------------------------------------------------------------------------------------------------
    \1\ Source: NIH/OD Budget Office & NIH OCPL.

        The NIH NIAMS, NINDS, NICHD, NHGRI the four lead institutes on
    muscular dystrophy reported a combined total of 113 projects on
    muscular dystrophy totaling $33,869,044 in fiscal year 2004. Of that
    total amount facioscapulohumeral muscular dystrophy (FSHD) received
    $1,572,853 for three grants, one contract and one-quarter of a
    Wellstone CRC.
        Looking at the three existing Wellstone Cooperative Research
    Centers (CRCs) the NIH NICHD is spending $1,631,994, the NIH NIAMS is
    spending $1,224,971, and the NIH NINDS is spending $1,462,151. Only
    one-quarter of the Wellstone CRC funded by the NIH NINDS specifically
    works on FSHD. One more Wellstone center is currently in the process of
    being funded and none of the work at the fourth Wellstone pertains to
    FSHD. Of $4,319,116 funded to the first three Wellstone CRCs, only
    $365,538 is directly titled for FSHD. Only 8.46 percent of the total
    Wellstone expenditure is being spent on the third most prevalent form
    of muscular dystrophy that affects both men and women.
        Mr. Chairman, we are troubled by the NIH grant review process used
    for the Wellstone Center applications as NIH uses a review process that
    deviates from its rigorous adherence to stating that it funds projects
    of the highest scientific merit. The Wellstone applications are
    reviewed for scientific merit and then the entire score is adjusted
    upward or downward based on a ``gestalt'' or an impression. The NIH
    NIAMS extramural program director writes that as an ``example, one or
    more of the research projects may have very high scientific merit but
    lack relevance or contribute little to the Center [Wellstone] as a
    whole; conversely, research projects with relatively lower scientific
    merit may provide necessary strengths to the other components of the
    Center, and make a major contribution to the Center as a whole.'' This
    changing of the rules has not worked in the favor of FSHD research and
    in fact quite the opposite in round two of the Wellstone evaluations.
    We ask the committee to hold a hearing to more closely examine if
    scientific quality is abrogated by a more subjective review standard.
        Mr. Chairman, we are asking you to inquire about the abysmal
    performance record in FSHD funding and FSHD oriented Wellstone CRCs by
    the NIH. Last, at the end of the day, we all recognize that simply not
    enough grants are being submitted by the extramural research community
    to the NIH. Note that the NIH has done nothing to date to specifically
    encourage or targeted to draw in FSHD research applications in five or
    six years. For most of fiscal year 2004, there was no active program
    announcement on the street in muscular dystrophy from the NIH giving
    researchers no obvious avenues or handles to submit basic research
    grants. Of course, researchers are not restricted from submitting
    applications and can always submit grants in the absence of a call for
    proposal but most look for a program announcement or call for
    applications as a signal of NIH interest. The NIH is certainly not
    receiving enough grants applications for FSHD, but it also manages to
    reject almost every one of the scarce few being submitted by the top
    FSHD researchers in the world. It can be said that the volunteer health
    agencies and extramural community of researchers have done everything
    in their power to grow the area of research and to promote new
    researchers and research projects. We have been very successful as
    shown above and need the NIH to capitalize on our success and
    investments. The NIH has recognized that there is a systemic problem
    and has even self-identified a significant gap as relates to FSHD, but
    it has not stated what and if anything it intends to do to ameliorate
    the unequal growth and opportunity for muscular dystrophies other than
    Duchenne muscular dystrophy.
        At the December 2004 MD CARE Act mandated Muscular Dystrophy
    Coordinating Committee (MDCC) the staff and Director's of the NIH
    admitted there was a problem in the gap with FSHD research. The follow-
    up has been deferred to programmatic staff and the implementation
    details of the pending muscular dystrophy research plan. The NIH did
    not say exactly when it would follow-up on funding new research in
    FSHD. The NIH has a history in FSHD of committing to address this issue
    and never following through. The two prior NIH sponsored research
    planning conferences on FSHD are an example. Only a minor fraction of
    the 2000 NIH planning conference research plan developed by the NIH has
    been implemented. At this point, we are unsure if the lack of FSHD
    research in the NIH portfolio is a problem of miscommunication or
    perhaps a more deliberate and calculated on the part of the NIH.
        We also ask that Congress request an explanation from the program
    staff and Directors of the NIH NIAMS, NHGRI, OD and NICHD for the
    inability to do better in the area of FSHD despite repeated
    Congressional requests. We implore Congress to request the NIH to
    specifically build the research portfolio on FSHD through all available
    means, including re-issuing specific calls for research on FSHD at an
    accelerated rate, to make up for historical and present neglect.
        Mr. Chairman, we trust your judgment on the matter before us. We
    believe the Committee should explore why muscular dystrophy in general
    and FSHD in particular has been left behind in the great rise in
    research support at the NIH. Frankly, we are extremely frustrated that
    amid a huge increase in funding and strong unambiguous expressions of
    Congressional support, the NIH commitment in facioscapulohumeral
    muscular dystrophy (FSHD) is so feeble. Mr. Chairman thanks to your
    extraordinary efforts, consideration and work in this area I have hope
    that we will find solutions and that hope keeps me going.
        Mr. Chairman, again, thank you for providing this opportunity to
    testify before your Subcommittee.
                                     ______

        Prepared Statement of the Federation of American Societies for
                              Experimental Biology

                             INTRODUCTION TO FASEB

        The Federation of American Societies for Experimental Biology
    (FASEB) is a coalition of 22 scientific societies who together
    represent more than 66,000 biomedical research scientists. The mission
    of FASEB is to enhance the ability of biomedical and life scientists to
    improve, through their research, the health, well-being and
    productivity of all people.

           FASEB'S RECOMMENDATION FOR NIH FUNDING IN FISCAL YEAR 2006

        As your committee begins deliberations on appropriations for
    agencies under its jurisdiction, FASEB would like to offer its views on
    funding for the National Institutes of Health (NIH). FASEB recommends
    that that the National Institutes of Health receive $30.07 billion in
    fiscal year 2006, an increase of 6 percent over the level for the
    previous fiscal year. This level of funding is consistent with our
    analysis of what is needed to prevent the curtailment of vital research
    programs.

                                 NIH'S MISSION

        The National Institutes of Health (NIH) is the single most
    important source of funding that drives advances in basic biomedical
    research and clinical medicine. Over the past 50 years, NIH research
    has transformed the practice of medicine and made significant
    improvements in the long-term health of our citizens. Even greater
    benefits are possible in the next two decades, if we are positioned to
    capitalize on the many profound advances in fundamental science.
        Modern medical research is poised to revolutionize the prevention,
    diagnosis and treatment of disease. These opportunities coincide with
    urgent public health needs. The baby boom generation is graying;
    without more effective strategies against chronic diseases, such as
    osteoporosis, Parkinson's and Alzheimer's diseases, and heart disease,
    the health care needs of this generation will place enormous economic
    and social burdens on their children and our Nation. In addition, new
    and emerging infectious diseases are a constant threat to our society;
    without novel and improved methods for predicting, detecting,
    controlling and preventing emerging and re-emerging diseases, our
    nation will be ill prepared to respond to the major public health
    challenges of the twenty-first century. To meet all of these challenges
    with improvements in patient care depends on continuous scientific
    discovery that will usher in a new age in the practice of medicine.

          NOVEL MEDICAL PRACTICE MADE POSSIBLE BY NIH-FUNDED RESEARCH

        The pace of advancement continues to accelerate such that there are
    new treatments that substantially increase the quality and length of
    life for a large number of Americans. Most of these successes were only
    made possible because of basic research and committed clinical
    development. Below, we have highlighted some major advances in
    prevention and treatment of heart disease, infectious diseases, cancer,
    vaccines, obesity and diabetes, and women's diseases. We point out how
    basic research is benefiting Americans and increasing their longevity
    and quality of life. At the same time, we indicate some of the many
    areas of medicine that provide opportunities for important advances in
    the future.
        Cardiovascular Disease.--Without doubt, one of the most important
    advances in human health for an aging population has been the
    investigation and treatment of cardiovascular disease (CVD). Basic
    research identified the limiting step in cholesterol biosynthesis, and
    this led directly to the development of statins. These wonder drugs
    lower levels of blood lipids, and they are remarkably effective in the
    reduction of coronary events and death from coronary heart disease.
    Without the basic research, drug development for the treatment of
    hypercholesterol would have languished for years.
        Although important progress has been made, there is need to
    understand the causes of CVD, and find new means of prevention. Studies
    published within the past 2 years affirm that CVD is strongly affected
    by inflammation, and that the most reliable early predictors of disease
    are blood proteins that reflect chronic inflammation such as C-reactive
    protein. Further research into the prevention of dangerous inflammatory
    responses promises to substantially reduce the major cause of death in
    Americans.
        Infectious Diseases.--Like HIV/AIDS, Ebola and West Nile virus,
    SARS reminds us that emerging and reemerging infectious diseases are
    constant threats to national and international public health. In 2003,
    SARS rapidly moved across the globe, becoming a worldwide health
    emergency that resulted in quarantines, travel warnings, and mounting
    economic damage. The ability of NIH to marshal its resources to rapidly
    initiate development of diagnostics, therapeutics and vaccines against
    SARS has positioned us well in our quest for tools to detect, treat and
    prevent SARS.
        Cancer.--Using monoclonal antibodies (mAb), scientists have also
    identified the cell surface receptors that characterize many different
    cells of the body. These same mAb can be chemically engineered for use
    as biologic drugs in the treatment of many different diseases. The mAb
    reagent that targets a lymphocyte receptor has become a proven therapy
    for non-Hodgkin's B cell lymphoma; many patients remain disease-free
    for several years after having failed chemotherapy. Based on more
    recent clinical trials, this same drug may also be effective in the
    treatment of several forms of autoimmune disease including rheumatoid
    arthritis. Many other engineered mAb are being tested in clinical
    trials for use as biologic drugs, and again, more research is needed to
    identify new disease targets.
        The latest genetic technologies are also beginning to deliver
    important tools for the treatment of cancer. Recently, NIH-supported
    research has been used to develop technologies where virtually the
    entire genome can be studied on a small chip (DNA microarray). A recent
    example of the promise of this technology comes from the study of
    chronic lymphocytic leukemia (CLL). CLL patients fall into two
    categories: those whose tumors progress slowly and those with highly
    malignant tumors that require aggressive therapy. Microarray analyses
    identified the expression of a single gene that discriminates these
    tumor types with a high degree of accuracy. This has now led to a
    simple blood test to determine tumor prognosis and guide therapy.
    Microarray analyses will be used in the future to analyze each
    individual cancer as a way of guiding highly individualized therapies,
    and this will in turn result in a new generation of highly effective
    treatments.
        Vaccines.--Vaccine research and development proceeds at a rapid
    pace using new tools from a variety of fields. Hemophilus influenza
    type b is one of the leading causes of invasive bacterial infection in
    young children worldwide. The development of a vaccine for this disease
    has dramatically decreased the incidence of pediatric meningitis from
    approximately 20,000 to 200 cases per year in the United States. The
    cost for treating this disease and its complications was $500 million
    annually, whereas the cost of vaccination is presently no more than
    fifty cents per patient. The development of this successful vaccine
    evolved naturally out of NIH-supported research in basic immunology and
    many additional breakthroughs are anticipated. For example, similar
    vaccines are being tested to prevent pneumoccocal and meningococcal
    infections that often result in pneumonia or meningitis.
        New sequencing techniques made possible from the Human Genome
    Project allow the rapid decoding of genomes of bioterrorism threats as
    well as rapidly mutating pathogens. Immunologists have created a
    malaria vaccine that was made possible by genome sequencing of the
    malaria parasite and its mosquito host, and recent results in children
    show that this vaccine can convey a 50 percent decline in infections.
    The genome sequence of each pathogen facilitates the identification of
    virulence factors, which in turn, constitute the best targets for
    vaccination. For example, the creation of a SARS DNA microarray chip,
    available from NIAID, will aid in the rapid development of vaccines
    against this recently identified pathogen. The complementary nature of
    basic and clinical research is no where more apparent than in the
    advantage that vaccine research takes of chemical structures determined
    by x-ray crystallography. The recent discovery of the 3-D structure of
    the anthrax bacterium will speed development of novel antitoxins to
    protect our populace against bioterrorism. Thus, work on the horizon
    promises vaccines that will confer resistance to previously
    uncontrollable infectious agents.
        Obesity and Diabetes.--The obesity epidemic continues to rise. The
    projected health care requirements arising from complications
    associated with excessive weight will substantially expand the costs of
    Medicare and private health insurance in an aging population. In
    response to this crisis, NIH has increased funding in obesity research
    and this has led to an explosion of new information concerning the
    regulation of metabolism and the causes of pathogenesis. For example,
    the 2004 Lasker Prize was shared by two American NIH-funded researchers
    and a Frenchman for their work on nuclear receptors, and in part for
    the role these receptors play in insulin resistance and metabolism of
    fat cells. This work holds great promise for therapeutic intervention
    since nuclear receptors are easily targeted by modified versions of
    steroid hormones. Remarkably, some of the most incisive work has come
    from basic studies using model organisms, such as worms and flies,
    where genetic screens have identified the essential metabolic pathways.
        Over the period of the NIH budget doubling, researchers have
    discovered previously unknown hormones such as Resistin and Gherlin.
    Resistin is a fat-cell derived hormone that, in excess, causes problems
    with carbohydrate metabolism, and this is turn can result in diabetes.
    Gherlin, along with Leptin, has been found to be important in the
    modulation of appetite. In another area of metabolic research, we now
    understand the molecular basis for trans fatty acid and saturated fatty
    acid effects on LDL cholesterol, and this has important implications
    both in weight control and in cardiovascular disease.
        Health care costs more than twice as much for diabetes patients as
    for all other individuals. Eliminating or reducing the health problems
    caused by diabetes could significantly improve the quality of life for
    people with diabetes and their families while at the same time
    potentially reducing national expenditures for health care services and
    increasing productivity in the U.S. economy. These costs will increase
    dramatically if the epidemic is allowed to worsen. Indeed, it was
    recently predicted by the Centers for Disease Control that one out of
    three children born in the United States in the year 2000 will develop
    diabetes in his or her lifetime.
        Obesity affected 44 million Americans as of 2001, an increase of 74
    percent from 1991. Obesity is a major risk factor for diabetes and is
    also associated with cardiovascular disease and cancer. The total cost
    attributable to obesity amounted to $99.2 billion in 1995.
    Approximately $51.7 billion of those dollars were direct medical costs.
    The number of restricted-activity days, bed-days, and work-lost days
    increased substantially between 1988 and 1994, while the number of
    physician visits attributed to obesity increased 88 percent during the
    same period.\1\ The health-related economic cost of obesity to U.S.
    business is substantial, representing approximately 5 percent of total
    medical care costs.\2\
    ---------------------------------------------------------------------------
        \1\ Obesity Research 1998; 6 (2): 97-106.
        \2\ American Journal of Health Promotion 1998; 13 (2): 120-127.
    ---------------------------------------------------------------------------
        Women's Health.--Recent work has demonstrated that estrogen and
    related compounds reduce brain damage from stroke in experimental
    animals. With these new findings it is extremely important that support
    for existing and new research to resolve the controversy of safety and
    risks of hormone replacement therapy be continued and increased. Such a
    resolution will have a wide impact on women's health concerns such as
    osteoporosis, stroke, Alzheimer's disease and memory loss.

                            COMPETITIVE PEER REVIEW

        Part of the success of American science derives directly from the
    system for awarding research grants. The majority of NIH funding comes
    in response to investigator-initiated research proposals that are
    evaluated by a committee of experts in each scientific field. Elaborate
    care is taken to ensure that conflicts of interest are minimized and
    each research proposal is evaluated on its merit. Over many years this
    competitive system has promoted the highest quality research, and it is
    a shining example of a program based on ``reward for excellence.'' No
    scientist can afford to rest on his or her previous accomplishments. As
    opposed to the entitlement system of funding found in some other
    countries, the American system rewards productivity, innovation, and
    impact. While FASEB welcomes new ideas to make the system function even
    more efficiently, we support the basic concept of peer review as
    practiced by NIH.

                   THE IMPORTANCE OF CONTINUING THE MOMENTUM

        There has never been greater opportunity for advancing biomedical
    science and generating more effective practices for clinical medicine.
    Within our reach are dramatic new breakthroughs that can lessen the
    economic and human costs of disease.
        In response to the massive amounts of new information being
    generated in every field of biomedical science, the NIH has recently
    developed a framework of priorities that NIH as a whole must address in
    order to optimize its entire research portfolio. The NIH Roadmap \3\
    identifies the most compelling opportunities in three main areas and
    will (1) promote a quantitative understanding of the many
    interconnected networks of molecules that comprise our cells and
    tissues, their interactions, and their regulation; (2) explore new
    organizational models for team science; and (3) foster large-scale
    epidemiological studies and clinical trials to enhance the state of
    medical treatment and move new therapies into practice. Specialized
    core facilities and consortia are being promoted to bring together
    scientists from different disciplines as a way of accelerating
    discovery. FASEB supports the goals and vision of this initiative,
    although we maintain that most novel discovery and innovative research
    will continue to originate from individual investigators. In order to
    maintain our rate of discovery and build the infrastructure outlined in
    the Roadmap, NIH requires adequate support for agency-initiated and
    investigator-initiated projects.
    ---------------------------------------------------------------------------
        \3\ http://nihroadmap.nih.gov/.
    ---------------------------------------------------------------------------
        The momentum generated from doubling the NIH budget has energized
    biomedical science at every level. We see new young investigators
    making some of the most important discoveries. Training initiatives
    have encouraged talented students to choose a career in academic
    medicine. These highly talented and motivated individuals spend 10
    years or more after college in graduate school and postdoctoral
    appointments. In 2003, only 16.6 percent of new investigators obtained
    funding within their first 3 years of applying for these critical
    grants, thereby making it very difficult for these young scientists to
    establish their new innovative research programs.
        It is impossible to predict which cures and therapies might be lost
    if funds for medical research are curtailed, but it is certain that
    inconsistent NIH funding sends a chilling message to young scientists
    in training and those just entering the research field. Scientific
    competition will always be intense, but exceptionally talented young
    scientists must be assured that sufficient research funding will be
    available or they will be forced to pursue alternative careers.

                                 RECOMMENDATION

        FASEB understands that the fiscal year 2006 budget for
    discretionary spending is projected to be constrained in light of the
    large deficit, the expenditures for defense and homeland security and
    the growth in entitlement obligations. However, FASEB strongly believes
    that the scientific opportunities for progress in medical research have
    never been greater. Therefore, FASEB recommends that the National
    Institutes of Health receive $30.07 billion in fiscal year 2006, an
    increase of 6 percent over the level for the previous fiscal year.
                                     ______

        Prepared Statement of the Friends of the National Institute of
                     Environmental Health Sciences (NIEHS)

        The Friends of the National Institute of Environmental Health
    Sciences (NIEHS) group appreciates the opportunity to comment on the
    fiscal year 2006 appropriation for the institute. The Friends of NIEHS
    is a coalition committed to expanding the National Institutes of
    Health's (NIH) environmental health research portfolio through
    increased appropriations for NIEHS. Comprised of over 50 patient,
    healthcare provider, children's health, and industry groups, the
    Friends of NIEHS represents an enormously broad constituency dedicated
    to improving the nation's knowledge about our health and our
    environment.
        Over the last several years Congress has shown a strong commitment
    to health research sponsored by NIH. This financial commitment has
    allowed the nation to dedicate resources to emerging scientific
    opportunities that will lead to beneficial health outcomes for
    Americans. We thank Congress for fulfilling its commitment to double
    the NIH overall budget. However, we remain concerned about how we will
    fund these opportunities in the upcoming years.
        This dilemma is particularly true for the NIEHS. This institute
    plays a critical role in what we know about the relationship between
    our environmental exposures and disease onset. Through the research
    sponsored by this Institute, we know that Parkinson's disease, breast
    cancer, birth defects, miscarriage, delayed or diminished cognitive
    function, infertility, asthma and many other diseases and ailments have
    confirmed environmental triggers. Specifically, NIEHS has played an
    important role in discovering the mechanisms by which DES
    (diethylstilbestrol) causes damage, through its historical and ongoing
    work on DES in the animal model. Continuing research of these
    mechanisms is vital to help determine future health events related to
    DES, such as the possibility of third generation effects in the
    grandchildren of women who took DES during pregnancy. Our expanded
    knowledge, as a result, allows both policy makers and the general
    public to make important decisions about how to reduce toxin exposure
    and reduce the risk of disease and other negative health outcomes.
        As the nation continues to steel itself from terrorist threats, the
    Friends of NIEHS applauds Congress's commitment to bolstering research
    funding in the area of infectious disease as a part of national anti-
    bioterrorism effort. The coalition, however, feels that an effort that
    only targets bioterrorism falls short of truly protecting the nation as
    it leaves the public vulnerable to chemical terrorism. Funding is
    critical for future initiatives such as research concerning the
    possible health effects of exposure to low levels of hazardous
    chemicals and the use of an Environmental Medical Unit (EMU), as
    previously supported by Congress and underway in Japan, to examine
    populations affected by toxicant-induced intolerances to determine the
    biomarkers and mechanisms by which to identify individual
    susceptibility so as to avoid placing such individuals in hazardous
    situations.
        In an effort to continue the expansion of this knowledge base, the
    Friends of NIEHS supports a $35 million increase in funding for NIEHS
    over fiscal year 2005 levels, bringing the total appropriation for
    fiscal year 2006 to $680 million. This additional funding will allow
    the Institute to continue current projects and pursue promising
    research in the areas of individual susceptibilities (due to gender,
    age, racial/ethnic backgrounds, etc.), environmental disease triggers
    and technologies (such as toxicogenomics and mouse genomics).
        While there are many competing interests that must be considered in
    the fiscal year 2006 budget, a top priority for Americans is medical
    research that explores the relationship between disease and the
    environment. The members of the Friends of NIEHS respectfully request a
    total of $680 million for fiscal year 2006 for the National Institute
    of Environmental Health Sciences. Thank you for this opportunity to
    discuss the importance of these programs as the Congress configures the
    Labor-HHS fiscal year 2006 budget.
        The Friends of NIEHS respectfully requests Congress to appropriate
    a total of $680 million for fiscal year 2006.
                                     ______

      Prepared Statement of the Friends of the National Institute on Drug
                                Abuse Coalition

        Mr. Chairman and Members of the Subcommittee: The Friends of the
    National Institute on Drug Abuse (FoN) a burgeoning coalition of over
    50 organizations, is pleased to provide testimony to support the
    extraordinary work of the NIDA. Although a new coalition, it is
    comprised of organizations representing scientists, health
    professionals, and advocates for preventing and treating substance use
    disorders as well as understanding the causes and public health
    consequences of addiction. Pursuant to clause 2(g)4 of House Rule XI,
    the Coalition does not receive any federal funds.
        Drug abuse and addiction represent a major health crisis in
    America, and create an economic burden of over $484 billion per year.
    One way we can and should continue to address this problem is through
    scientific research. Because of the critical importance of drug abuse
    research for the health and economy of our nation, we write to you
    today to request your support for a 6 percent increase for NIDA in the
    Fiscal 2006 Labor, Health and Human Services, Education and Related
    Agencies Appropriations bill. That would bring total funding for NIDA
    in Fiscal 2006 to $1,067,040,300. Recognizing that so many health
    research issues are inter-related, we also support a 6 percent increase
    for the National Institutes of Health overall, which would bring its
    total to $30 billion for Fiscal 2006.
        NIDA is the world's largest supporter of research on the health
    aspects of drug abuse and addiction. The Institute supports a
    comprehensive research portfolio that has led to our current
    understanding of addiction as a preventable developmental disorder and
    a chronic relapsing disease associated with long-lasting changes in the
    brain and the body that can affect all aspects of a person's life.
    NIDA's research portfolio is broad and deep, and spans the continuum of
    basic neuroscience, behavior and genetics research through applied
    health services research and epidemiology. This work deserves
    continuing, strong support from the Congress. Some examples include:
        New research supported by NIDA and others reveals that drug
    addiction is a ``developmental disease.'' That is, it often starts
    during the early developmental stages in adolescence and sometimes as
    early as childhood. This is a time when the brain undergoes major
    changes in both structure and function. We now know that the brain
    continues to develop throughout childhood and into early adulthood.
    Exposure to drugs of abuse at an early age may increase a child's
    vulnerability to the effects of drugs and may impact brain development.
    As a result, NIDA has increased its emphasis on adolescent brain
    development to better understand how developmental processes and
    outcomes are affected by drug exposure, the environment and genetics.
    Recent advances in genetic research have enabled researchers to start
    to investigate which genes make a person more vulnerable, which genes
    protect a person against addiction, and how genes and environment
    interact. As part of the prevention portfolio NIDA is also involving
    pediatricians and other primary care providers to develop tools, skills
    and knowledge to be able to screen and treat patients as early as
    possible, including patients with mental disorders who may be at a high
    risk to develop addiction. We know that if we do not intervene early,
    drug problems can last a lifetime, making prevention a high research
    priority.
        Treatment research is another priority area for NIDA. Significant
    effort is underway to develop, test, and ensure the delivery of
    evidence-based interventions to all practitioners and patients across
    the country. Building on advances from the Institute's basic
    neuroscience and behavioral research program NIDA has introduced a
    number of effective medications and behavioral treatments. The
    Institute also continues to look for more innovative, efficacious, and
    cost-effective ways to treat patients for a variety of addictions,
    including addiction to nicotine. NIDA is also using the National Drug
    Abuse Treatment Clinical Trials Network (CTN) to help respond to
    emerging public health needs like prescription drug abuse and the
    increases in patients who are seeking treatment for both substance
    abuse and mental disorders.
        Another priority area for NIDA is curtailing the spread of HIV/
    AIDS. Because illicit drug use can impact decision-making and increase
    the likelihood that an individual will engage in risk-taking behaviors,
    treatment for drug abuse is, itself, HIV prevention. Drug abuse
    treatment can reduce activities related to drug use that increase the
    risk of getting or transmitting HIV. NIDA is especially interested in
    reducing HIV/AIDS rates in racial and ethnic minority populations,
    which are disproportionately affected by this disease.
        Recognizing substance abuse as a disorder that can affect the
    course of other diseases, including HIV/AIDS, mental illness, trauma,
    cancer, cardiovascular disease and even obesity is critical to
    improving the health of our citizens. NIDA has launched several efforts
    to reach out to numerous professions within the healthcare community to
    address these issues.

            ADDITIONAL SUCCESS STORIES, CHALLENGES AND OPPORTUNITIES

        Adolescent Brain Development--How Understanding the Brain Can
    Impact Prevention Efforts.--NIDA maintains a vigorous developmental
    research portfolio focused on adolescent populations. NIDA working
    collaboratively with other NIH Institutes has shown that the human
    brain does not fully develop until about age 25. This adds to the
    rationale for referring to addiction as a ``developmental disease;'' it
    often starts during the early developmental stages in adolescence and
    sometimes as early as childhood, a time when we know the brain is still
    developing. Having insight into how the human brain works, and
    understanding the biological underpinnings of risk taking among young
    people will help in developing more effective prevention programs. FoN
    believes NIDA should continue its emphasis on studying adolescent brain
    development to better understand how developmental processes and
    outcomes are affected by drug exposure, the environment and genetics.
        Medications Development.--NIDA has demonstrated leadership in the
    field of medications development by partnering with private industry to
    develop anti-addiction medications resulting in a new medication,
    buprenorphine, for opiate addiction. FoN recommends that NIDA continue
    its work with the private sector to develop much needed anti-addiction
    medications, for cocaine, methamphetamine, and marijuana dependence.
        Co-Occurring Disorders.--NIDA recognizes substance abuse rarely
    occurs in isolation. And to adequately address co-occurring substance
    abuse and mental health problems, NIDA has developed robust
    collaborations with other agencies (such as NIAAA, NIMH and SAMHSA) to
    stimulate new research to develop effective strategies and to ensure
    the timely adoption and implementation of evidence-based practices for
    the prevention and treatment of co-occurring disorders. Through these
    initiatives, NIDA is supporting research to determine the most
    effective models of clinically appropriate treatment and how to bring
    them to communities with limited resources. FoN recognizes the
    imperative for continued funding of essential research into the nature
    of and improved treatment for these complex disorders and endorses
    these efforts.
        Drug Abuse and HIV/AIDS.--One of the most significant causes of HIV
    virus acquisition and transmission involves drug taking practices and
    related risk factors in different populations (e.g. criminal justice,
    pregnant women, minorities, and youth). Drug abuse prevention and
    treatment interventions have been shown to be effective in reducing HIV
    risk. Therefore, FoN trusts that NIDA will continue its support of
    research that is focused on the development and testing of drug-abuse
    related interventions designed to reduce the spread of HIV/AIDS in
    these populations.
        Emerging Drug Problems.--NIDA recognizes that drug use patterns are
    constantly changing and expends considerable effort to monitor drug use
    trends and to rapidly inform the public of emerging drug problems. FoN
    believes NIDA should continue supporting research that provides
    reliable data on emerging drug trends, particularly among youth and in
    major cities across the country and will continue its leadership role
    in alerting communities to new trends and creating awareness about
    these drugs.
        Reducing Prescription Drug Abuse.--NIDA research has documented
    recent increases in the numbers of adults and young people who are
    using prescription drugs for non-medical purposes. Reducing
    prescription drug abuse, particularly among our Nation's youth will
    continue to be a priority for NIDA. FoN endorses NIDA's programmatic
    research designed to further the development of medications that are
    less likely to have abuse/addiction liability, and to develop
    prevention and treatment interventions for adolescents and adults who
    are abusing prescription drugs.
        Reducing Methamphetamine Abuse.--NIDA continues to recognize the
    epidemic abuse of methamphetamine across the United States.
    Methamphetamine abuse not only affects the users, but also the
    communities in which they live, especially due to the dangers
    associated with its production. FoN believes NIDA should continue to
    support research to address the medical consequences of methamphetamine
    abuse. Topics of particular concern include: understanding the effects
    of prenatal exposure to methamphetamine and developing
    pharmacotherapies and behavioral therapies to treat methamphetamine
    addiction.
        Reducing Inhalant Abuse.--For the second year in a row, NIDA's
    Monitoring the Future Survey (MTF) has shown an increase in the use of
    inhalants by 8th graders. Inhalants pose a particularly significant
    problem since they are readily accessible, legal, and inexpensive. They
    also tend to be abused by younger teens and can be highly toxic and
    even lethal. FoN applauds NIDA's inhalant research portfolio and
    believes NIDA should continue its support of research on prevention and
    treatment of inhalant abuse, and to enhance public awareness on this
    issue as it did recently with the release of a Community Drug Alert
    Bulletin: Inhalants, as well as its new dedicated web site,
    www.inhalants.drugabuse.gov.
        General Medical Consequences of Drug Abuse.--NIDA recognizes that
    addiction is a disorder that affects the course of other diseases such
    as cancer, cardiovascular and infectious diseases. Therefore, FoN
    believes that NIDA should continue to support research on the medical
    consequences associated with drug abuse and addiction.
        Long-Term Consequences of Marijuana Use.--NIDA research shows that
    marijuana can be detrimental to educational attainment, work
    performance, and cognitive function. However, more information is
    needed in order to assess the full impact of long-term marijuana use.
    Therefore, FoN recommends that NIDA continue to support efforts to
    assess the long-term consequences of marijuana use on cognitive
    abilities, achievement, and mental and physical health, as well as work
    with the private sector to develop medications focusing on marijuana
    addiction.
        Translating Research Into Practice.--NIDA has been a leader working
    with State substance abuse authorities to reduce the current 15- to 20-
    year lag between the discovery of an effective treatment intervention
    and its availability at the community level. In particular, NIDA worked
    with SAMHSA on a recent RFA designed to strengthen State agencies'
    capacity to support and engage in research that will foster statewide
    adoption of meritorious science-based policies and practices. FoN
    believes that NIDA should continue collaborative work with States to
    ensure that research findings are relevant and adaptable by State
    Substance Abuse systems. NIDA is also to be congratulated for its broad
    and varied information dissemination programs as part of an effort to
    ensure drug abuse research is used in everyday practice. The Institute
    is focused on stimulating and supporting innovative research to
    determine the components necessary for adopting, adapting, delivering,
    and maintaining effective research-supported policies, programs, and
    practices. As evidence-based strategies are developed, FoN urges NIDA
    to support research to determine how these practices can be best
    implemented at the community level.
        Primary Care Settings and Youth.--NIDA recognizes that primary care
    settings, such as offices of pediatricians and general practitioners,
    are potential key points of access to prevent and treat problem drug
    use among young people; yet primary care and drug abuse services are
    commonly delivered through separate systems. FoN encourages NIDA to
    continue to support health services research on effective ways to
    educate primary care providers about drug abuse; develop brief
    behavioral interventions for preventing and treating drug use and
    related health problems, particularly among adolescents; and develop
    methods to integrate drug abuse screening, assessment, prevention and
    treatment into primary health care settings.
        Utilizing Knowledge of Genetics and New Technological Advances to
    Curtail Addiction.--NIDA recognizes that not everyone who takes drugs
    becomes addicted and that this is an important phenomenon worthy of
    further exploration. Research has shown that genetics plays a critical
    role in addiction, and that the interplay between genetics and
    environment is crucial. The science of genetics is at a crucial phase--
    technological advances are providing the tools to make significant
    breakthroughs in disease research. For example, FoN believes NIDA
    should take advantage of new high-resolution genetic technologies which
    may help to develop new tailored treatments for smoking.
        Combating Nicotine Addiction.--NIDA understands that the use of
    tobacco products remains one of the Nation's deadliest addictions and
    Fon supports NIDA's continuing efforts to address this major public
    health problem through its comprehensive research portfolio.
        Reducing Health Disparities.--NIDA research demonstrates that the
    consequences of drug abuse disproportionately impacts minorities,
    especially African American populations. FON was pleased to learn that
    NIDA formed a Subgroup of its Advisory Council to address this
    important topic and applauds NIDA for working to strategically reduce
    the disproportionate burden of HIV/AIDS among the African American
    population. FoN believes that researchers should be encouraged to
    conduct more studies in this population and to target their studies in
    geographic areas where HIV/AIDS is high and or growing among African
    Americans, including in criminal justice settings.
        The Clinical Trials Network--Using Infrastructure to Improve
    Health.--NIDA's National Drug Abuse Treatment Clinical Trials Network
    (CTN), which was established in 1999 and has grown to include over 17
    research centers or nodes spread across the country. The CTN provides
    an infrastructure to test the effectiveness of new and improved
    interventions in real-life community settings with diverse populations,
    enabling an expansion of treatment options for providers and patients.
    FoN suggests NIDA continue to develop ways to use the CTN as a vehicle
    to address emerging public health needs.
        Neuroscience Blueprint and Training.--NIDA is one of the 15
    Institutes and Centers involved in the NIH Blueprint activities and FoN
    recommends that NIDA continue to demonstrate leadership to foster
    additional training in cross-cutting scientific issues.
        Neuroimaging and the Developing Brain.--NIDA has also demonstrated
    leadership in the development and application of neuroimaging
    technologies to gain a greater understanding of the circuitry of the
    human brain underlying drug addiction. FoN encourages NIDA to utilize
    neuroimaging technology to improve its understanding of how the brain
    of children and adolescents develop.
        Behavioral Science.--NIDA has long demonstrated a strong commitment
    to supporting behavioral science research. FoN encourages NIDA to
    continue to determine the interplay of behavioral, biological, and
    social factors that affect development and the onset of diseases like
    drug addiction to understand common pathways that may underlie other
    compulsive behaviors such as gambling and eating disorders.
        Drug Treatment in Criminal Justice Settings.--NIDA is very
    concerned about the well-known connections between drug use and crime.
    Research continues to demonstrate that providing treatment to
    individuals involved in the criminal justice system decreases future
    drug use and criminal behavior, while improving social functioning.
    Blending the functions of criminal justice supervision and drug abuse
    treatment and support services create an opportunity to have an optimal
    impact on behavior by addressing public health concerns while
    maintaining public safety. FoN strongly supports NIDA's efforts in this
    area, particularly the Criminal Justice Drug Abuse Treatment Studies
    (CJ-DATS), a multi-site set of research studies designed to improve
    outcomes for offenders with substance use disorders by improving the
    integration of drug abuse treatment with other public health and public
    safety systems.

                                   CONCLUSION

        It is true that many challenges remain. However, only the resources
    available for carrying out its vital mission limit the potential
    contributions of NIDA-funded research to the lives of countless
    individuals. This is why the Friends of NIDA ask you to provide an
    appropriation of $1,067,040,300 billion to the Institute so that our
    nation and the world will continue to benefit from NIDA's commitment to
    improving health and scientific advancement.
        We understand that the fiscal year 2006 budget cycle will involve
    setting priorities and accepting compromise. However, in the current
    climate, we believe a focus on substance abuse and addiction, which
    according to the World Health Organization account for nearly 20
    percent of disabilities among 15-44 year olds, deserve to be
    prioritized accordingly. We look forward to working with you to make
    this a reality.
        Thank you, Mr. Chairman, and the Subcommittee, for your support for
    the National Institute on Drug Abuse.
                                     ______

                 Prepared Statement of the Heart Rhythm Society

        The Heart Rhythm Society (HRS) thanks you and the Subcommittee on
    Labor, Health and Human Services and Education for your past and
    continued support of the National Institute of Health, and specifically
    the National Heart, Lung and Blood Institute (NHLBI). The Heart Rhythm
    Society is the international leader in science, education and advocacy
    for cardiac arrhythmia professionals and patients, and the primary
    information resource on heart rhythm disorders. Its mission is to
    improve the care of patients by promoting research, education and
    optimal health care policies and standards. Founded in 1979 to address
    the scarcity of information about the diagnosis and treatment of
    cardiac arrhythmias, the Heart Rhythm Society is the preeminent
    professional group representing more than 3,700 specialists in cardiac
    pacing and electrophysiology in 64 countries.
        The Heart Rhythm Society recommends the Subcommittee continue its
    commitment to supporting biomedical research in the United States and
    recommends Congress provide NIH with a 6 percent increase for fiscal
    year 2006. This translates into an appropriation of $30 billion for
    NIH, with $3.1 billion designated to the National Heart, Lung, and
    Blood Institute (NHLBI). This increase will enable the NIH and NHLBI to
    sustain the level of research that leads to research breakthroughs and
    improved health outcomes.
        In particular, the Heart Rhythm Society recommends Congress support
    research into abnormal rhythms of the heart, known as cardiac
    arrhythmias. HRS appreciates the actions of Congress to double the
    budget of the NIH in recent years. The doubling of the NIH budget has
    served to promote a series of innovations that have improved treatments
    and cures for a variety of medical problems facing our nation.

                            RESEARCH ACCOMPLISHMENTS

        In our field for example, this research has provided critically
    important insights into the genetic basis of sudden death syndrome,
    which takes the lives of infants, children and young adults born with
    inherited defects in the ion channels or contractile proteins of the
    heart. SIDS (Sudden Infant Death Syndrome) remains the leading cause of
    death for infants one month to one year of age, continuing to claim the
    lives of approximately 2,500 babies each year.\1\ Our research has led
    to the recognition that sudden infant death syndrome is due, in part,
    to abnormal rhythms of the heart. This research is offering these
    babies a chance at a normal life span.
    ---------------------------------------------------------------------------
        \1\ First Candle/SIDS Alliance, Facts on SIDS, 2005 http://
    www.sidsalliance.org/FC-PDF4/Expectant%20Parents/facts%20on%20sids.pdf.
    ---------------------------------------------------------------------------
        Major advances have also been realized in our ability to treat
    atrial fibrillation and to prevent the complications of stroke. Atrial
    fibrillation is found in about 2.2 million Americans and is an
    independent risk factor for stroke, increasing the risk about 5-fold.
    About 15-20 percent of strokes occur in people with atrial
    fibrillation. Stroke is a leading cause of serious, long-term
    disability in the United States and people who have strokes caused by
    AF have been reported as 2-3 times more likely to be bedridden compared
    to those who have strokes from other causes. Each year about 700,000
    people experience a new or recurrent stroke and in 2002 stroke
    accounted for more than 1 of every 15 deaths in the United States.\2\
    ---------------------------------------------------------------------------
        \2\ American Stroke Association and American Heart Association,
    Heart Disease and Stroke Statistics--2005 Update, 2005 http://
    www.americanheart.org/downloadable/heart/
    1105390918119HDSStats2005Update.pdf.
    ---------------------------------------------------------------------------
        Ablation therapy has provided a cure for individuals whose rapid
    heart rates had previously incapacitated them, giving them a new lease
    on life. Important advances have been made in identifying patients with
    heart failure and those who had suffered a heart attack and are at risk
    for sudden death. The development and implantation of sophisticated
    internal cardioverter defibrillators (ICD) in such patients has saved
    the lives of hundreds of thousands and provided peace of mind for
    families everywhere, including that of Vice-President Cheney. A new
    generation of pacemakers and ICDs is restoring the beat of the heart as
    we grow older, permitting us to lead more normal lives. Many of these
    advances are due to the research sponsored by the NHLBI.

                              BUDGET JUSTIFICATION

        These impressive strides notwithstanding, cardiac arrhythmias
    continue to plague our society and take the lives of loved ones at all
    ages, nearly one every minute of every day. Sudden Cardiac Arrest is a
    leading cause of death in the United States, claiming an estimated
    325,000 lives every year, or one life every two minutes.\3\ The burden
    of morbidity and mortality due to cardiac arrhythmias is predicted to
    grow dramatically as the baby boomers age. Atrial fibrillation strikes
    3-5 percent of people over the age of 65,\4\ presenting a skyrocketing
    economic burden to our society in the form of healthcare treatment and
    delivery. As previously mentioned one in seven of all strokes are due
    to atrial fibrillation. It is estimated in 2005 that the direct and
    indirect cost of stroke will be $56.8 billion.\5\ Cardiac diseases of
    all forms increase with advancing age, ultimately leading to the
    development of arrhythmias.
    ---------------------------------------------------------------------------
        \3\ Heart Rhythm Foundation, The Facts on Sudden Cardiac Arrest,
    2004 http://www.heartrhythmfoundation.org/its_about_time/pdf/
    provider_fact_sheet.pdf.
        \4\ Heart Rhythm Society, Atrial Fibrillation & Flutter, 2005
    http://www.hrspatients.org/patients/heart_disorders/
    atrial_fibrillation/default.asp.
        \5\ American Stroke Association, Impact of Stroke, 2005 http://
    www.strokeassociation.org/presenter.jhtml?identifier=1033.
    ---------------------------------------------------------------------------
        The above progress we have witnessed in recent years is gradually
    eroding as the resources available to the academic scientific and
    medical community are diminished. The budgets appropriated by Congress
    to the NIH in the past two years averaged 2.8 percent and were far
    below the level of scientific inflation. These vacillations in funding
    cycles threaten the continuity of the research and the momentum that
    has been gained over the years.
        It is for this reason that we are asking for your support to
    increase NIH appropriations by 6 percent for a fiscal year 2006 budget
    of $30 billion for NIH and $3.1 billion for NHLBI. The Heart Rhythm
    Society recommends Congress specifically acknowledge the need for
    cardiac arrhythmia research to prevent sudden cardiac arrest and other
    life threatening conditions such as sudden infant death syndrome,
    definitive therapeutic approaches for atrial fibrillation and the
    prevention of stroke, and other genetic arrhythmia conditions.
        Thank you very much for your consideration of our request. If you
    have any questions or need additional information, please contact Amy
    Melnick, Vice-President, Health Policy at the Heart Rhythm Society
    (amelnick@hrsonline.org or 202-464-3434). Thank you again for the
    opportunity to submit testimony.
                                     ______

           Prepared Statement of the Hemophilia Federation of America

                  SUMMARY OF FISCAL YEAR 2006 RECOMMENDATIONS

      --Continued support for the completion of Ricky Ray Hemophilia Relief
            Fund ``half-cases''.
      --An additional $10 million for Hemophilia Treatment Centers through
            the Maternal Child Health Bureau at the Health Resources and
            Services Administration.
      --Continued support for the Centers for Disease Control and
            Prevention's hemophilia grant program, including expansion of
            the program to additional patient-based organizations within
            the hemophilia community.
      --A 6 percent increase overall for the National Institutes of Health,
            including a 6 percent increase for the National Heart, Lung,
            and Blood Institute, and the National Institute for Allergy and
            Infectious Diseases.

                                  INTRODUCTION

        The Hemophilia Federation of America (HFA) is a national voluntary
    health organization that both assists and advocates for the blood
    clotting disorders community. The Federation was founded in 1994 and
    exists for the purpose of serving its constituents as an advocate for
    blood safety, best practices treatment for hemophilia, issues involving
    health insurance, and enhancing the quality of life for those who
    suffer with hemophilia and other blood clotting disorders. Our mission
    is to serve the needs of all families with coagulation disorders and
    mitigate the complications of treatment. Our vision at the Hemophilia
    Federation of America is that the blood clotting disorders community
    has removed all barriers to both choice of treatment and quality of
    life.
        The Hemophilia Federation of America provides a multitude of
    programs and services to the bleeding disorder community. These
    programs include the Emergency Room Triage Program, which educates
    emergency room physicians and support staff to the sensitivities of
    patients with hemophilia need in an ER medical setting. The Moms on a
    Mission and Dads in Action programs work to intimately educate parents
    of those with hemophilia to be active in the care of their child and
    understand the care that the disorder needs to lead a healthy,
    productive life. The Helping Hands Project assists struggling families
    of hemophilia patients with resources to meet their medical and living
    expenses, because of the high costs of hemophilia treatment. HFA is
    proud of the services our organization provides to the hemophilia
    community and encourages the community to take advantage of them.

                        RICKY RAY HEMOPHILIA RELIEF FUND

        Mr. Chairman, we are extremely grateful for your leadership last
    year in supporting efforts to finalize pending ``half-cases'' within
    the Ricky Ray Hemophilia Relief Fund.
        The closing of the Ricky Ray fund in November of 2003 marked the
    completion of the 5-year period that the federal government designated
    to provide compassionate payments to those in the hemophilia community
    who were infected with HIV/AIDS due to contaminated anti-hemophilia
    factor concentrates in the 1980s.
        In the closing days of the Fund, the program administrator
    contacted HFA to ask for our assistance in the completion of many
    unfinished cases. He brought to our attention 43 cases where the
    entitled family only received half of the compassionate payment, due to
    a parent's absence from a patient's life. The Ricky Ray Fund
    administrator asked the Federation to assist him in the adjudication of
    those cases that qualified for additional support. HFA would like to
    thank the subcommittee for its assistance in working with the community
    to provide the remaining payments and encourage you to continue this
    support until this process is completed.

          HEMOPHILIA TREATMENT CENTERS/HEALTH RESOURCES AND SERVICES
                                 ADMINISTRATION

        In 1974, Congress created a network of Hemophilia Treatment Centers
    (HTCs) throughout the United States. This treatment centers remain
    essential to ensuring that comprehensive and specialized care is
    available for persons with bleeding disorders. There are currently over
    130 HTCs in the United States. These centers abide by federal
    guidelines for the delivery of comprehensive hemophilia services as
    developed by the Maternal Child Health Bureau and the Centers for
    Disease Control and Prevention.
        Hemophilia Treatment Centers provide family centered, state of the
    art medical and psychosocial services, as well as education and
    research to persons with inherited bleeding disorders. The bleeding
    disorder community utilizes many services through the Hemophilia
    Treatment Centers. These services include diagnostic evaluations for
    hemophilia, von Willebrand disease and other bleeding disorders. They
    also include annual comprehensive evaluations, clinical trials on new
    blood clotting therapies, coordination with the individual's primary
    care physician, emergency consultations, hematological management for
    surgeries, dental procedures and childbirth. Hemophilia Treatment
    Centers educate patients and family members on infusion training,
    encourage collaboration with HTC clinicians throughout the United
    States, participate in CDC research, and collaboration with the
    hemophilia voluntary health community.
        For fiscal year 2006 HFA encourages the subcommittee to increase
    funding for HTC's at the Maternal and Child Health Bureau by $10
    million.

        HEMOPHILIA GRANT PROGRAM AT THE CENTERS FOR DISEASE CONTROL AND
                                   PREVENTION

        Mr. Chairman, HFA strongly supports the expansion of the Centers
    for Disease Control and Prevention's hemophilia grant program. This
    important initiative provides support for education and awareness
    activities regarding hemophilia, as well as disease management, blood
    safety, and surviellance projects.
        Given the important contributions that all voluntary organizations
    in the hemophilia community make to patients and families, we are
    recommending that steps be taken to ensure that additional
    organizations can participate in the hemophilia program on an annual
    basis. Based on the current structure of the grant program, only one
    organization is able to receive funds to support patients. In order to
    maximize the effectiveness of this important initiative, we believe
    that additional organizations should be empowered to participate in the
    CDC program on an annual basis. We encourage the subcommittee to
    support our efforts in this area in fiscal year 2006 bill.

                         NATIONAL INSTITUTES OF HEALTH

        HFA applauds the National Heart, Lung and Blood Institute and the
    National Institute of Allergy and Infectious Diseases for their support
    of hemophilia research. In addition, we are grateful to the
    subcommittee for recognizing the growing problem of women and bleeding
    disorders, which if left untreated, can lead to such dangerous medical
    conditions as anemia, unnecessary hysterectomies, and complications
    during menstruation.
        Patients and families in the hemophilia community are placing their
    hopes for a better quality of life on treatment advances made through
    biomedical research. For fiscal year 2006, we encourage the
    subcommittee to provide a 6 percent increase overall for NIH, and a 6
    percent increase for NHBLI and NIAID.
        Mr. Chairman, thank you for the opportunity to present the views of
    the Hemophilia Federation of America. If you have any questions, please
    do not hesitate to contact HFA's Washington Representative, Dale Dirks
    at (202) 544-7499.
                                     ______

          Prepared Statement of the Hepatitis Foundation International

                  SUMMARY OF FISCAL YEAR 2006 RECOMMENDATIONS

      --Continue the great strides in research and prevention at the
            National Institutes of Health (NIH) by providing a 6 percent
            budget increase for fiscal year 2006. Increase funding for the
            National Institute for Allergy and Infectious Diseases (NIAID),
            the National Institute of Diabetes and Digestive and Kidney
            Diseases (NIDDK), the National Institute on Alcohol Abuse and
            Alcoholism (NIAAA), and the National Institute on Drug Abuse
            (NIDA) by 6 percent.
      --$41 million in fiscal year 2006 for a hepatitis B vaccination
            program for high risk adults at CDC as recommended by the
            National Hepatitis C Prevention Strategy.
      --$40 million in fiscal year 2006 for CDC's Prevention Research
            Centers.
      --Continued support of the National Viral Hepatitis Roundtable.
        Mr. Chairman and members of the subcommittee thank you for your
    continued leadership in promoting better research, prevention, and
    control of diseases affecting the health of our nation. I am Thelma
    King Thiel, Chairman and Chief Executive Officer of the Hepatitis
    Foundation International (HFI), representing members of 425 patient
    support groups across the nation, the majority of whom suffer from
    chronic viral hepatitis.
        Currently, five types of viral hepatitis have been identified,
    ranging from type A to type E. All of these viruses cause acute, or
    short-term, viral hepatitis. Hepatitis B, C, and D viruses can also
    cause chronic hepatitis, in which the infection is prolonged, sometimes
    lifelong. While treatment options are available for all types of
    hepatitis, individuals with chronic viral hepatitis (types B, C, and D)
    represent the majority of liver failure and transplant patients.
    Treatment options and immunizations are available for most types of
    hepatitis (see below). However, all types of viral hepatitis are
    preventable.

                                  HEPATITIS A

        The hepatitis A virus (HAV) is contracted through fecal/oral
    contact (i.e. fecal contamination of food, or diaper changing tables if
    not cleaned properly), and sexual contact. In addition, eating raw or
    partially cooked shellfish contaminated with HAV can spread the virus.
    Children with HAV usually have no symptoms; however, adults may become
    quite ill suddenly experiencing jaundice, fatigue, nausea, vomiting,
    abdominal pain, dark urine/light stool, and fever. There is no
    treatment for HAV; however, recovery occurs over a 3 to 6 month period.
    About 1 in 1,000 with HAV suffer from a sudden and severe infection
    that may require a liver transplant. Luckily, a highly effective
    vaccine can prevent HAV. This vaccination is recommended for
    individuals who have chronic liver disease (i.e. HCV or HBV) or
    clotting factor disorders, in addition to those who travel or work in
    developing countries.

                                  HEPATITIS B

        Hepatitis B (HBV) claims an estimated 5,000 lives every year in the
    United States, even though we have therapies to both prevent and treat
    this disease. This disease is spread through contact with the blood and
    body fluids of an infected individual. Unfortunately, due to both a
    lack in funding to vaccinate adults at high risk of being infected and
    the absence of an integrated preventive education strategy,
    transmission of hepatitis B continues to be problematic. Additionally,
    there are significant disparities in the occurrence of chronic HBV-
    infections. Asian Americans represent four percent of the population;
    however, they account for over half of the 1.3 million chronic
    hepatitis B cases in the United States. Current treatments have limited
    success in treating the chronically infected and there is no treatment
    available for those who are considered ``HBV carriers''. Preventive
    education and vaccination are the best defense against hepatitis B.

                                  HEPATITIS C

        Infection rates for hepatitis C (HCV) are at epidemic proportions.
    Unfortunately, as many are not aware of their infection until several
    years after infection, we are dealing with an ``epidemic of
    discovery''. This creates a vicious cycle, as individuals who are
    infected continue to spread the disease, unknowingly. Hepatitis C is
    also spread through contact with an infected individual's blood. The
    CDC estimates that there are over 4 million Americans who have been
    infected with hepatitis C, of which over 2.7 million remain chronically
    infected, with 8,000-10,000 deaths each year. Additionally, the death
    rate is expected to triple by 2010 unless additional steps are taken to
    improve outreach and education on the prevention of hepatitis C, new
    research is undertaken, and case-finding is enhanced and more effective
    treatments are developed. As there is no vaccine for HCV, prevention
    education and treatment of those who are infected serve as the most
    effective approach in halting the spread of this disease.

                             PREVENTION IS THE KEY

        Only a major investment in immunization and preventive education
    will bring these diseases under control. All newborns, young children,
    young adults, and especially those who participate in high-risk
    behaviors must be a priority for immunization, outreach initiatives and
    preventive education. We recommend that the following activities be
    undertaken to prevent the further spread of all types of hepatitis:
      --Provide effective preventive education in our elementary and
            secondary schools helping children avoid the ravages of health
            problems resulting from viral hepatitis infection.
      --Training educators, health care professionals, and substance abuse
            counselors in effective communication and counseling
            techniques.
      --Public awareness campaigns to alert individuals to assess their own
            risk behaviors, motivate them to seek medical advice, encourage
            immunization against hepatitis A and B, and to stop the
            consumption of any alcohol if they have participated in risky
            behaviors that may have exposed them to hepatitis C.
      --Expansion of screening, referral services, medical management,
            counseling, and prevention education for individuals who have
            HIV/AIDS, many of whom may be co-infected with hepatitis.
        HFI recommends an increase of $41 million in fiscal year 2006 for
    further implementation of CDC's Hepatitis C Prevention Strategy. This
    increase will support and expand the development of state-based
    prevention programs by increasing the number of state health
    departments with CDC funded hepatitis coordinators. The Strategy will
    use the most cost-effective way to implement demonstration projects
    evaluating how to integrate hepatitis C and hepatitis B prevention
    efforts into existing public health programs. Additionally, HFI
    recommends that $10 million be used to train and maintain hepatitis
    coordinators in every state.
        CDC's Prevention Research Centers, an extramural research program,
    plays a critical role in reducing the human and economic costs of
    disease. Currently, CDC funds 26 prevention research centers at schools
    of public health and schools of medicine across the country. HFI
    encourages the Subcommittee to increase core funding for these
    prevention centers, as it has been decreasing since this program was
    first funded in 1986. We recommend the Subcommittee provide $40 million
    for the Prevention Research Centers program in fiscal year 2005.

                            INVESTMENTS IN RESEARCH

        Investment in the National Institutes of Health (NIH) has led to an
    explosion of knowledge that has advanced understanding of the
    biological basis of disease and development of strategies for disease
    prevention, diagnosis, treatment, and cures. Countless medical advances
    have directly benefited the lives of all Americans. NIH-supported
    scientists remain our best hope for sustaining momentum in pursuit of
    scientific opportunities and new health challenges. For example,
    research into why some HCV infected individuals resolve their infection
    spontaneously may prove to be life saving information for others
    currently infected. Other areas that need to be addressed are:
      --Reasons why African Americans do not respond to antiviral agents in
            the treatment of chronic hepatitis C.
      --Pediatric liver diseases, including viral hepatitis.
      --The outcomes and treatment of renal dialysis patients who are
            infected with HCV.
      --Co-infections of HIV/HCV and HIV/HBV positive patients.
      --Hemophilia patients who are co-infected with HIV/HCV and HIV/HBV.
      --The development of effective treatment programs to prevent
            recurrence of HCV infection following liver transplantation.
      --The development of effective vaccines to prevent HCV infection.
        The Hepatitis Foundation International supports a 6 percent
    increase for NIH in fiscal year 2006. HFI also recommends a comparable
    increase of 6 percent in hepatitis research funding at the National
    Institute of Diabetes and Digestive and Kidney Diseases and the
    National Institute of Allergy and Infectious Diseases.

                      NATIONAL VIRAL HEPATITIS ROUNDTABLE

        Victims of hepatitis suffer emotionally as well as physically. They
    experience discrimination in employment, strained personal
    relationships and severe depression when treatments fail to control
    their illness as well as during their treatment. Traditionally,
    however, there has not been an organized effort to periodically convene
    all stakeholder organizations that play a role in hepatitis prevention,
    education, treatment and patient advocacy. Successfully addressing
    viral hepatitis will require a comprehensive and strategic approach
    developed by all key stakeholders.
        In order to fill this void, HFI and CDC co-founded the ``National
    Viral Hepatitis Roundtable''. HFI believes that a National Viral
    Hepatitis Roundtable will enhance and assist CDC's viral hepatitis
    mission for the prevention, control, and elimination of hepatitis virus
    infections in the United States, as well as the international public
    health community. It will provide an infrastructure for the sharing of
    information and education of all stakeholders.
        The ``National Viral Hepatitis Roundtable'' is a coalition of
    public, private, and voluntary organizations dedicated to reducing the
    incidence of infection, morbidity, and mortality from viral hepatitis
    in the United States through research, strategic planning,
    coordination, advocacy, and leadership.
        HFI is dedicated to the eradication of viral hepatitis, which
    affects over 500 million people around the world. We seek to raise
    awareness of this enormous worldwide problem and to motivate people to
    support this important--and winnable--battle. Thank you for providing
    this opportunity to present our testimony.

                     THE HEPATITIS FOUNDATION INTERNATIONAL

        The Hepatitis Foundation International (HFI) is dedicated to the
    eradication of viral hepatitis, a disease affecting over 500 million
    people around the world. We seek to raise awareness of this enormous
    worldwide problem and to motivate people to support this important--and
    winnable--battle.
        Our mission has four distinct parts:
      --Teach the public and hepatitis patients how to prevent, diagnose,
            and treat viral hepatitis.
      --Prevent viral hepatitis by promoting liver wellness and healthful
            lifestyles.
      --Serve as advocates for hepatitis patients and the related medical
            community worldwide.
      --Support research into prevention, treatment, and cures for viral
            hepatitis.
                                     ______

       Prepared Statement of the International Foundation for Functional
                           Gastrointestinal Disorders

                  SUMMARY OF FISCAL YEAR 2006 RECOMMENDATIONS

      --Provide a 6 percent increase for fiscal year 2006 to the National
            Institutes of Health (NIH) budget. Within NIH, provide
            proportional increases of 6 percent to the various institutes
            and centers, specifically, the National Institute of Diabetes
            and Digestive and Kidney Diseases (NIDDK).
      --Continue to accelerate funding for extramural clinical and basic
            functional gastrointestinal research at NIDDK.
      --Continue to urge NIDDK to develop a strategic plan setting research
            goals on IBS and functional bowel diseases and disorders.
      --Urge NIDDK to develop a standardization of scales to measure
            incontinence severity and quality of life and to develop
            strategies for primary prevention of fecal incontinence
            associated with childbirth.
      --Provide funding to NIDDK and the National Cancer Institute (NCI)
            for more research on the causes of esophageal cancer.
        Chairman Specter and members of the Subcommittee, thank you for the
    opportunity to present this written statement regarding the importance
    of functional gastrointestinal and motility research.
        IFFGD has been serving the digestive disease community for fourteen
    years. We work to broaden the understanding about functional
    gastrointestinal and motility disorders in adults and children.
        IFFGD speaks about and raises awareness on disorders and diseases
    that many people are uncomfortable and embarrassed to talk about. The
    prevalence of fecal incontinence and irritable bowel syndrome, as well
    as a host of other gastrointestinal disorders affecting both adults and
    children, is underestimated in the United States. These conditions are
    truly hidden in our society. Not only are they misunderstood, but the
    burden of illness and human toll has not been fully recognized.
        Given that we have been diligently working for the past thirteen
    years, it is an exciting time to work for IFFGD, not only are we
    serving more and more people, but we are beginning to be able to
    privately fund research. Our first research awards were made on April
    6, 2003.
        Since its establishment, the IFFGD has been dedicated to increasing
    awareness of functional gastrointestinal disorders and motility
    disorders, among the public, health professionals, and researchers. In
    November of 2002, we hosted a conference on fecal and urinary
    incontinence, the proceedings of which were published in
    Gastroenterology, the Official Journal of the American
    Gastroenterological Association. During the first week of April 2003 we
    also hosted the Fifth International Symposium on Functional
    Gastrointestinal Disorders, which was a great success in bringing
    scientists from across the world together to discuss the current
    science and opportunities on irritable bowel syndrome and other
    functional gastrointestinal and motility disorders. The IFFGD has
    become known for our professional symposia. We consistently bring
    together a unique group of international multidisciplinary
    investigators to communicate new knowledge in the field of
    gastroenterology. In 1 week, we will be holding the Sixth International
    Symposium on Functional Gastrointestinal Disorders.
        The majority of the diseases and disorders we address have no cure.
    We have yet to understand the pathophysiology of the underlying
    conditions. Patients face a life of learning to manage chronic illness
    that is accompanied by pain and an unrelenting myriad of
    gastrointestinal symptoms. The costs associated with these diseases are
    enormous, conservative estimates range between $25-$30 billion
    annually. The human toll is not only on the individual but also on the
    family. Economic costs spill over into the workplace. In essence these
    diseases reflect lost potential for the individual and society. The
    IFFGD is a resource and provides hope for hundreds of thousands of
    people as they try to regain as normal a life as possible.

                               FECAL INCONTINENCE

        At least 6.5 million Americans suffer from fecal incontinence.
    Incontinence is neither part of the aging process nor is it something
    that affects only the elderly. Incontinence crosses all age groups from
    children to older adults, but is more common among women and in the
    elderly of both sexes. Often it is a symptom associated with various
    neurological diseases and many cancer treatments. Yet, as a society, we
    rarely hear or talk about the bowel disorders associated with multiple
    sclerosis, diabetes, colon cancer, uterine cancer, and a host of other
    diseases.
        Damage to the anal sphincter muscles; damage to the nerves of the
    anal sphincter muscles or the rectum; loss of storage capacity in the
    rectum; diarrhea; or pelvic floor dysfunction can cause fecal
    incontinence. People who have fecal incontinence may feel ashamed,
    embarrassed, or humiliated. Some don't want to leave the house out of
    fear they might have an accident in public. Most try to hide the
    problem as long as possible, so they withdraw from friends and family.
    The social isolation is unfortunate but may be reduced because
    treatment can improve bowel control and make incontinence easier to
    manage.
        In November 2002, the International Foundation for Functional
    Gastrointestinal Disorders (IFFGD) sponsored a consensus conference--
    ``Advancing the Treatment of Fecal and Urinary Incontinence Through
    Research: Trial Design, Outcome Measures, and Research Priorities.''
    Among other outcomes, the conference resulted in six key research
    recommendations:
        1. More comprehensive identification of quality of life issues
    associated with fecal incontinence and improved assessment and
    communication of treatment outcomes related to quality of life.
        2. Standardization of scales to measure incontinence severity and
    quality of life.
        3. Assessment of the utility of diagnostic tests for affecting
    management strategies and treatment outcomes.
        4. Development of new drug compounds offering new treatment
    approaches to fecal incontinence.
        5. Development and testing of strategies for primary prevention of
    fecal incontinence associated with childbirth.
        6. Further understanding of the process of stigmatization as it
    applies to the experience of individuals with fecal incontinence.

                         IRRITABLE BOWEL SYNDROME (IBS)

        Irritable Bowel Syndrome affects approximately 30 million
    Americans. This chronic disease is characterized by a group of
    symptoms, which can include abdominal pain or discomfort associated
    with a change in bowel pattern, such as loose or more frequent bowel
    movements, diarrhea, and/or constipation. Although the cause of IBS is
    unknown, we do know that this disease needs a multidisciplinary
    approach in research and treatment.
        Similar to fecal incontinence and depending on severity, IBS can be
    emotionally and physically debilitating. Because of persistent bowel
    irregularity, individuals who suffer from this disorder may distance
    themselves from social events, work, and even may fear leaving their
    home.
        In the House and Senate fiscal year 2003, 2004, and 2005 Labor,
    Health and Human Services, and Education Appropriations bills, Congress
    recommended that the National Institute of Diabetes and Digestive and
    Kidney Diseases (NIDDK) develop an IBS strategic plan. The development
    of a strategic plan on IBS would greatly increase the institute's
    progress toward the needed research on this functional gastrointestinal
    disorder.

                     GASTROESOPHAGEAL REFLUX DISEASE (GERD)

        Gastroesophageal reflux disease, or GERD, is a very common disorder
    affecting both adults and children, which results from the back-flow of
    acidic stomach contents into the esophagus. GERD is often accompanied
    by persistent symptoms, such as chronic heartburn and regurgitation of
    acid. But sometimes there are no apparent symptoms, and the presence of
    GERD is revealed when complications become evident. Symptoms of GERD
    vary from person to person. The majority of people with GERD have mild
    symptoms, with no visible evidence of tissue damage and little risk of
    developing complications. Periodic heartburn is a symptom that many
    people experience. There are several treatment options available for
    individuals suffering from GERD.
        Gastroesophageal reflux (GER) affects as many as one third of all
    full term infants born in America each year. GER results from an
    immature upper gastrointestinal motor development. The prevalence of
    GER is increased in premature infants. Many infants require medical
    therapy in order for their symptoms to be controlled. Up to 25 percent
    of older children and adolescents will have GER or GERD due to lower
    esophageal sphincter dysfunction. In this population, the natural
    history of GER is similar to that of adult patients, in whom GER tends
    to be persistent and may require long-term treatment.

                               ESOPHAGEAL CANCER

        Approximately 13,000 new cases of esophageal cancer are diagnosed
    every year in this country. Although the causes of this cancer are
    unknown, it is thought that this cancer may be more prevalent in
    individuals who develop Barrett's esophagus. Diagnosis usually occurs
    when the disease is in an advanced stage, early screening tools are
    currently unavailable.

                  CHILDHOOD DEFECATION DISORDERS AND DISEASES

        Chronic Intestinal Pseudo-Obstruction (CIP).--About 200 new cases
    of CIP are diagnosed in American Children each year. Often life
    threatening, the future for children severely affected with CIP is
    brightened by the evolving promise of cure with intestinal or multi-
    organ transplantation.
        Hirschsprung's disease.--A serious childhood and sometimes life-
    threatening condition that can cause constipation, occurs only once in
    every 5,000 American children born each year. Approximately 20 percent
    of children with HD will continue to have complications following
    surgery. These complications include infection and/or fecal
    incontinence.
        Functional constipation.--Millions of children (1 in every 10) each
    year will be diagnosed with functional constipation. In fact, it is the
    chief complaint of 3 percent of pediatric outpatient visits and 10-25
    percent of pediatric gastroenterology visits.

      FUNCTIONAL GASTROINTESTINAL AND MOTILITY DISORDERS AND THE NATIONAL
                              INSTITUTES OF HEALTH

        The International Foundation for Functional Gastrointestinal
    Disorders recommends an increase of 6 percent or 1.7 billion for NIH
    overall, and a 6 percent increase for NIDDK. However, we request that
    this increase for NIH does not come at the expense of other Public
    Health Service agencies.
        We urge the subcommittee to provide the necessary funding for the
    expansion of the NIDDK's research program on functional
    gastrointestinal (FGI) and motility disorders, this increased funding
    will allow for the growth of new research, a prevalence study and a
    strategic plan on IBS, and increased public and professional awareness
    of FGI and motility disorders.
        A primary tenant of IFFGD's mission is to ensure that clinical
    advancements concerning GI disorders result in improvements in the
    quality of life of those affected. By working together, this goal will
    be realized and the suffering and pain millions of people face daily
    will end.
        Thank you.

    The International Foundation for Functional Gastrointestinal Disorders
        The International Foundation for Functional Gastrointestinal
    Disorders is a nonprofit education and research organization founded in
    1991. IFFGD addresses the issues surrounding life with gastrointestinal
    (GI) functional and motility disorders and increases the awareness
    about these disorders among the general public, researchers, and the
    clinical care community.
                                     ______

             Prepared Statement of the Lymphoma Research Foundation

        I am Melanie Smith, Director of Public Policy and Advocacy for the
    Lymphoma Research Foundation (LRF). LRF appreciates the opportunity to
    submit this statement to the record of the Labor, Health and Human
    Services and Education Appropriations Subcommittee. The LRF is the
    nation's largest lymphoma-focused voluntary health organization devoted
    exclusively to funding lymphoma research and providing patients and
    healthcare professionals with critical information on the disease. Our
    ultimate goal is to find a cure for all forms of lymphoma. To that end,
    we fund some of the world's leading lymphoma researchers at outstanding
    academic institutions. These researchers are engaged in research aimed
    at understanding the basic mechanisms of lymphoma and improving the
    current treatments for the disease. LRF also aims to equip those who
    are diagnosed with lymphoma with up-to-date information about treatment
    options. The organization sponsors educational conferences at which the
    leaders in lymphoma research and treatment address patients and
    families regarding cutting edge research and the most recent
    developments in therapies.

                             BACKGROUND ON LYMPHOMA

        Lymphoma is a major health problem. It is the most common form of
    blood cancer and the third most common form of childhood cancer. In
    2005, approximately 56,390 cases of non-Hodgkin's lymphoma (NHL) will
    be diagnosed in this country, and more than 19,000 Americans will die
    from NHL. Also this year, 7,350 cases of Hodgkin's lymphoma will be
    diagnosed, and more than 1,400 Americans will die from the disease.
    Nearly 500,000 Americans are living with lymphoma.
        In recent years, there have been exciting reports regarding the
    improvements in treatments for a number of forms of cancer, as well as
    reports that the incidence of cancer overall is declining. Regrettably,
    NHL stands in contrast to the general trends in cancer incidence, and
    the treatment options for NHL remain inadequate. Since the early 1970s,
    incidence rates for NHL have nearly doubled, although incidence rates
    have stabilized the last few years. And the 5-year survival rate for
    NHL stands at 59 percent. These are not satisfactory numbers, and they
    serve as measures of the work we still have to do.

                              RESEARCH ON LYMPHOMA

        We have learned a great deal about the genetic, molecular, and
    cellular basis of cancer. We do not know the cause of most lymphomas,
    but there is increasing information to suggest a link between
    environmental factors and infections and the development of many
    lymphomas. The environmental factors may include chemicals, toxins,
    drugs, infectious agents, such as hepatitis C and Epstein Barr virus,
    and the gastric pathogen Helicobacter pylori. There is strong evidence
    that in some individuals, immune dysfunction is a critical factor in
    the development of lymphoma.
        Our knowledge of cancer has improved significantly in the last
    decade, in large part due to the strong commitment of Congress to the
    National Institutes of Health (NIH) and its willingness to boost NIH
    funding. These funds have supported strong basic and clinical
    researchers who are focused on unlocking the secrets to cancer. There
    is a need to sustain that commitment to NIH, in order to equip
    scientists engaged in basic research and facilitate the translation of
    basic research findings into new treatments. This is certainly true in
    the case of lymphoma. There is a need to clarify the interactions among
    the environmental, viral, and immunogenetic factors that contribute to
    development of lymphoma and to ensure the development of new treatments
    based on our enhanced understanding of lymphoma.
        Over the last decade several new lymphoma treatments have been
    developed, expanding the options for those who are diagnosed with the
    disease. Lymphoma patients and researchers have clearly benefited from
    the nation's significant investment in research, and Congress deserves
    the appreciation of the community of lymphoma patients and researchers.
    Among the lymphoma treatments approved in the last decade are a
    monoclonal antibody and two different radioimmunotherapies. While we
    applaud the new treatments of the last decade, they are not magic
    bullets. For many, lymphoma remains a fatal disease.
        New therapies that capitalize on different research approaches are
    currently under investigation. These include therapeutic vaccines,
    immunotherapies, proteasome inhibitors, and examination of the
    microenvironment of lymphomas. Other work is focused on refining the
    chemotherapy regimens and developing treatment regimens with lower
    toxicities. All of this work deserves the support of private and public
    research funders.

                        ROLE OF NIH IN LYMPHOMA RESEARCH

        Although LRF plays a critical and creative role in funding lymphoma
    research, NIH is, and will remain, the key player in this field. NIH is
    the pivotal player not only because of the magnitude of its financial
    commitment to lymphoma research, but also because of the role it can
    play in bringing together all of the partners in the research
    community--NIH intramural researchers, academic researchers, private
    foundations, industry, and the Food and Drug Administration (FDA).
        NIH is also in the best position to encourage, facilitate, and fund
    the translation of basic research findings into new treatments. It is
    absolutely critical that we not lose the research momentum that has
    been the result, in significant part, because of the doubling of the
    NIH budget between fiscal year 1999 and fiscal year 2003. We recognize
    that funding for NIH will not be increased as rapidly in the near
    future as it was from fiscal year 1999 to fiscal year 2003, but we urge
    Congress to protect the investment in NIH research and to realize that
    a rapid deceleration in research funding threatens the past investment.
        LRF recommends that Congress urge NIH to direct special attention
    to translational and clinical research. LRF proposes that NIH
    strengthen its lymphoma research program by several actions:
      --The National Cancer Institute (NCI) should boost its support for
            translational and clinical lymphoma research. NCI should
            evaluate its current investment in clinical research and expand
            or initiate programs to strengthen the clinical research
            effort.
      --NCI should also increase its support for correlative studies of
            tumor biology and treatment response, as well as its investment
            in research on the late and long-term effects of current
            lymphoma treatments.
      --NCI should strengthen its research effort focused on understanding
            the complex interaction among environmental, viral and
            immunogenetic factors that are involved in the initiation and
            promotion of lymphoma.
      --Although NCI has historically been the lead institute in funding
            lymphoma research, other institutes--the National Heart, Lung,
            and Blood Institute (NHLBI), the National Institute on Aging
            (NIA), and the National Institute of Environmental Health
            Sciences (NIEHS)--should also evaluate and improve their
            lymphoma research programs. A lymphoma-focused program to
            investigate environmental/viral links is warranted.
        A strong partnership among voluntary health agencies like LRF,
    academic researchers, industry, and NIH will be optimal for advancing
    lymphoma research and improving the outlook for those who are diagnosed
    with the disease. New strategies are necessary for the rapid
    translation of basic research findings into new treatments. These
    strategies may include systems for funding collaborative research
    projects that engage researchers in multiple institutions and multiple
    disciplines, including academic researchers and industry. Private
    foundations are looking at creative means to ensure that their research
    dollars are optimized, and we encourage NIH to employ the same creative
    and flexible approaches.

    ROLE OF THE CENTERS FOR DISEASE CONTROL AND PREVENTION IN BLOOD CANCER
                                   EDUCATION

        LRF is actively engaged in providing patients and their families
    and caregivers complete and up-to-date information about lymphoma,
    lymphoma research, and lymphoma treatment options. Because of our
    strong history in this area, we were gratified when Congress authorized
    and funded a program at the Centers for Disease Control and Prevention
    (CDC) for public and patient education on blood cancers. LRF was one of
    nine organizations that received grants, funded by fiscal year 2004
    appropriations, for public and patient education regarding the blood
    cancers. The benefits of our federally funded program, Lymphoma
    Awareness for Multicultural Populations (LAMP), which includes outreach
    to underserved communities, are already being realized.
        Congress was also generous in providing funding for this program in
    fiscal year 2005, an action that will allow the organizations to
    continue their programs and conduct full evaluations of their
    strategies for outreach and education. We urge Congress to provide a
    third year of funding, because the programs are being operated on a 3-
    year cycle. Their full potential will be realized only if they run for
    the full 3-year anticipated cycle.
        LRF believes that strong partnerships will be a key feature of
    efforts to improve lymphoma treatments and provide lymphoma patients
    current information about their disease and treatment options. We
    encourage NCI to fund collaborative research ventures, and we urge CDC
    to continue its support of those private organizations that have years
    of experience in patient education. Those who receive a diagnosis of
    lymphoma face difficult choices, and we must work together to improve
    their options and their lives.
                                     ______

                   Prepared Statement of Mended Hearts, Inc.

        I am Robert H. Gelenter, a volunteer for the Mended Hearts, Inc., a
    national heart disease patient support group with more than 289
    chapters across the United States and in Canada. We visit patients in
    approximately 460 hospitals throughout the United States. I have been
    appointed by the group to assist in this lobbying effort--a volunteer
    position.
        More than 29 years ago, I was diagnosed with a rare heart disease.
    After having severe chest pains and trouble breathing for more than two
    years, I was diagnosed with hypertrophic cardiomyopathy (HCM), a
    disease in which the heart enlarges. The heart muscle eventually
    thickens so much that it can't pump blood effectively. The heart muscle
    does not grow in the normal parallel patterns. Rather it grows in a
    haphazard manner. It affects men and women of all ages. When you read
    of a young athlete who has dropped dead on an athletic field the odds
    are very good that he or she had HCM. HCM is one of the leading causes
    of sudden cardiac death. There is no cure for this disease.
        Medication may work and there is a surgical procedure that may
    alleviate the pain. If that doesn't work a patient may need a heart
    transplant, yet spare organs are scarce. The doctor who made my
    diagnosis was trained at the National Heart, Lung, and Blood Institute
    of the National Institutes of Health.
        Initially, I received several medications, which allowed me to
    engage in most activities. But, some activities, such as walking up
    hills, caused severe shortness of breath and severe chest pains. But,
    generally I could function normally. However, after about 11 years, the
    discomfort was increasing, and it became apparent that I was in serious
    trouble. I could not walk 60 feet without having to stop to catch my
    breath. Sometimes the pain was so great that I would almost double over
    in the middle of the street. My wife told me that my face would become
    gray. The perspiration would pour off my body. If I was lucky I could
    find a chair to sit on. The quality of my life had deteriorated so
    drastically that I knew I needed some treatment.
        In 1988, I went to Georgetown University Medical Center for an
    angiogram--the gold standard for diagnosing heart problems. The
    cardiologist who performed the angiogram told me that he had bad news
    and worse news. The bad news was that I had a 95 percent blockage in my
    left anterior descending heart artery--the so-called ``widow makers
    spot.'' The worse news was that I had a major chance of having a severe
    heart attack with a less than a 5 percent chance of surviving that
    heart attack because of the hypertrophic cardiomyopathy. At this point,
    my wife was quietly crying and I was perspiring profusely. Since
    Georgetown University Medical Center did not have the expertise to
    operate on me, they called the NIH to see if they would accept me as a
    patient. I was sent home pending notice from the NIH.
        The NIH accepted me. After entering the National Heart, Lung, and
    Blood Institute on February 6, I was operated on February 11, 1988. No
    matter how trite the expression--that was the first day of the rest of
    my life. The surgery, considered drastic and rare as it is, is still
    the gold standard throughout the world for the treatment of
    hypertrophic cardiomyopathy. The Murrow Procedure, in honor of the
    innovator, was developed and improved at the NIH.
        Although this surgery is no longer performed at the National Heart,
    Lung, and Blood Institute, there is another experimental ongoing
    protocol in which the same effect is being attempted by using alcohol
    to deaden the excessive heart tissue.
        I am on medication for the rest of my life. My condition is
    progressive. Ten years ago, I was fitted with a pacemaker to insure
    that my heart beats at the correct rate. I am 100 percent dependent on
    this pacemaker. Without the pacemaker, there are times when my normal
    heart beat is so slow that I would die.
        I am eternally grateful to the physicians funded by the National
    Heart, Lung, and Blood Institute, particularly to Dr. MacIntosh and his
    staff, for the gift of life. Because of this marvelous research
    supported by the NHLBI, I have lived 17 years pain free. I have seen
    two children graduate from college and three grandchildren born, I have
    shared these years with a wonderful wife. I have been able to work at
    my profession--attorney at law.
        I have had the gift of life restored to me. To express my gratitude
    for that gift, I visit patients recovering from heart episodes at two
    hospitals, Washington Hospital Center and Washington Adventist
    Hospital.
        If this tale of woe is not enough about 2\1/2\ years ago, I
    suddenly began to have mini strokes. I experienced four episodes within
    7 months. The last episode was just a year ago. Medication now seems to
    have the incidents under control.
        I respectfully ask for the fiscal year 2006 appropriation in the
    following amounts:
      --NIH $30 billion, including $2.3 billion for heart research and $341
            million for stroke;
      --NHLBI $3.1, including $1.9 billion for heart and stroke-related
            research; and
      --NINDS $1.6 billion, including $183 million for stroke research.
        My experience is proof that the research supported by the National
    Heart, Lung, and Blood Institute and the National Institute for
    Neurological Disorders and Stroke benefits not just the patients at the
    NIH Clinical Center, but throughout the United States. The benefits go
    worldwide as well.
        Heart attack, stroke and other cardiovascular diseases remain the
    No. 1 killer and major cause of disability of men and women in the
    United States. Nearly 40 percent of people who die in the United States
    die from cardiovascular diseases. Last year, nearly 930,000 Americans
    died from cardiovascular diseases, including more than 150,000 under
    the age of 65.
        Thank you for your support of National Heart, Lung, and Blood
    Institute's heart research and the National Institute for Neurological
    Disorders and Stroke's stroke research.
                                     ______

       Prepared Statement of the March of Dimes Birth Defects Foundation

        The 3 million volunteers and 1,400 staff members of the March of
    Dimes appreciate the opportunity to submit the Foundation's federal
    funding recommendations for fiscal year 2006. The March of Dimes is a
    national voluntary health agency founded in 1938 by President Franklin
    D. Roosevelt to prevent polio. Today, the Foundation works to improve
    the health of mothers, infants, and children by preventing birth
    defects and infant mortality through research, community services,
    education, and advocacy. The March of Dimes is a unique partnership of
    scientists, clinicians, parents, members of the business community, and
    other volunteers affiliated with 52 chapters in every state, the
    District of Columbia and Puerto Rico.
        The volunteers and staff of the March of Dimes are deeply concerned
    that the funding recommendations and levels in the President's Budget
    and congressional Budget Resolutions will not be sufficient to support
    biomedical research and services needed to improve the health of
    children and families. For instance, the infant mortality rate
    increased in 2002 for the first time since 1958. Increases in deaths
    due to premature birth, birth defects, and maternal complications
    during pregnancy account for most of the increase. In our judgment, the
    funding increases recommended below are fully justified and would have
    an immediate positive impact on this disturbing trend and thereby lead
    to an overall improvement in the health of the nation's children.

                         NATIONAL INSTITUTES OF HEALTH

        The March of Dimes joins the larger research community in
    recommending a 6 percent increase in funding for the National
    Institutes of Health (NIH), bringing total federal support to just over
    $30 billion. The Administration's fiscal year 2006 budget proposal is
    insufficient to keep up with inflation and certainly will not sustain
    the necessary investment in medical research.

    National Institute for Child Health and Human Development
        The mission of the National Institute for Child Health and Human
    Development (NICHD) is closely aligned with that of the March of Dimes.
    According to the National Center for Health Statistics (NCHS), in 2002,
    more than 480,000 babies were born prematurely in the United States--1
    in 8 births. Premature birth accounts for nearly 24 percent of deaths
    in the first month of life. Those babies that survive are more likely
    than full-term infants to face serious multiple health problems
    including cerebral palsy, mental retardation, chronic lung disease, and
    vision and hearing loss. Preterm labor can happen to any pregnant woman
    and the causes of nearly half of all preterm births are unknown.
        The NICHD has made a major commitment to understanding and
    preventing premature birth but additional funding is desperately
    needed. The March of Dimes recommends a 10 percent increase for NICHD
    in fiscal year 2006 and an increase of at least $100 million over the
    next five years to boost prematurity-related research. This increase
    should be devoted to a comprehensive biomedical research program to
    study preterm delivery etiology, prevention, and treatment regimens.
        Last year, the NCHS reported the first increase in the U.S. infant
    mortality rate since 1958 and 61 percent of this increase was due to an
    increase in the birth of premature and low birth weight babies. An
    analysis of Agency for Healthcare Research and Quality data conducted
    by the March of Dimes Perinatal Data Center estimated that the total
    national hospital bill for premature babies was $15.5 billion in 2002.
    The financial burden of prematurity is expected to continue to worsen
    until prevention of preterm births is better understood and clinical
    interventions are developed.
        The NICHD began a major new initiative involving genomic and
    proteomic research into the causes of premature birth in an effort to
    accelerate knowledge in the mechanisms responsible for premature birth.
    The RFA soliciting proposals for the establishment of a collaborative
    network for premature birth research was issued in June 2004. The NICHD
    received an excellent response to this RFA and had anticipated the
    start of this initiative in early 2005. The March of Dimes is very
    disturbed that the start of this crucial initiative has now been
    delayed because of insufficient funding.
         Unfortunately, even a 10 percent increase in funding would not be
    enough to enable NICHD to begin implementing the National Children's
    Study (NCS) of environmental and genetic influences on child health and
    development. The goal of the NCS is to pinpoint causes and find
    prevention and treatment strategies for many of today's childhood
    diseases and disorders. The planning of the study is largely complete
    and the study is ready to be piloted. On November 16, 2004, the Request
    for Proposals for the first NCS study sites and the data-coordinating
    center were published. But beyond the pilot sites, the future of this
    important study is uncertain without additional funding. The cost of
    this study is dwarfed by the $269 billion annual cost of treating the
    diseases and conditions it is designed to address, including preterm
    birth, according to NICHD estimates. If study findings were to result
    in only a 1 percent reduction in those costs, the expense of the entire
    study could be recovered in a single year. The March of Dimes believes
    it would be shortsighted to put off this study.

                CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)

    Division of Reproductive Health
        The National Center for Chronic Disease Prevention and Health
    Promotion, Division of Reproductive Health works to promote optimal
    reproductive and infant health, but does not have the resources it
    requires to study the growing problem of preterm birth. Therefore, the
    March of Dimes recommends a $20 million increase in fiscal year 2006 to
    expand research related to preterm birth. Worsening rates of preterm
    birth require an expanded, comprehensive prevention research agenda to
    identify the causes, risk factors, and to find clinical interventions
    that are effective in preventing preterm labor. In particular, two
    specific programs should receive additional funding: (1) the Pregnancy
    Risk Assessment Monitoring System and (2) epidemiological research.
        The Pregnancy Risk Assessment Monitoring System (PRAMS) is a state-
    specific, population based surveillance system designed to identify and
    monitor maternal behaviors and experiences before, during, and after
    pregnancy. Currently, CDC supports cooperative agreements with 29
    states and New York City through which PRAMS monitors approximately 62
    percent of all U.S. births. Data collected through PRAMS is used by
    researchers and policy makers to increase understanding of adverse
    pregnancy outcomes, to develop maternal and child health programs, and
    to incorporate the most up to date research findings into standards of
    practice. The March of Dimes recommends an increase of $5 million to
    expand PRAMS so that CDC can develop better national estimates on
    behavioral as well as demographic risk factors for preterm birth.
        Epidemiological research conducted at CDC is vital to reducing the
    incidence of preterm birth. The March of Dimes recommends an increase
    of $15 million to expand research on the prevention of preterm delivery
    for women at risk, focusing especially on factors contributing to
    higher rates of preterm delivery among African-American women.
    Increasing CDC's activities related to identifying the causes of
    preterm birth would improve early detection of women at risk for
    preterm labor and lead to new interventions for those at greatest risk.
    National Center on Birth Defects and Developmental Disabilities
        Created by the Children's Health Act of 2000 (Public Law 106-310),
    the National Center on Birth Defects and Developmental Disabilities
    (NCBDDD) conducts programs to protect and improve the health of
    children and adults by preventing birth defects and developmental
    disabilities; promoting optimal child development and health and
    wellness among children and adults with disabilities. The March of
    Dimes recommends at least $135 million in fiscal year 2006 funding for
    the NCBDDD.
        Of particular interest to the March of Dimes is the NCBDDD's
    comprehensive birth defects program that includes surveillance,
    research and prevention activities. Of the four million babies born
    each year in the United States, 3 percent are born with one or more
    birth defects. Birth defects are the leading cause of infant mortality,
    accounting for more than 20 percent of all infant deaths. Children with
    birth defects who survive often experience lifelong physical and mental
    disabilities. In fact, birth defects contribute substantially to the
    nation's health care costs. According to CDC, the medical treatments
    and supportive services for the 17 most common birth defects exceed $8
    billion annually. A modest increase of $6 million in funding for
    surveillance, research and prevention activities is a vital step to
    making progress in reducing the incidence of birth defects.
        NCBDDD provides funding to states to develop, implement, and/or
    expand community-based birth defects surveillance systems, programs to
    prevent birth defects, and activities to improve access to health
    services for children with birth defects. Surveillance is vitally
    important for the early detection of new birth defects, for discovering
    the causes of birth defects and for evaluating the effectiveness of
    prevention programs. Due to lack of funds, CDC will only fund 15 states
    in fiscal year 2005, down from 28 states in fiscal year 2004.
    Additional resources are needed to fund all states seeking CDC
    assistance and increase assistance to states already receiving funds.
        The National Birth Defects Prevention Study is the largest case-
    control study of birth defects ever conducted. This CDC-funded study is
    being carried out by 9 regional Centers for Birth Defects Research and
    Prevention located in Arkansas, California, Georgia, Iowa,
    Massachusetts, New York, North Carolina, Texas, and Utah. These centers
    obtain data and identify cases for inclusion in the study and conduct
    epidemiological research on birth defects. With adequate funding, this
    study has the potential to dramatically increase understanding of the
    causes of birth defects and is already providing information for
    improvement of programs to prevent birth defects. The causes of nearly
    70 percent of birth defects are still unknown.
        The centers study possible genetic and environmental causes, the
    use of certain medications during pregnancy, maternal diet, and vitamin
    use. This study provides the nation a continuing source of information
    on potential causes of birth defects. For example, in response to a
    scientific study showing a possible association between the drug
    loratadine, also sold under the brand name Claritin, and the
    occurrence of the birth defect hypospadias the National Birth Defects
    Prevention Study conducted a review that showed no association. This
    information is useful to physicians as well as women who take
    loratadine and become pregnant.
        The NCBDDD also is conducting a national public and health
    professions education campaign designed to increase the number of women
    taking folic acid. CDC estimates that up to 70 percent of neural tube
    defects (NTDs), serious birth defects of the brain and spinal cord
    including anencephaly and spina bifida, could be prevented if all women
    of childbearing age consume 400 micrograms of folic acid daily,
    beginning before pregnancy. Since fortification of U.S. enriched grain
    products with folic acid, the rate of NTDs in the United States has
    decreased by 26 percent. It is critical that CDC increase its campaign
    efforts to educate every woman of childbearing age and their providers
    about the importance of folic acid to further reduce the rates.
    Therefore, the March of Dimes recommends an appropriation of at least
    $4 million in fiscal year 2006 for the Folic Acid Education Campaign.

                            ADDITIONAL CDC PROGRAMS

    National Immunization Program
        If we are to meet the Healthy People 2010 goals of vaccinating 90
    percent of children and adults, CDC, states and localities will need
    sufficient resources to ensure that those in need of immunizations
    receive them. Annually, 4 million children should be immunized against
    12 preventable diseases before the age of two. Yet, nearly 25 percent
    of two-year-olds have not received all of the recommended vaccine
    doses. CDC's National Immunization Program provides grants to 64 state,
    local, and territorial public health agencies to reduce the incidence
    of disability and death resulting from vaccine preventable diseases. To
    move the nation closer to the goal of vaccinating at least 90 percent
    of children and adults, the March of Dimes urges the Subcommittee to
    continue its longstanding policy of ensuring that federal vaccine
    programs are adequately funded. For fiscal year 2006, the March of
    Dimes recommends an overall increase of $232 million in order to ensure
    that the National Immunization Program has the resources it needs to
    account for vaccine price increases, introduction of new vaccines, and
    to facilitate implementation of recommendations developed by the
    Institute of Medicine.

    Polio Eradication
        April 12, 2005 marks the 50th anniversary of the declaration that
    the poliovirus vaccine developed by Dr. Jonas Salk was safe and
    effective. The March of Dimes, formerly known as the National
    Foundation for Infantile Paralysis, funded Dr. Salk's groundbreaking
    work on the polio vaccine. Although eradication of polio in the United
    States resulted in a shift in the Foundation's focus to a new set of
    challenges pertaining to children's health, the March of Dimes
    continues to support completing the task of polio eradication
    worldwide. Global polio eradication will save lives and reduce
    unnecessary health-related costs. The March of Dimes supports a funding
    level of $106.4 million for CDC's fiscal year 2006 global polio
    eradication activities. With polio epidemics now confined to only 6
    countries (Nigeria, India, Pakistan, Niger, Egypt and Afghanistan), it
    is important that the U.S. government maintain its commitment to
    completion of the worldwide eradication initiative.

    National Center for Health Statistics
        The Foundation also supports the vital work of the National Center
    for Health Statistics (NCHS), which provides data essential for
    research and programmatic initiatives. For example, the National Vital
    Statistics System is a major source of information on the utilization
    of prenatal care and on adverse birth outcomes such as preterm births,
    low birthweight, and infant mortality. Increased funding would allow
    CDC to modernize this system using web-based technology that
    facilitates rapid compilation of accurate and comprehensive data
    obtained from health professionals and facilities. This information is
    needed to track trends in birth outcomes and to support birth defects
    registries. Data from NCHS' surveys are also important to identify
    emerging trends and optimal uses of existing program resources.
    Additional resources would also enable CDC to continue the National
    Survey of Family Growth, which provides essential information on
    factors affecting birth outcomes.

              HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)

    Newborn Screening
        Newborn screening is a vital public health activity used to
    identify genetic, metabolic, hormonal and/or functional conditions in
    newborns that left untreated can cause disability, mental retardation,
    and even death. Although nearly all babies born in the United States
    are screened for some genetic birth defects, the number and quality of
    these tests varies from state to state. The March of Dimes recommends
    that every baby born in the United States receive, at a minimum,
    screening for a core set of 29 metabolic disorders including hearing
    deficiencies.
        In fiscal year 2005, the Congress provided funding for
    implementation of Title XXVI of the Children's Health Act of 2000. This
    program is designed to strengthen state newborn screening programs; to
    improve states' ability to develop, evaluate, and acquire innovative
    testing technologies; and to establish and improve programs to provide
    screening, counseling, testing and special services for newborns and
    children at risk for heritable disorders. Unfortunately, funding for
    Title XXVI activities was obtained by diverting a portion of the SPRANS
    section of the Maternal and Child Health Block Grant which the
    Administration proposes to level fund in fiscal year 2006. The March of
    Dimes recommends that Title XXVI of the Children's Health Act be funded
    at a level of $25 million in new money to support HRSA's work with
    states to improve newborn screening programs across the nation.

    Maternal and Child Health Block Grant
        Federal funding for Title V of the Social Security Act, the
    Maternal and Child Health (MCH) Block Grant, has failed to keep pace
    with increased demand for services. Although the Block Grant provides
    funds for a growing number of community-based programs such as home
    visiting, respite care for children with special health care needs and
    ``wrap around'' services for pregnant women and children enrolled in
    Medicaid and SCHIP, the funding level for the Grant has not increased
    since fiscal year 2002. In order for maternal and child health programs
    to continue to shoulder responsibility for additional services, it must
    be adequately funded. The March of Dimes recommends fully funding Title
    V at the authorized level of $850 million.
        Thank you for the opportunity to testify on the federally supported
    programs of highest priority to the March of Dimes. The Foundation's
    staff and volunteers look forward to working with Members of the
    Subcommittee to improve the health of mothers, infants and children.

           MARCH OF DIMES FISCAL YEAR 2006 FEDERAL FUNDING PRIORITIES
                            [In millions of dollars]
    ------------------------------------------------------------------------
                                                             March of Dimes
                   Program                Fiscal year 2005  fiscal year 2006
                                               funding        recommendation
    ------------------------------------------------------------------------
    National Institutes of Health                 28,444.0          30,150.0
     (Total)............................
        National Institute of Child                1,270.0           1,397.0
         Health & Human Development.....
        National Human Genome Research               489.0             518.0
         Institute......................
        National Center on Minority                  196.0             208.0
         Health and Disparities.........
    Centers for Disease Control and                8,034.0           8,650.0
     Prevention (Total).................
        Center on Birth Defects and                  125.0             135.0
         DevelopmentalDisabilities......
        Birth Defects Research &                      14.0              20.0
         Surveillance...................
        Folic Acid Education Campaign...               2.0               4.0
        Immunization....................             479.0             711.0
        Polio Eradication...............             106.4             106.4
        Safe Motherhood/Infant Health                 45.0              65.0
         (NCCDPHP)......................
        Pregnancy Risk Assessment                      7.3              12.3
         Monitoring System..............
        Prevention Research (Preterm                   1.5              16.5
         Birth).........................
        National Center for Health                   109.0             118.0
         Statistics.....................
    Health Resources and Services                  6,809.0           7,500.0
     Administration (Total).............
        Maternal and Child Health Block              730.0             850.0
         Grant..........................
        Newborn Screening...............               2.0              25.0
        Newborn Hearing Screening.......              10.0              10.0
        Consolidated (Community) Health            1,734.0           2,038.0
         Centers........................
        Healthy Start...................             102.0             102.0
    Agency for Healthcare Research and               319.0             440.0
     Quality............................
    ------------------------------------------------------------------------

                                     ______

       Prepared Statement of the National Coalition for Heart and Stroke
                                    Research

        My name is Jack Owen Wood. I solicit your support for more
    aggressive federal funding for research into prevention and treatment
    of the sister diseases, stroke and heart disease. Strokes and heart
    attacks are occurring at an alarming rate.
        I am representing the National Coalition for Heart and Stroke
    Research. The coalition consists of 18 national organizations
    representing more than 5 million volunteers and members united in
    support for increased funding for heart and stroke research. Members of
    the Coalition include:
        American Academy of Neurology; American Academy of Physical
    Medicine and Rehabilitation; American Association of Neurological
    Surgeons; American College of Cardiology American College of Chest
    Physicians; American Heart Association; American Neurological
    Association; American Stroke Association; American Vascular Association
    Foundation; Association of Black Cardiologists; Children's
    Cardiomyopathy Foundation, Inc.; Citizens for Public Action on Blood
    Pressure and Cholesterol, Inc.; Congress of Neurological Surgeons;
    Heart Rhythm Society; Mended Hearts, Inc.; National Stroke Association;
    Society of Interventional Radiology; and Society for Vascular Surgery.
        I will deal primarily with one man's personal experience with
    stroke and its functional and financial costs--my own. I have only the
    use of my right arm.
        I was born in 1937, raised in Vicksburg, Mississippi, earned an
    engineering degree at Mississippi State University and currently reside
    in Port Orchard, Washington. I worked for the Boeing Company in
    Seattle, am a former Director of the Washington State Energy Office,
    served as Director of Cost and Revenue Analysis and as the Forcasting
    Manager for a major Northwest Area Natural Gas Utility until May 1,
    1995.
        On May 1, 1995, at the age of 57, I was stricken and severely
    disabled by my stroke. Two years later I experienced a triple bypass
    heart operation. You might say I've ``been there and done that'' for
    both major cardiovascular diseases. So you see, I am an expert.
        Years ago I was offered an exciting and rewarding volunteer
    opportunity. I was asked to lead the ``Jack Wood Stroke Victor Tour''
    for the American Heart Association.
        The Jack Wood Stroke Victor Tour was a 5-state lobbying tour.
    Through it I tried to meet personally with every Northwest
    Congressional representative on his or her home turf (in Alaska, Idaho,
    Montana, Oregon and Washington). In each meeting I was joined by local
    people, stroke survivors and their families and medical professionals.
    I told my story and asked them to join the Congressional Heart and
    Stroke Coalition and to support increased federal funding for heart and
    stroke research.
        I am proud to say I traveled to 18 communities and met personally
    with 28 members of our delegation or their staff.
        One of the most powerful memories for me was the frequency in which
    Members of Congress or staff members related their personal experience
    with stroke. One member I spoke to lost both parents to stroke. I
    suspect many of you have stories too.
        I realize your interest is greater than the physical impact of my
    stroke. Your concern must include the financial impact, not only to me,
    but also on our country from increased health care costs and lost
    productivity and its many implications.
        I have confronted the difficult and painful task of calculating
    that cost to me. Besides being a man whose stroke took his ability to
    pick up and play with his grandchildren and his livelihood, I remain a
    statistician at heart. I could not resist calculating and telling that
    part of my story. But please remember my story is not dissimilar to
    that of many of the 5.4 million stroke survivors in the United States.
    Many of whom were stricken in their prime earning years. Who in a
    matter of moments, seemingly without warning, are transformed from a
    contributor and provider to a receiver and patient.
        Allow me to highlight three figures that I feel sum up my data and
    should be important to you. I estimate that my stroke at age 57:
      --Reduced my earnings before retirement age 65 by more than $600,000.
      --Subsequently, the cost to the federal government in lost income and
            other taxes, early Medicare payments and Social Security
            disability payments is more than $320,000.
      --My HMO spent approximately $150,000 to respond to and treat my
            stroke.
      --One man, over $1 million.
        About 700,000 Americans will suffer a stroke this year costing this
    nation an estimated $57 billion in medical expenses and lost
    productivity.
        Earlier I described a stroke as occurring seemingly without
    warning. All too often as in my case, people either don't know or
    ignore the signs of a stroke, even one in progress. When my stroke hit
    I denied it. It took me two days after my stroke to acknowledge it and
    seek help. Because of research into new treatments, we now have tPA, a
    clot-busting drug, which if administered within 3 hours of the onset of
    stroke symptoms, can dramatically reduce the damage of clot-based
    strokes. Had I recognized and acknowledged my stroke, gone to a
    hospital with a neurologist on staff and had there been tPA, the impact
    of my stroke most certainly would have been lessened.
        What is even more painful to me is that my impending stroke could
    have been detected. Unfortunately, we need to create easier and less
    expensive diagnostic techniques so that effective diagnostics can be
    given routinely as part of regular health exams. And they must be
    covered through insurance.
        I am not asking for your sympathy. Instead, please think of me as
    two of the ghosts in the famous Dickens' story. Please don't
    misunderstand, I am not casting you as Scrooge. See me as both the
    ghosts of things past and things yet to be. I too am here to tell you,
    the future, which I represent, needs not be. It is largely up to you.
        I hope my story and estimate of the cost of my stroke convinces you
    that taking on stroke and heart disease through increased research,
    leading to better prevention, diagnosis and treatment is fiscally
    responsible. The human and financial costs are astronomical.
        Thank you for your past support of research.
                                     ______

            Prepared Statement of the National Hemophilia Foundation

        Thank you for the opportunity for the National Hemophilia
    Foundation (NHF) to submit testimony to the Chairman and Members of the
    Appropriations Subcommittee on Labor, Health and Human Services,
    Education, and Related Agencies. NHF is a national voluntary health
    organization dedicated to improving the health and welfare of people
    affected by bleeding and clotting disorders, including hemophilia,
    women's bleeding disorders, and thrombophilia.

                                   BACKGROUND

        Bleeding and clotting disorders are caused by genetic defects in
    the body's blood coagulation system, usually a missing protein that
    prevents or slows down blood clotting, or sometimes causes excessive
    clotting. There are several types of bleeding disorders. The most
    recognized bleeding disorder is hemophilia, a predominantly male
    disorder affecting approximately 20,000 individuals in the United
    States. The most common bleeding disorder is von Willebrand disease,
    which affects between one to two percent of the U.S. population.
    Thrombophilia, a blood clotting disorder effecting 2 million people
    each year, puts both men and women at risk of developing dangerous
    blood clotting in veins and arteries. These clots can obstruct the
    blood flow through the vessels causing pain and swelling of the tissue
    in the area and can lead to permanent tissue damage as well as death.

                            PREVENTION AND TREATMENT

    Centers for Disease Control and Prevention
        The national network of hemophilia treatment centers (HTCs) created
    by Congress in 1974 remains essential to ensuring that comprehensive
    and specialized care is available for persons with bleeding and
    clotting disorders. The HTC role has expanded dramatically over the
    last three decades, evolving with the needs of the hemophilia and
    bleeding disorders community to provide coordinated care, blood safety
    surveillance, prevention, and improved disease management. This
    expansion also has included outreach and treatment for women with
    bleeding disorders and persons with thrombophilia.
        These programs, carried out by the Hereditary Blood Disorders
    Program in the National Center for Birth Defects and Developmental
    Disabilities at the Centers for Disease Control and Prevention (CDC),
    have demonstrated significant reductions in mortality and morbidity.
    More than 75 percent of the hemophilia community participates in one of
    the 140 centers that comprise the HTC network and more than 10,000
    women receive care at a HTC. Despite this dramatic growth in support
    and services, HTC funding has not increased in the last 10 years.
    Support for an increase has been identified in Congress, and
    Congressman Tom Price (R-GA) and many of his colleagues have sponsored
    a letter of support encouraging the Committee to allocate an additional
    $7 million for HTC funding. NHF urges the Committee's strong support
    for this additional funding to ensure HTCs can carry out needed
    education, prevention, blood safety, surveillance, and outreach
    programs with the bleeding and clotting disorders community.
    Health Resources and Services Administration
        HTCs also receive needed funding as a special project of regional
    and national significance within the Maternal and Child Health Bureau
    (MCHB) Block Grant set-aside. MCHB funds are utilized by HTCs to cover
    the non-reimbursable costs of providing on-going nursing, prevention,
    dental, and rehabilitative services and support. MCHB funding for HTCs
    has remained steady for the past 20 years, resulting in eroded
    resources over time. MCHB funds for the HTC disease management network
    are essential to meeting the needs of the bleeding and clotting
    disorders community. NHF urges the Committee to maintain funding
    support for the HTCs through MCHB.

                              HEMOPHILIA RESEARCH

    Bleeding and Clotting Disorders Research
        NHF is appreciative of the Committee's continued commitment to
    research. The strengthened research funding provided by the Committee
    to the National Institutes of Health has brought about rapid advances
    in science. Within NIH, the National Heart, Lung, and Blood Institute
    (NHLBI) has taken the lead on advancing research on bleeding and
    clotting disorders and the complications of these disorders. NHF is
    particularly appreciative of NHLBI's collaborative research program
    with the Foundation to support research on improved and novel therapies
    for treating these disorders and, like the Institute, has been
    overwhelmed by the scientific community's positive response to this
    approach. NHF encourages the Committee to increase its funding support
    for NHLBI such that valuable initiatives like the collaborative
    research program can be sustained.

    Hepatitis C Virus
        HCV continues to severely impact the hemophilia and bleeding
    disorders community. As a result of their dependence on blood-based
    products, the hemophilia and bleeding disorders community has been
    severely affected by HIV and hepatitis. More than 80 percent of people
    with hemophilia born before 1992 have the Hepatitis C Virus (HCV).
    Today, nearly half of all persons with hemophilia have HCV. NHF has
    been grateful for the support of the Committee in encouraging continued
    partnerships between NHF and the National Institute of Allergy and
    Infectious Disease (NIAID) to address the importance of developing and
    advancing research initiatives for addressing HCV within the bleeding
    disorders community. NHF requests that NIAID continue to work with the
    Foundation's medical and scientific leadership and develop a report by
    March 31, 2006 on HCV research strategies that are being pursued within
    the bleeding disorders community.
        Over the last 20 years, the National Cancer Institute (NCI) has
    collected samples from patients with hemophilia infected with HIV and
    HCV through the Multi-Center Hemophilia Cohort Study. This cohort
    offers a rich database for improving the understanding of HCV and has
    served as the basis of significant peer reviewed findings. NHF
    understands that NCI has decided to no longer fund further research
    studies of the cohort. NHF requests the Committee's support in urging
    NCI to ensure the samples obtained through this cohort are preserved
    and accessible for future research. NHF also requests a report on
    possible future research opportunities provided by the cohort samples.
        The National Institute of Diabetes and Digestive and Kidney
    Diseases (NIDDK) has played a significant role in advancing and
    coordinating NIH's HCV research activities. With the high incidence of
    HCV within the bleeding disorders community, it is critical to further
    investigate and understand treatment options and advancements. NHF
    urges the Committee's support for NHF to work with NIDDK in developing
    and advancing research initiatives to address HCV within the bleeding
    disorders community.

                                RECOMMENDATIONS

        We are grateful for the Committee's support of bleeding and
    clotting disorders research, prevention, treatment, and outreach
    initiatives. For fiscal year 2006, we urge the Committee to:
      --Strengthen funding support for hemophilia and bleeding and clotting
            disorders prevention and treatment programs by providing an
            additional $7 million for the HTC network through CDC's
            Hereditary Blood Disorders Program.
      --Provide continued support for the HTC network through MCHB.
      --Maintain support at NHLBI for research on improved and novel
            therapies for bleeding and clotting disorders.
      --Provide support for continued collaboration between NHF and NIAID
            in developing and advancing research initiatives for addressing
            HCV within the bleeding disorders community.
      --Preserve NCI samples obtained through the Multi-Center Hemophilia
            Cohort Study and ensure their accessibility for future research
            initiatives.
      --Provide support for NIDDK to work with NHF in addressing HCV within
            the bleeding disorders community.
        Thank you for the opportunity to provide this statement to the
    Committee.
                                     ______

         Prepared Statement of the National Multiple Sclerosis Society

        Mr. Chairman and distinguished members of the Subcommittee, we
    appreciate the opportunity to submit written testimony on behalf of the
    National Multiple Sclerosis Society. The Society was founded in 1946.
    Since its inception, the Society's highest priority has been to support
    research aimed at finding the cause of MS, better treatments, and a
    cure. In 2005, the National MS Society will spend over $35 million on
    MS research supporting over 350 MS investigations. By the end of 2005,
    the Society cumulatively will have expended some $460 million since
    awarding its first three grants in 1947. This represents the largest
    privately funded program of basic, clinical, and applied research and
    training related to MS in the world.
        The federal government must continue its vital role in furthering
    the scientific understanding of MS. To this end, the Society supports
    the following:
      --That the National Institutes of Health (NIH), in partnership with
            the Society, invest additional funds to identify and
            characterize MS susceptibility genes and bring additional
            research focus to the primary progressive form of MS.
      --That NIH, in collaboration with the Society, other MS
            organizations, and other federal research agencies, undertake a
            study of the incidence, demographics and environmental factors
            that may contribute to disease onset.
      --The National Institute on Disability and Rehabilitation Research
            (NIDRR) in the Department of Education fund one additional
            Medical Rehabilitation Research and Training Center for MS and
            take steps to stimulate individual research projects.
      --That Congress increase fiscal year 2006 NIH funding by 6 percent.
        Multiple sclerosis is a chronic, unpredictable and often disabling
    disease of the central nervous system. Symptoms range from numbness in
    the limbs, to loss of vision, memory deficits, and in some instances
    partial or total paralysis. The progress, severity and specific
    symptoms of MS in any one person can vary and cannot yet be predicted,
    but advances in research and treatment are giving hope to those
    affected by the disease.
        The federal investment in the National Institutes of Health (NIH)
    and the National Institute on Disability and Rehabilitation Research
    (NIDRR) plays a major role in MS research. At the NIH, there are two
    institutes that conduct or fund the majority of MS research: the
    National Institute of Neurological Disorders and Stroke (NINDS) which
    funds 75 percent, and the National Institute of Allergy and Infectious
    Diseases (NIAID) which funds about 20 percent. The National Center for
    Medical Rehabilitation Research (NCMRR--a unit of the National
    Institute of Child Health and Human Development) also funds a small
    amount of MS research specifically targeting rehabilitation issues. In
    addition to the NIH, the NIDRR through the Department of Education
    invests in MS research.
        For fiscal year 2005 and fiscal year 2006, it is estimated that NIH
    expenditures on MS research will be approximately $102 and 103 million,
    respectively. For fiscal year 2005 and fiscal year 2006 NIDRR
    expenditures on MS research will be approximately $1.5 million per year
    out of a total budget of $140 million per year. While this demonstrates
    one measure of the federal investment in MS research, this amount pales
    in comparison with the annual direct and indirect disease cost--
    approximately $23 billion for all people with MS in the United
    States.\1\
    ---------------------------------------------------------------------------
        \1\ Based on a 1994 Duke University study, indexed for 2004 by the
    National MS Society, the average annual cost of MS is estimated at
    $57,500 per person due to lost wages, increased medical care and other
    expenses. Nationwide, there are an estimated 400,000 people with MS.
    ---------------------------------------------------------------------------
        The National MS Society has had a long and productive relationship
    with the NIH, particularly with NINDS. Our founder Sylvia Lawry helped
    spearhead the legislation that established NINDS in 1950. The Society
    has been pleased to work with the NINDS on many areas of mutual
    interest and we hope to strengthen our partnership with NINDS and
    expand our relationships with other federal funders of MS research in
    the coming year.
        The Society supports the NIH Neuroscience Blueprint, announced last
    Fall, that reinforces intra-collaboration and information-sharing among
    14 NIH Institutes that conduct or support research on the brain and
    nervous system. The Blueprint should accelerate the translation of
    basic neuroscience discoveries into better ways to treat and prevent
    nervous system disease.

                INVESTING IN RESEARCH PRIORITIES RELEVANT TO MS

        The National MS Society will continue to pursue research
    opportunities with NIH and NIDRR in priority areas that are key to
    furthering the understanding of MS. We continue to monitor NIH's
    progress in expanding its commitment to MS research as suggested by
    Congress.
        In 2004, as part of our NIH advocacy efforts, the Society had the
    following congressional ``report language'' added by the House and
    Senate Appropriations Conference Committee as an instruction to NIH in
    the fiscal year 2004 omnibus appropriations package:

        ``The conferees urge NINDS to increase its overall investment in
    multiple sclerosis (MS) research. Special emphasis on imaging,
    biological markers and clinical trials for new therapeutics should be
    areas of high priority. The conferees are pleased to note the
    development of a joint symposium on MS genetics sponsored by NINDS and
    the National MS Society, and encourage the Institute to take a more
    active role at the NIH in furthering MS genetics research by developing
    collaborative strategies with the National Human Genome Research
    Institute and other relevant NIH institutes. The conferees request that
    NIH report back to Congress no later than September 30, 2004 with
    progress in its efforts to expand its commitment to multiple sclerosis.
    The conferees also are pleased to note a major success in past years in
    the creation of a joint collaborative research program in ``gender and
    immunity'' between the National Institute on Allergy and Infectious
    Diseases (NIAID) and a major voluntary association for the disease, in
    which NINDS participates. The conferees encourage NINDS to seek similar
    collaborative activities related to MS.''

        The Society was pleased to receive a copy of the report. While the
    Society is gratified by the many intramural and extramural activities
    and progress described in the report, we are disappointed to note that
    it did not address steps that NINDS would take to expand its commitment
    MS research as requested by the committee. We urge NINDS to increase
    its commitment to MS by:
      --Partnering with the Society to invest additional resources to help
            solve the genetic basis of MS.
      --Working with the Society to bring additional research focus to the
            primary progressive form of MS (PPMS).
        Family studies of people with MS and their relatives, have shown
    that the risk for MS depends on relatedness to the affected individual,
    that is, a sibling has a higher risk of developing MS than a cousin. In
    no other disease have recurrence risks been so comprehensively
    catalogued in groups of biological and social relatives. A strategy is
    needed to penetrate the genetics of MS. Although the NIH and the
    National MS Society have invested independently substantial funds in MS
    genetics over the past decade, this is an area that calls for
    additional collaboration. The past few years have seen real progress in
    the development of laboratory and analytical approaches to the study of
    genetic disorders. The Society encourages the NIH to move forward with
    the Society as a true partner in identifying those DNA regions that can
    be prioritized for encoding MS susceptibility genes. The identification
    and characterization of the MS genes will help to define the basic
    etiology of the disease, to help predict the course of the disease, and
    to influence therapeutics.
        Advances in immunology have provided clinicians with powerful tools
    to better understand the underlying causes of MS, leading to new
    therapeutic advances. Although there are FDA-approved treatments for
    relapsing MS, there are no approved treatments for progressive MS. The
    primary progressive form of MS (PPMS) is characterized from the onset
    by the absence of acute attacks and instead involves a gradual clinical
    decline. Approximately 10 percent of individuals are diagnosed with
    PPMS from the onset. Clinically this form of the disease is associated
    with a lack of response to any form of immunotherapy. This leads to the
    concept that PPMS may in fact be a very different disease as compared
    to relapsing remitting MS. The Society identifies the study of
    progressive MS as an area that merits greater attention by the research
    community in order to increase our understanding of PPMS and to have
    effective therapies for this progressive form of the disease. In the
    upcoming year, the Society encourages NIH to help the Society address
    this underserved area of MS research.
        In addition to efforts at the NIH, the Society is pleased to note
    that for more than 20 years, NIDRR has funded a Medical Rehabilitation
    Research and Training Center (MRRTC) for MS. However, the institute's
    overall investment in MS research remains limited, $1.5 million in
    fiscal year 2005. The NIDRR portfolio includes only two current
    projects related to MS, the aforementioned MRRTC and a Rehabilitation
    Research and Training Center on Health and Wellness in Long Term
    Disability that is only partially focused on MS. In contrast, spinal
    cord injury, with a prevalence less than that of MS, has 39. Since the
    advent of FDA-approved MS disease-modifying treatments in 1993, persons
    with MS have had access to therapeutics which can slow the progression
    of disability. However, in order to maintain maximum levels of
    independence, persons with MS need rehabilitation to address residual
    deficits. Unfortunately, due to the limited support for MS
    rehabilitation research, we know relatively little about the efficacy
    of rehabilitative interventions in MS. We therefore urge the NIDRR to
    increase its support for MS rehabilitation research through the funding
    of at least one additional MRRTC along with initiatives to stimulate
    individual research projects.

                        THE IMPORTANCE OF COLLABORATION

        The National MS Society cannot overemphasize the importance of
    collaboration. We are pleased to see that the Roadmap Initiative--a 3-
    year plan addressing key research issues throughout NIH--continues to
    develop. The National MS Society encourages NIH to continue its efforts
    to increase collaboration across institutes and to pursue collaborative
    opportunities with other organizations. As we see it, there is no other
    choice.
        An area in critical need of attention concerns data related to the
    incidence, prevalence, and distribution of MS. The last national study
    of incidence and prevalence of MS in the United States took place more
    than 30 years ago. Since that time the population of the United States
    has changed dramatically in size, composition, and distribution.
    Moreover, numerous questions have arisen concerning possible ethnic,
    geographic, and local variations in the distribution of MS. Knowledge
    concerning these distributions and possible causal factors may provide
    important information concerning the nature of MS and its triggers.
    Moreover, rational policy formulation for MS health care requires up-
    to-date information concerning numbers and characteristics of persons
    with MS down to the state level. Addressing these information needs is
    beyond the resources of the Society. We therefore urge the NIH, the
    CDC/ATSDR to work with the Society and perhaps other MS organizations
    such as the Consortium of MS centers, to begin the task of
    understanding how many Americans have MS, where they reside, and what
    environmental factors may have contributed to disease onset.
        To date, the Society has been successful with NIH on jointly
    funding a major initiative on gender and immune function. In 2001, the
    Society entered into a $20 million collaborative project with NIAID and
    other NIH institutes to investigate gender effects on the immune
    function, including autoimmunity. This is important because most
    autoimmune diseases (including MS) are far more prevalent in women than
    men. The Society is co-funding six projects and will contribute up to
    $4 million to this project. We would like to engage in other
    collaborative projects, especially with NINDS.
        The Society also was pleased that in 2004 NINDS and NMSS co-
    sponsored a scientific workshop on biomarkers in MS. As outcomes from
    this workshop, the Society is looking to work closely with NINDS
    projects, such as the development of collaborative and international
    efforts to identify biomarkers for MS. Such efforts would significantly
    advance our efforts to effectively diagnose and treat MS.
        The Society was also pleased that in 2004 NINDS and NMSS co-
    sponsored a scientific workshop on design of clinical trials in MS. The
    tremendous increase in potential therapies for MS has created new
    challenges in the design and execution of new MS therapies. The Society
    was pleased that an outcome of this workshop was an effort to draft a
    white paper for the Food and Drug Administration on the topic of use of
    magnetic resonance imaging (MRI) as a surrogate measure in MS clinical
    trials. Acceptance of MRI as a valid surrogate measure by the FDA would
    represent a significant step forward in testing the potential MS
    therapies and bringing them to approval in a more expeditious manner.
        The Society is also currently collaborating with the National
    Center for Medical Rehabilitation Research (NCMRR--a unit of the
    National Institute of Child Health and Human Development) on an
    international workshop to foster rehabilitation research in MS. This
    workshop will address the critical need to expand the quality and
    quantity of MS rehabilitation research. It is hoped that from this
    workshop may emerge opportunities for collaborative support of research
    initiatives to advance scientific knowledge concerning MS
    rehabilitation.

               OVERALL NIH FUNDING INCREASE FOR FISCAL YEAR 2006

        The Society is concerned that NIH may face a third year of overall
    low funding increases. Furthermore, in fiscal year 2004 and fiscal year
    2005, only bioterrorism research received a healthy increase, with much
    smaller increases allocated for disease research. We fear the same may
    occur in fiscal year 2006. This is particularly disappointing after the
    fiscal year 1999-2003 funding campaign that doubled the NIH budget in
    the 5-year period.
      --We urge Congress to appropriate a 6 percent fiscal year 2005
            funding increase for NIH.
      --While there is a need to increase our country's investment in
            bioterrorism research, we ask Congress to balance the fiscal
            year 2006 NIH appropriation to allow growth across all NIH
            institutes and all areas of disease research.
        We thank the Subcommittee for this opportunity to comment and
    applaud your commitment to advancing the health and well-being of all
    Americans through investment in biomedical research.
                                     ______

                 Prepared Statement of the NephCure Foundation

                SUMMARY OF RECOMMENDATIONS FOR FISCAL YEAR 2006

        1. A 6 percent increase for the National Institutes of Health and
    the National Institute of Diabetes and Digestive and Kidney Diseases
    (NIDDK).
        2. Continue to expand the NIDDK Nephrotic Syndrome (NS)/Focal
    Segmental Glomerulosclerosis (FSGS) research portfolio by aggressively
    supporting grant proposals in this area and encouraging the National
    Center for Minority Health and Health Disparities (NCMHD) to initiate
    studies into the incidence/cause of NS/FSGS in the African-American
    population.
        3. The NephCure Foundation encourages we encourage follow up to the
    scientific workshop that took place in January, 2005, sponsored by
    NIDDK, in effort to initiate grant proposals focused on achieving the
    goals developed by the workshop. The workshop examined observations and
    opportunities for improved diagnosis and therapeutic interventions for
    Glomerular disease and Focal Segmental Glomerulosclerosis (FSGS).
        Mr. Chairman, and members of the subcommittee, I am pleased to
    present testimony on behalf of the NephCure Foundation (NCF), a non-
    profit organization driven by a blue-ribbon panel of respected medical
    experts and a dedicated band of patients and families working for a
    common goal--to save kidneys and lives.
        I am Ed Hearn, former Major League catcher for the 1986 World
    Series Champion New York Mets and the Kansas City Royals. My career as
    a professional athlete came to an abrupt end in 1991, due to a shoulder
    injury. Upon recuperation, I intended to return to my team. While I was
    out due to my injury, I began to experience symptoms that indicated
    kidney malfunction, and within six months, I was diagnosed with Focal
    Segmental Glomerulosclerosis (FSGS), a debilitating and degenerative
    kidney disease. Today, after three kidney transplants, the aid of a
    breathing machine at night, a $3,000 IV once a month, and $40,000 of
    medication to pay for up to 50 pills that I must swallow each day, I
    live to tell my story and to speak for those suffering from FSGS. My
    hope is that we can find the means to prevent this life-threatening
    disease from affecting our youth and from jeopardizing the normalcy of
    their lives as it has mine and many others. I remain hopeful that a
    cure for FSGS will be uncovered, but until then, our focus must be on
    prevention.

                TREATMENT TRIALS BEGINNING, BUT NO CURE IN SIGHT

        Mr. Chairman, FSGS is one of a cluster of glomerular diseases that
    attack the one million tiny filtering units contained in each human
    kidney. These filters are called nephrons and these diseases attack the
    portion of the nephron called the glomerulus, scarring and often
    destroying the irreplaceable filters. Scientists do not know why
    glomerular injury occurs and they are not sure how to stop its
    inevitable destruction of the kidney.
        When I was a teenager, doctors found protein in my urine and told
    me that some day I might have kidney trouble. I pushed it out of my
    mind, thinking that some day meant when I was an old man down the road.
    Some day came faster than anyone expected. I believe that because I was
    a highly conditioned athlete, and catchers are more conditioned than
    most athletes, my body initially masked the symptoms of FSGS.
    Consequently, I retained the facde of physical health, and I do not
    know when FSGS initially began to internally attack my body.
        My first kidney transplant lasted more than seven years until the
    FSGS returned, as it often does. I received a second kidney from my
    aunt in 2000, but my body rejected it almost immediately, and I
    received a third kidney transplant in May of 2002. My story is not
    unique; there are thousands of other people in this country who have
    had their lives disrupted due to the sudden onset of FSGS. Although
    kidney transplants have been very successful for thousands of FSGS
    patients, there are many patients of whom the body rejects the
    transplanted kidney or the FSGS comes back and attacks the transplanted
    kidney, leaving the patient with no functioning kidneys. He or she must
    then rely on daily dialysis as a means of survival.
        FSGS patients are often on several medications, which cause medical
    complications and unbearable side effects. FSGS patients, upon
    diagnosis, often take a downward plunge at a rapid rate, and it is
    extremely difficult to make a comeback. In the last four years, I have
    undergone two kidney transplants, two years of dialysis, and a six week
    course of daily radiation treatment for rapidly spreading cancer that
    was primarily the result of the high doses of immunosuppressant drugs I
    am taking for FSGS. In the last three months alone, I have had over 65
    medical appointments. As you can see, it is nearly impossible for an
    FSGS patient to live a normal life.
        We are extremely thankful that an NIDDK-funded clinical trial began
    last year to study the efficacy of the current treatments for FSGS, and
    that ancillary studies are underway to examine tissue samples of
    injured glomerulus. However, these clinical trials hold no particular
    hope for patients who suffer from FSGS.
        There are thousands of young people who are in a race against time,
    hoping for a treatment that will save their lives. The NephCure
    Foundation today raises its voice to speak for them all, asking you to
    take specific actions that will aid our quest to find the cause and the
    cure of NS/FSGS.
        First and foremost, we support a 10 percent increase for the
    National Institutes of Health and the National Institute of Diabetes
    and Digestive and Kidney Diseases (NIDDK).

                    TOO LITTLE DATA ABOUT A GROWING PROBLEM

        When glomerular disease strikes, the resulting Nephrotic Syndrome
    causes loss of protein in the urine and symptoms such as edema, a
    swelling that often appears first in the face. For example, many
    physicians mistake children's puffy eyelids as an allergy symptom.
    Stories of similar misdiagnoses are common at our Foundation. With
    experts projecting a substantial increase in Nephrotic Syndrome in the
    coming years, there is a clear need to educate pediatricians and family
    physicians about glomerular disease and its symptoms.
        The NephCure Foundation has numerous education programs underway,
    including patient education seminars; the most recent of which took
    place in March 2004. The next patient education seminar will take place
    in Washington, DC in May 2005. News of our most recent activities can
    be found on our web site at www.nephcure.org. However, our efforts
    alone are not enough.
        NIDDK launched a major federal outreach program early in 2002--the
    National Kidney Disease Education Program--we seek your support in
    urging NIDDK to assure that glomerular disease receives high visibility
    in this important program.

                GLOMERULAR DISEASE STRIKES MINORITY POPULATIONS

        Nephrologists tell us that glomerular diseases such as FSGS affect
    a disproportionate number of African-Americans and, according to NIDDK,
    ``the worst prognosis is observed in African-American children.''
    NephCure officials have described this situation in a meeting with Dr.
    John Ruffin, director of the National Center for Minority Health and
    Health Disparities (NCMHD).
        As the NCMHD becomes fully operational and plans programs, our
    Foundation will continue to work with the Center to encourage the
    creation of programs to study the high incidence of glomerular disease
    within the African-American population.
        We ask the Committee to join with us in expanding the NS/FSGS
    research portfolio by requesting that the National Center for Minority
    Health and Health Disparities seize the opportunity to establish
    research into the phenomenon of glomerular disease within the African
    American community.

                          MORE BASIC SCIENCE IS NEEDED

        The current FSGS clinical trials which follow an estimated 400
    patients over a three year period, are limited, according to the RFA,
    to examining the ``impact of immunomodulatory therapy on proteinuria.''
    While the trials may lead to safer or more efficient care for children
    with FSGS, no one is suggesting that they will bring us closer to
    finding the cause and cure. Science has yet to prove that FSGS is an
    immune-mediated disease.
        Scientists tell us that much more needs to be done in the area of
    basic science, beginning with collection of tissue and fluid samples
    from a large number of patients on which years of important scientific
    research can be founded. NephCure is collaborating with the NIH in a
    major way to work for such progress.
        The National Institute of Diabetes and Digestive and Kidney
    Diseases (NIDDK) has agreed to match, dollar-for-dollar, funds raised
    by NephCure that will allow researchers to obtain DNA samples from
    hundreds of FSGS patients in upcoming clinical trials. The NIDDK will
    match up to $300,000 raised by NephCure for a combined total of
    $600,000. These trials are an ancillary study in conjunction with the
    first-ever national medication trials of FSGS treatment that may
    possibly lead to better understanding of the more common Nephrotic
    Syndrome, which can be a precursor to FSGS.
        We encourage follow up to the Scientific Workshop that took place
    in January, 2005, sponsored by NIDDK, in effort to initiate grant
    proposals focused on achieving the goals developed by the workshop. The
    workshop examined observations and opportunities for improved diagnosis
    and therapeutic interventions for glomerular disease and Focal
    Segmental Glomerulosclerosis (FSGS). This goal is consistent with the
    NIH Roadmap to Research initiative developed by NIH Director, Dr. Elias
    Zerhouni.
        The workshop united basic science and clinical investigators, FSGS
    patients, physician researchers, nephrologists from around the world
    and anyone with an interest in treatment for glomerular diseases to
    share and collaborate upon advances, challenges and research potential
    of these debilitating diseases. We must use the conference as a
    stepping stone and build upon the information collectively gathered to
    determine the resources needed to carry out these opportunities and
    challenges. The workshop/conference gave hope to the thousands of young
    people whose kidneys and lives are threatened by this terrible disease,
    and it gave honor to their heroic stories.
        We anticipate the potential for a Program Announcement and the
    potential for a Special Emphasis Program Announcement resulting from
    the conference or some other traditional mechanism to generate grant
    proposals. These mechanisms to encourage investigator initiated grant
    proposals should help to continue to expand the NS/FSGS portfolio at
    NIH.
        Mr. Chairman, as you know, patient support and advocacy groups such
    as the NephCure Foundation work closely with medical research
    organizations. They share a mutual understanding that unless major
    research efforts are undertaken, advances and improvements in the
    health of patients will not occur. Every year, the NephCure Foundation
    participates in advocating increased funding for the NIH and NIDDK. We
    want to reiterate how deeply grateful we are for your leadership and
    that of the subcommittee on medical research matters, which means so
    much for the health of the people in our nation.
        I will be pleased to answer any questions you may have.
                                     ______

          Prepared Statement of the National Prostate Cancer Coalition

        Mr. Chairman and members of the Committee, thank you for the
    opportunity to share my remarks. The National Prostate Cancer Coalition
    (NPCC) was founded in 1996 to combat a long overlooked killer of men. I
    came to NPCC in 2001, having just recently been impacted by the disease
    myself. In 2000, my grandfather was diagnosed with prostate cancer.
    Having served his country so valiantly in World War II, he was now
    facing a new battle. Luckily, because of early detection through the
    prostate specific antigen (PSA) test and the digital rectal exam (DRE),
    the disease was caught early and, following a radical prostatectomy, he
    is now cancer free. But there are many men who are not so lucky. That's
    why you must adequately fund prostate cancer research for veterans like
    my grandfather, families like mine, and men all over America.
        Under the leadership of this committee we have seen prostate cancer
    research funding increase by nearly $300 million since in the last 6
    years. While we have come a long way, there is still much work to be
    done. For the second year since the founding of NPCC, prostate cancer
    deaths will continue to increase in 2005. More than 30,000 lives will
    be lost to the disease. Occurrences of prostate cancer are increasing
    as well, to over 230,000 men this year. While cases continue to grow,
    more men are catching the disease in its early stages, when the disease
    is most treatable, by early detection through screening.
        NPCC would like to offer its gratitude on behalf of the 2 million
    American men with prostate cancer for the support this committee has
    offered in the past. The recent doubling of the National Institutes of
    Health's (NIH) budget has helped prostate cancer research funding to
    expand to record levels, but we must ensure this funding is used
    appropriately. To that end, your committee was instrumental in
    requiring NIH and the National Cancer Institute (NCI) to submit a
    professional judgment budget for fiscal year 2003-fiscal year 2008 to
    outline the agencies' plans for prostate cancer research. You have also
    been influential in requesting a fiscal budget for that document, which
    was Congress received passed the April 2004 deadline. The budget
    requested lacked connectivity to the previous plan and made no
    references to goals or priorities. While no one disputes the historic
    importance of doubling, we ask you to encourage NIH and NCI to
    coordinate with each agency to put forward a comprehensive and cohesive
    plan that brings us closer to eradicating cancer. Additionally, we
    respectfully request your oversight to ensure this funding is producing
    results for prostate cancer.
        Huge sums of taxpayers' money have been allocated to NIH over the
    years and it is now time to examine what this windfall has produced.
    Therefore, we request that you to ensure that NIH to submits the yearly
    update on its prostate cancer research portfolio that reflects its
    progress according to the fiscal year 2003-fiscal year 2008
    professional judgment budget that was requested in fiscal year 2005.
        We are entering an exciting time in biomedical research. The recent
    Food and Drug Administration's approval of Avastin has opened a new
    door for cancer research. Avastin targets cancerous cells by blocking
    their blood supply, an idea that had been previously dismissed by the
    medical community as ``absurd''. The drug not only signals a turning
    point in changing cancer into a manageable, chronic disease but also
    demonstrates the value of seeking out novel and innovative research. We
    must encourage this kind of research at NIH, including assessing the
    value of stem cell research which has shown promise in research for
    neurological diseases, diabetes, and cancer.
        Developing a new approach to research is a priority for NPCC. The
    Prostate Cancer Research Funders Conference, first convened in 2001 and
    then revitalized last fall, seeks to formulate a collaborative, public-
    private approach to seek out new ways of attacking the problem of
    prostate cancer. Originally co-convened by NPCC and NCI, participants
    now also include the Department of Defense, the Veterans Health
    Administration, the Centers for Disease Control and Prevention, the
    Food and Drug Administration, Canadian and British government agencies,
    private foundations/organizations and representatives from industry.
    Members of the Conference have come together to form a partnership that
    allows them to focus on key objectives and to address commonly
    recognized barriers in research. This could propel research forward
    significantly. As the Conference continues, we ask that the Committee
    make its functionality part of its oversight commitments to prostate
    cancer research. Currently, federal agencies participate voluntarily,
    but they can opt in or out based on the tenure of executive leadership
    and its time-limited decisions. For the conference to be successful
    federal agencies engaged in the prostate cancer research should, in our
    opinion, be required to participate, and we ask for your leadership to
    make that happen.
        Recognizing the importance of cutting edge research initiatives and
    collaborative research efforts, NIH director Elias Zerhouni, M.D.
    recently unveiled the NIH Roadmap. The Roadmap's strategy mirrors that
    of the Funders Conference, specifically by seeking out new approaches
    and ideas and stimulating cross-institutional and cross-center research
    for all NIH driven biomedical research. Believing, we think correctly,
    that the synergies in the Roadmap can achieve outcomes that are greater
    than those any one Institute or Center can achieve, we support its
    efforts to advance key biomedical research initiatives at an
    exponential rate. NPCC applauds the Roadmap and pledges its support to
    take biomedical research in new directions.
        As NIH and NCI look to redefine and increase the efficiencies of
    their research programs, Congress must equip them with the resources
    they need to implement new initiatives. Unprecedented increases in NIH
    and NCI's funding over the last 6 years have created opportunities
    never before available. We must take advantage of these achievements,
    to not do so will not only harm cancer patients everywhere but is,
    quite simply, poor business sense.
        NPCC was heartened when the President stated 2 years ago that ``in
    order to win the war against cancer, we must fund the war against
    cancer,'' but we are very concerned by recent reports suggesting the
    Administration's budget for fiscal year 2006 will propose a cut in the
    overall budget of the National Institutes of Health and other critical
    programs. Such a cut would be a major reversal in our nation's
    commitment to the fight against cancer.
        Societies for Experimental Biology (FASEB) have stated if increases
    are held to 2 percent-3 percent the grant funding rate at NIH will drop
    below 30 percent and approximately 500 fewer grants would be funded. To
    allow NIH and NCI to adequately continue to fund promising grants and
    research first realized during the budget doubling, Congress must
    appropriate at least ($30.1 billion) in funding for these agencies in
    fiscal year 2006. That may seem like a large number, but in reality, it
    is only a small fraction of the estimated $189 billion that cancer
    alone costs this nation yearly.
        Increasing NIH's budget by 8.5 percent would also allow NCI to
    dedicate more than $400 million to prostate cancer research in fiscal
    year 2005. Last year, NCI received only a 3.3 percent increase in
    funding over the previous year's level. Yet, with previously committed
    grant awards and outlays to the NIH Roadmap, NCI is ``effectively
    operating with a budget that is $2.7 million less than last year's
    operating budget (NCI Cancer Bulletin 2/3/04).'' The President's fiscal
    year 2006 budget allocates over $4.8 billion to NCI, is much less than
    the fiscal year 2005 increase. This level will mean even tougher
    choices in awarding grants at NCI. We believe that Congress should
    fully fund the NCI Director's Bypass Budget at $6.2 billion, which
    would rapidly accelerate the nations' fight against all cancers.
        As you know, education and early detection through screening are
    the catalyst to beating prostate cancer. Right now, the PSA blood test
    and DRE physical exam are the best measures for detecting prostate
    cancer early. We ask the Committee to allocate at least $20 million to
    the Center for Disease Control and Prevention's (CDC) prostate cancer
    awareness program. We also encourage the Committee to work with CDC to
    address our concern that the agency places insufficient value on these
    screening tools.
        Thank you again for the leadership you have shown in advancing
    biomedical and, more specifically, prostate cancer research. Under your
    leadership, the nation's war on cancer has reached heights never before
    realized. We look forward to continuing to work with you and the
    members of the Committee until a cure is found.
                                     ______

              Prepared Statement of the National Sleep Foundation

                  SUMMARY OF FISCAL YEAR 2006 RECOMMENDATIONS

     --Provide a 6 percent increase for fiscal year 2006 to the National
            Institutes of Health (NIH) and a proportional increase of 6
            percent to the individual institutes and centers, specifically,
            the National Heart, Lung, and Blood Institute (NHLBI).
      --Urge the National Center on Sleep Disorders Research (NCSDR) to
            partner with other federal agencies, such as the Centers for
            Disease Control and Prevention (CDC), and voluntary health
            organizations, such as the National Sleep Foundation (NSF), to
            develop a collaborative sleep education and public awareness
            initiative.
      --Urge the United States Surgeon General to issue a Surgeon General's
            Report on Sleep and Sleep Disorders.
        Mr. Chairman and members of the Subcommittee, thank you for
    allowing me to present testimony on behalf of the National Sleep
    Foundation or NSF. I am Dr. James Walsh, Chairman of the Board of
    Directors of the National Sleep Foundation, Executive Director of the
    Sleep Medicine and Research Center affiliated with St. John's Mercy and
    St. Luke's Hospitals, and Clinical Professor of Psychiatry at St. Louis
    University. The National Sleep Foundation is an independent, non-profit
    organization whose mission is to enhance public awareness about the
    need for sufficient restorative sleep, to increase the detection and
    treatment of sleep disorders, to foster sleep-related programs and
    policy for the betterment of public health, and to promote sleep
    research. We work with thousands of sleep medicine and other health
    care professionals, researchers, patients, drowsy driving victims
    throughout the country, and collaborate with many government and
    private organizations with the goal of preventing health and safety
    problems related to sleep deprivation and untreated sleep disorders.
        Sleep problems, whether in the form of medical disorders, or
    related to work schedules and a 24/7 lifestyle, are ubiquitous in our
    society. At least 40 million Americans suffer from sleep disorders; yet
    more than 60 percent of adults have never been asked about the quality
    of their sleep by a physician, and fewer than 20 percent have ever
    initiated such a discussion. Millions of individuals struggle to stay
    alert at school, on the job, and on the road. The latest estimates from
    the National Highway Transportation Safety Administration and the
    Federal Motor Carriers Safety Administration implicate fatigue and
    sleepiness in 1.1 million crashes annually. A recent study in Sweden
    showed that sleep disturbances are the second greatest risk factor for
    fatal accidents at work. Sleep apnea, a sleep-related breathing
    disorder which affects at least 5 percent of adult Americans, is
    closely related to some of America's most pressing health problems,
    such as obesity, hypertension, heart failure, and diabetes. Chronic
    insomnia, experienced by 10 percent of our population is a strong risk
    factor for depression and other widespread mental health conditions.
    Sleep disorders, sleep deprivation, and excessive daytime sleepiness
    add approximately $15 billion to our national health care bill each
    year. The National Center on Sleep Disorders Research estimates that by
    the year 2050, sleep problems will affect as many as 100 million
    Americans.
        Sleep science has clearly demonstrated the importance of sleep to
    health and well being, yet research studies continue to show that
    millions of Americans are at risk for the serious health, safety
    consequences of sleep disorders and inadequate sleep. Moreover their
    quality of life suffers and the personal and national economic impact
    is staggering. NSF believes that every American needs to understand
    that good health includes healthy sleep, just as it includes regular
    exercise and balanced nutrition. We must elevate sleep to the top of
    the national health agenda. We need your help to make this happen.
        Our biggest challenge is bridging the gap between the outstanding
    scientific advances we have seen in recent years and the level of
    knowledge about sleep held by health care practitioners, educators,
    employers, and the general public. This gap in knowledge is being
    discussed as I present this testimony today, by hundreds of concerned
    professionals. Yesterday and today, the National Center on Sleep
    Disorders Research, the National Heart, Lung, and Blood Institute, and
    the Trans-NIH Sleep Research Coordinating Committee are sponsoring a
    translational conference entitled ``Frontiers of Knowledge in Sleep and
    Sleep Disorders: Opportunities for Improving Health and Quality of
    Life.'' This two-day program has assembled health care providers,
    public health and education experts, policy makers, patient advocacy
    organizations, sleep medicine specialists, and other stakeholders. It
    is intended to address how information about sleep and sleep disorders
    can translate into improvements in public health and safety using cost-
    effective, comprehensive, and broadly-applied strategies for education,
    societal change, and improved sleep-related health care.
        This conference is an important step in translating research into
    practice and into a broad-based public health message. The development
    of a sleep education and public awareness initiative would serve as a
    key legacy for the sleep translational conference and provide a forum
    for dissemination of the outcomes of the sleep translational
    conference. The National Sleep Foundation has been leading the way on
    public education regarding sleep and sleep disorders since it was
    founded in 1990. NSF and others have done a lot, but so much more needs
    to be done in order to educate the public and actually change behavior.
    Because resources are limited and the challenges great, we think
    creative and new partnerships need to be created to address the issues
    that are before us.
        In the fiscal year 2005 appropriations bill, Congress recommended
    that The National Center on Sleep Disorders Research partner with other
    federal agencies, such as the Centers for Disease Control and
    Prevention, and voluntary health organizations, such as NSF, to develop
    an ongoing, inclusive mechanism for public and professional awareness
    on sleep, sleep disorders, and the consequences of fatigue. Such a
    collaboration between federal agencies and voluntary health
    organizations will create an opportunity for dramatically improving
    public health and safety as well as the quality of life for millions,
    if not all, Americans. Beginning steps have been taken to establish
    this collaboration, but continued support from the National Center on
    Sleep Disorders Research and the Centers for Disease Control and
    Prevention is critical.
        Last year, at a National Institutes of Health sleep conference, the
    U.S. Surgeon General reported on the profound impact that chronic sleep
    loss and untreated sleep disorders have on all Americans. He emphasized
    that dissemination of the existing body of medical knowledge and
    implementation of expanded clinical practice guidelines regarding sleep
    and sleep disorders are critically important.
        Conferences and workshops held by the Surgeon General involve
    educating the public, advocating for effective disease prevention and
    health promotion programs and activities, and providing a highly
    recognized symbol of national commitment to protecting and improving
    the public's health.
        We believe that it is time that the federal government helps
    promote sleep as a public health concern through the development of a
    Surgeon General's report on sleep and sleep disorders in order to call
    attention to the importance of sleep and develop strategies to protect
    and advance the health and safety of the nation.
        Thank you again for the opportunity to present testimony to this
    Subcommittee.
                                     ______

              Prepared Statement of the NTM Info & Research, Inc.

                            SPECIFIC RECOMMENDATIONS

        NTMIR requests an allocation in the budget to enable NIH, (NIAID &
    NHLBI) to advance diagnostics and treatments for patients suffering
    from pulmonary Nontuberculous Mycobacteria (NTM) disease.
        NTMIR requests funds to facilitate and increase multi-centered
    trials to advance the effectiveness of treatments and to develop new
    treatments.
        NTMIR recommends that CDC/NCHS engage in surveillance to better
    understand the incidence of NTM disease and assess the level of
    awareness within the medical community.
        NTMIR supports the American Lung Association's request for an
    increase of $77 million in funding to combat TB so that we avoid the
    risk of a rise in incidence that complacency can yield.
        NTMIR supports the request of the Ad Hoc Group for Medical Research
    Funding for a $30 billion appropriation for NIH in fiscal 2006.
         what is pulmonary nontuberculous mycobacterial disease (ntm)?
        NTM is an infectious disease considered to be of environmental
    origin as these bacteria are ubiquitous in the water and soil that
    surround us. Although NTM is diagnosed by the same basic test used to
    diagnose traditional tuberculosis (TB), it is significantly more
    difficult to treat. NTM progressively diminishes lung capacity, with
    all the attendant negative consequences in life.
        Unfortunately, even though TB has a significantly high profile, NTM
    does not because education and awareness have been lacking.
    Furthermore, there is growing evidence that NTM is many times more
    prevalent than TB in the United States. For example, the State of
    Florida Infectious Disease Laboratory reports receiving over twice as
    many specimens that are NTM positive for every one that is positive for
    TB. Even more startling, the Agency for Health Care Administration for
    Florida hospital patient discharges shows almost 9 times the number of
    patients with the primary diagnosis of NTM versus those with TB.
        Doctors in leading treating facilities are reporting that even
    though NTM is not reportable, they are seeing more NTM patients than TB
    patients. A current report from Toronto, Ontario indicates that the
    prevalence may be six times higher than the older data we have in the
    United States.
        NTM is not limited to one strain and has certain strains that are
    inherently resistant to drug therapy, and in all cases multiple drugs
    are required on a lengthy to permanent basis. A significant number of
    patients require short to long term intravenous medication and this is
    a particular hardship for the elderly because Medicare does not cover
    in-home therapy. Medicare recipients must be hospitalized one to three
    times a week driving treatment costs significantly higher than in
    alternate settings.

                          NTM INFO & RESEARCH (NTMIR)

        NTMIR was founded through a partnership of concerned patients and
    interested physicians who see increasing numbers of people affected by
    this devastating disease. NTMIR was created to expand professional
    awareness, diagnosis and treatment, facilitate research and provide
    patient support. Our mission is a public/private partnership to advance
    the science and the outcomes for countless patients with NTM disease.
        NTMIR has already demonstrated a track record of success since it
    commenced its activities just two years ago. These include, successful
    implementation of the NTMInfo.com website and online support group,
    patient education throughout the country through the replication of an
    NTM information pamphlet, initiating professional education and Grand
    Round lectures to increase professional education both for specialists
    and family physicians, establishment of a partnership of cooperation
    with public health in the State of Florida and with the American Lung
    Association of Florida. Our most recent effort resulted in agreement
    between a major pharmaceutical company, the FDA and a division of HRSA
    to provide an urgently needed drug for patients who could not otherwise
    obtain it, some of whom might have died without it.
        We anticipate that these efforts will serve as models in other
    states and at the federal level.
         fern r. leitman, patient & director, ntm info & research, inc.
        Fern Leitman is a patient who has severe pulmonary NTM disease that
    has required ongoing medical therapy since 1996. Nonetheless, in
    addition to serving as vice president of Philip Leitman, Inc. where she
    is responsible for asset and acquisition evaluation, she is co-founder
    of the NTM website and NTM Info & Research, Inc.
        Since becoming ill, Fern has dedicated many hours each week to
    communicating with patients from around the United States to help them
    understand how they help themselves to battle NTM disease by being an
    active participant in their own treatment and care. In spite of living
    with devastating and chronic illness, Fern Leitman is committed to
    helping others to live a full life by enhancing the role that NTM Info
    & Research can play in bringing patients, physicians, and government
    organizations to a partnership that will raise awareness and actively
    pursue treatment options to improve the quality of life of those
    suffering with NTM.

                           STATEMENT OF FERN LEITMAN

        Thank you for the opportunity to submit a statement on behalf of
    NTM Info & Research and all the patients suffering with pulmonary NTM
    disease. NTM is an infectious disease that challenges treating
    physicians. Lung transplantation is usually not an option because
    immune suppressants complicate treatment.
        Before NTM struck and caused me to be very ill, I was extremely
    driven, highly competitive and very independent. I spent much of my
    life in sales and was the first woman to sell cars in Florida. I was a
    partner in a New York based garment manufacturing business and I
    survived that without a scratch. I enjoy being extremely active but
    life with nontuberculous mycobacterial disease (NTM) is really tough
    and debilitating.
        This disease has taken away my drive and endurance, one activity at
    a time. It is insidious, frightening, and misunderstood. Many patients
    have told us that they can no longer function because they are so short
    of breath. Others can no longer work and many are hospitalized
    repeatedly.
        The symptoms and the tests to diagnose NTM are much like those for
    TB. Unfortunately, it is much harder to treat. I am witness to the fact
    that after almost nine years of drug therapy I am still not well and
    have been told I will likely require lifelong drug therapy including IV
    medicines.
        Not enough is done because most doctors don't look for this
    disease. When NTM infected my lungs, I coughed continuously and was
    fatigued. I had a low-grade fever for years but never looked ill; I had
    repeated bouts of pneumonia, coughed up blood, and it took 10 years for
    a diagnosis. We hear the same story from other patients. Unfortunately,
    it was too late to repair the damage because the middle portion of my
    left lung was destroyed and there were areas where the tissue had been
    destroyed throughout both lungs. Many others are suffering with NTM and
    most don't even know it yet because, sadly, they haven't been
    diagnosed. Please help them.

              PHILIP LEITMAN, PRESIDENT, NTM INFO & RESEARCH, INC.

        Philip Leitman co-founded NTM Info & Research when his wife Fern
    became ill with severe pulmonary NTM disease. Fern and Philip began
    meeting and hearing from numerous patients who were struggling with NTM
    and had a lack of understanding about it. His personal commitment has
    drawn the support of numerous physicians, the media, as well as
    government and government organizations at various levels. Efforts that
    began by developing the website, (NTMInfo.com) are now an established
    not-for-profit seeking to enhance knowledge about NTM through
    collaborative efforts with leading institutions, government, and
    patients, as well as increased education to provide broader awareness
    and understanding of the need for timely diagnosis and effective multi-
    faceted treatments.
        Mr. Leitman has an extensive background in business and
    international business. He currently is a Regional Vice-Chair of the
    Council of National Trustees of National Jewish Medical and Research
    Center, President and co-founder of NTM Info & Research, Inc., Board
    member of the American Lung Association of Florida, member of the
    Florida TB Control Coalition, and a former Board member of Senior Care
    and JVS Rehabilitation Sheltered Workshop.
        Philip Leitman is also President and CEO of Philip Leitman, Inc. He
    is active as a real estate developer in South Florida. He and his wife
    Fern live in Pinecrest, Florida, and their children and grandchildren
    live nearby.

                          STATEMENT OF PHILIP LEITMAN

       Fern's doctors say she sets a standard for wanting to survive,
    wanting to live, and wanting to function highly. I am proud to follow
    her lead. This is why!
        In September 1996, shortly after lung surgery, Fern's health
    deteriorated to the point where her doctors suggested that we call our
    children. Fern was rushed to a procedure room to put a bronchoscope
    into her lungs to see what was happening. At that moment, Fern told me
    to go back and talk to her roommate at the hospital because that woman
    had the same illness and was about to have lung surgery. Fern said,
    ``Please tell her that she is not as sick and this won't happen to
    her.'' The other woman looked very much like Fern.. NTM can affect any
    one of us but for some unknown reason, it affects more women than men.
        What Fern is going through is simply not unique! There are support
    groups in New York, California, Texas, Florida, and soon in Boston. The
    NTMInfo.com website has now exceeded one million hits. A number of
    leading hospitals and a branch of the CDC are linked.
        Fern's normal morning routine starts with pulmonary therapy to
    clear her airways. Then there is a sinus wash. With breakfast, Fern
    takes five different oral drugs and IV medicines. In addition, there
    are inhaled medicines. The total time from awakening to being able to
    leave the house is usually four (4) hours.
        While tuberculosis is often known to appear in inner cities and
    immigrant populations, NTM knows no such boundaries. However, current
    epidemiologic data is not available. The latest data that we have from
    the Centers for Disease Control was collected in the 1980's and we
    urgently need newer data. Current data from the University of Toronto
    suggests that the prevalence may be six times higher than our older
    information. We have no reason to believe that Toronto is any different
    than Chicago or any other major U.S. city.
                                     ______

           Prepared Statement of the Ovarian Cancer National Alliance

        On behalf of the Ovarian Cancer National Alliance (the Alliance), I
    thank the Subcommittee for this opportunity to submit comments for the
    record regarding the Alliance's fiscal year 2006 funding
    recommendations that we believe are necessary to help reduce and
    prevent suffering from ovarian cancer. For 8 years, the Alliance has
    worked to increase awareness of ovarian cancer and advocated increased
    federal resources to support research on identifying more effective
    ovarian cancer diagnostics and treatments. While I recently joined the
    Alliance as executive director, my journey with ovarian cancer began
    with my own diagnosis 3 years ago.
        As an umbrella organization with 46 state and local groups, the
    Alliance unites the efforts of more than 500,000 grassroots activists,
    women's health advocates, and health care professionals to bring
    national attention to ovarian cancer. As part of this effort, the
    Alliance advocates sustained federal investment in the Centers for
    Disease Control and Prevention's (CDC) Ovarian Cancer Control
    Initiative. The Alliance respectfully requests that Congress provide $9
    million for the program in fiscal year 2006.

                       OVARIAN CANCER'S DEADLY STATISTICS

        According to the American Cancer Society, in 2005, more than 22,000
    American women will be diagnosed with ovarian cancer, and approximately
    16,000 will lose their lives to this terrible disease. Ovarian cancer
    is the fourth leading cause of cancer death in women. Currently, more
    than half of the women diagnosed with ovarian cancer will die within 5
    years. Among African American women, only 48 percent survive 5 years or
    more. When detected early, the 5-year survival rate increases to more
    than 90 percent, but when detected in the late stages, the 5-year
    survival rate drops to 28 percent.
        Today, it is both striking and disheartening to see that despite
    progress made in the scientific, medical and advocacy communities,
    ovarian cancer mortality rates have not significantly improved during
    the past decade, and a valid and reliable screening test--a critical
    tool for improving early diagnosis and survival rates--still does not
    yet exist for ovarian cancer. Behind the sobering statistics are the
    lost lives of our loved ones, colleagues and community members. While
    we have been waiting for the development of an effective early
    detection test--thousands of our sisters, including one-third of our
    founding board members, have lost their battle to ovarian cancer.
        I am considered one of the lucky ones. When I was diagnosed 3 years
    ago, my two cancers--ovarian and endometrial--were found to be in early
    Stage 1 when I had the best chance for surviving beyond 5 years--
    something only 25 percent of women with this disease can claim. Like
    most women diagnosed in early stage ovarian cancer, my good fortune was
    not the result of my awareness of the symptoms, it was not the result
    of my awareness that I was at a higher risk, and it was not the result
    of having access to a currently non-existent early screening test. My
    good fortune was the lucky result of my perseverance with my doctor,
    and my subsequent treatment by the appropriate gynecologic oncologist
    specialist.
        I have come to work for the Alliance to ensure that other women can
    have the opportunity to be as fortunate as I have been. We cannot rely
    on luck for our survival. All women should have access to treatment by
    a specialist. All women should have access to a valid and reliable
    screening test. We must deliver new and better treatments to patients
    and the physicians and nurses who treat patients with this disease tell
    us that until we have a test, we must continue to increase awareness
    and educate women and health professionals about the signs and symptoms
    associated with this disease.

       THE OVARIAN CANCER CONTROL INITIATIVE AT THE CENTERS FOR DISEASE
                             CONTROL AND PREVENTION

        As the statistics indicate, among the most urgent challenges in the
    ovarian cancer field are late detection and poor survival. The CDC's
    cancer program, with its strong capacity in epidemiology and excellent
    track record in public and professional education, is well positioned
    to address these problems. As the nation's leading prevention agency,
    the CDC plays an important role in translating and delivering at the
    community level what is learned from research, especially ensuring that
    those populations disproportionately affected by cancer receive the
    benefits of our nation's investment in medical research.
        Specifically, the CDC's Ovarian Cancer Control Initiative helps
    give all women the opportunity to survive ovarian cancer. Public
    awareness and education programs funded by the program make women and
    health professionals aware of the warning signs of ovarian cancer and
    examine survival trends based on care received, so they can better
    detect the cancer by identifying and understanding symptoms exhibited
    in early stages.
        In addition, the CDC has a strong tradition of partnering with
    primary care physicians to combat two key barriers to early detection--
    recognition and diagnosis of the disease. Primary care physicians
    usually are the first to see women presenting with the disease.
    Increasing awareness and understanding of the signs and symptoms of
    ovarian cancer among these physicians can help improve early detection
    and survival rates.
        Prompted by efforts from leaders of the Alliance and championed by
    Representative Rosa DeLauro--with bipartisan, bicameral support--
    Congress established the Ovarian Cancer Control Initiative at the CDC
    in November 1999. Congress' directive to the agency was to develop an
    appropriate public health response to ovarian cancer and conduct
    several public health activities targeted toward reducing ovarian
    cancer morbidity and mortality.
        Currently, the Ovarian Cancer Control Initiative supports several
    national program grants, including three new CDC funded state
    initiatives:
      --The Center for Health Promotion and Prevention Research at the
            University of Texas in Houston--Funded to conduct a study
            focusing on symptoms relating to early detection of ovarian
            cancer and staging distinctions.
      --The School of Public Health at the University of Alabama at
            Birmingham--Funded to conduct a study focusing on barriers to
            early detection of ovarian cancer.
      --The North American Association of Central Cancer Registries
            (NAACCR)--Funded to analyze and report data on ovarian cancer
            incidence by race, and to find new ways to improve accuracy of
            ovarian cancer incidence and mortality data among women who are
            neither Caucasian nor African American.
      --The Department of Preventive Medicine at the University of Southern
            California--Funded for 1 year to analyze cancer registry data
            on borderline ovarian cancer cases in California.
      --The Oklahoma University Health Sciences Center--Funded to conduct a
            2-year, multiple component study of women experiencing possible
            ovarian cancer symptoms, how they seek treatment, and possible
            barriers to their medical care.
      --Battelle Centers for Public Health and Evaluation--Funded to
            conduct a review of medical literature on clinical management
            of non-specific abdominal and pelvic symptoms potentially
            suspicious of ovarian cancer in older women. The review will
            provide the foundation for CDC funding to develop evidence-
            based guidelines for primary care providers to increase ovarian
            cancer cases detected in early stages.
      --State tumor registries in California, Maryland, and New York--Each
            state received funding from the National Program of Cancer
            Registries to conduct a 3 year study to determine the
            proportion of women who had their initial surgery performed by
            a gynecologic oncologist and to detail aspects of the second
            course of treatment provided.

                TAKING THE NEXT STEP IN PREVENTION AND AWARENESS

        In only 5 years, the CDC's Ovarian Cancer Control Initiative, with
    its support of studies on early detection and underserved populations,
    has made an important contribution to a better understanding and
    awareness of the disease. However, without a screening test, it is
    clear that more needs to be done. Additional funding in fiscal year
    2006 will enable the CDC to expand the reach and scope of its current
    ovarian cancer initiatives to help advance our nation's effort's to
    reduce and prevent ovarian cancer morbidity and mortality. The
    allocation of $9 million in fiscal year 2006 funding will continue the
    excellent progress being made and could expand the program's efforts to
    include:
      --Development of a risk model for ovarian cancer like the model for
            breast cancer. This would help health care professionals
            identify high-risk women, who then could be monitored
            regularly. By helping health care providers to be ``on alert,''
            they have the information and tools they need to catch the
            disease early and improve survival rates.
      --Conduct an education campaign targeted to high-risk women to
            educate them about the signs and symptoms of ovarian cancer,
            the importance of regular monitoring, and strategies for risk
            reduction.
      --Development and implementation of a national campaign to inform
            primary care physicians, who are usually the first to see women
            with symptoms, about ovarian cancer.
      --Examination of the reasons why minority women have higher mortality
            rates and development of appropriate strategies for addressing
            this terrible health disparity.
      --Conduct an education initiative targeted to health care
            professionals about best practices for treating the disease,
            especially referral to a gynecologic oncologist for optimal
            survival outcome.

                 A SUSTAINED COMMITMENT TO FUND CANCER RESEARCH

        When funding stagnates or does not keep pace with inflation,
    progress in critical research programs is halted or slows
    significantly. Inadequate funding for the National Institutes of Health
    (NIH) and the National Cancer Institute (NCI) means smaller ``trickle
    down'' occurs for the lesser-known or less popular--yet terribly
    devastating--diseases like ovarian cancer. To ensure adequate funding
    for all types of cancer, particularly those most deadly and least
    understood, the Alliance joins the cancer community in asking for $30.1
    billion for NIH and $6.17 billion for NCI in fiscal year 2006.

                                    SUMMARY

        The Alliance maintains a long-standing commitment to work with
    Congress, the Administration, and other policymakers and stakeholders
    to improve the survival rate from ovarian cancer through education,
    public policy, research, and communication. Please know that we
    appreciate and understand that our nation faces many challenges and
    Congress has limited resources to allocate, however, we are concerned
    that without increased funding to bolster and expand ovarian cancer
    education, awareness, and research efforts, the nation will continue to
    see growing numbers of women losing their battle with this terrible
    disease.
        On behalf of the entire ovarian cancer community--patients, family
    members, clinicians and researchers--we thank you for your leadership
    and support of federal programs that seek to reduce and prevent
    suffering from ovarian cancer. Thank you in advance for your support of
    $9 million in fiscal year 2006 funding for the CDC's Ovarian Cancer
    Control Initiative.
                                     ______

          Prepared Statement of the Pulmonary Hypertension Association

                  SUMMARY OF FISCAL YEAR 2006 RECOMMENDATIONS

      --$250,000 within the Centers for Disease Control and Prevention
            (CDC) for a pulmonary hypertension awareness and education
            program.
      --A 6 percent increase for the National Heart, Lung and Blood
            Institute (NHLBI) and the establishment of Pulmonary
            Hypertension Centers of Excellence at the Institute.
      --$30 million for the Health Resources and Services Administration's
            (HRSA) ``Gift of Life Donation Initiative.
        Mr. Chairman, thank you for the opportunity to submit testimony on
    behalf of the Pulmonary Hypertension Association.
        I am Dr. Anne Caesar, a professor of medicine at Georgetown
    University and a pulmonary hypertension patient (PH). PH is a rare
    disorder involving both the heart and the lungs. The walls of the blood
    vessels that supply the lungs thicken and often constrict, making them
    unable to carry normal amounts of blood. The heart works harder to
    compensate and eventually can't keep up. Life is threatened. Currently,
    there is no cure. Symptoms of pulmonary hypertension include shortness
    of breath with minimal exertion, fatigue, chest pain, dizzy spells and
    fainting.
        When PH occurs in the absence of a known cause, it is referred to
    as primary pulmonary hypertension (PPH). This term should not be
    construed to mean that because it has a single name it is a single
    disease. There are likely many unknown causes of PPH.
        Secondary pulmonary hypertension (SPH) means the cause of the
    disease is known. Common causes of SPH are the breathing disorders
    emphysema and bronchitis. Other less frequent causes are scleroderma,
    CREST syndrome and systemic lupus. In addition, the use of diet drugs
    can lead to the disease.
        While new treatments are available, unfortunately, PH is frequently
    misdiagnosed and often progresses to late stages by the time it is
    detected. Although PH is chronic and incurable with a poor survival
    rate, the new treatments becoming available are providing a
    significantly improved quality of life for patients. Recent data
    indicates that the length of survival is continuing to improve, with
    some patients able to manage the disorder for 20 years or longer.
        Eleven years ago, when three patients who were searching to end
    their own isolation founded this organization, there were less than 200
    diagnosed cases of this disease. It was virtually unknown among the
    general population and not well known in the medical community. They
    soon realized that this was not enough and as membership began to
    grow--driven by a newsletter written by patients and distributed by
    doctors--and as a community began to form, an 800 number support line
    was launched, support groups were established, a Scientific Advisory
    Board (SAB) was formed, a Patient's Guide to Pulmonary Hypertension was
    written, and a web site was launched.
        Today, PHA includes:
      --Over 5,000 patients, family members, and medical professionals.
      --An international network of over 100 support groups.
      --An active and growing patient telephone helpline.
      --A new and fast-growing research fund. (A cooperative agreement has
            been signed with the National Heart, Lung, and Blood Institute
            to jointly create and fund five, five-year, mentored clinical
            research grants and PHA has awarded seven Young Researcher
            Grants.)
      --A host of numerous electronic and print publications, including the
            first medical journal devoted to pulmonary hypertension--
            published quarterly and distributed to all cardiologists,
            pulmonologists and rheumatologists in the United States.

                   CENTERS FOR DISEASE CONTROL AND PREVENTION

        PHA applauds the subcommittee for its leadership in encouraging CDC
    to initiate a professional and public PH awareness campaign. We
    continue to work with officials at the CDC to establish this important
    program which will better inform health care professionals and the
    general public about PH, its symptoms, and treatment options.
        PHA knows that Americans are dying because of a lack of awareness
    of both pulmonary hypertension and recent advances in research and
    treatments. Most particularly, this is true among underserved
    populations. These are the least likely and the least able to see the
    three and four doctors it often takes to get a correct diagnosis. We
    believe that activities proposed below need to include special focus on
    reaching underserved populations and their medical services.
        The following is a description of the specific initiatives we hope
    to launch in collaboration with CDC.
        (1) Increasing awareness and understanding of PH among primary care
    physicians is critically important, because these practitioners are
    usually the first point of contact for PH patients. If the primary care
    doctor misses the symptoms, then the chance for early diagnosis depends
    upon the intuition and persistence of the patient. They have a chance,
    if they aggressively pursue diagnosis by trained and aware specialists.
    If they are not aggressive, or if they are in a health plan that
    requires their general practitioner to prescribe the referral, they are
    more likely to go undiagnosed until it is too late to control their
    illness. To increases awareness we propose to launch the following:
      --Written and video diagnostic tools for placement on the Internet.
      --Working with state health departments and clinic administrators to
            develop information for mailing to primary care physicians,
            medical schools and medical centers in the United States
            drawing their attention to the new web resources.
      --A simplified and visually attractive print version of the proper
            diagnostic procedures, which will be targeted to primary care
            physicians, public health clinics, medical schools, and medical
            centers in the United States.
      --Advertising in publications general practitioners and public health
            professionals are likely to read. The emphasis will be the
            importance of early diagnosis and the ease of accessing
            diagnostic tools via the Internet.
      --Improvements to an already produced CD-ROM that explains pulmonary
            hypertension from a variety of perspectives. We would like to
            make these available to the medical community and patients
            through our web site on an as requested basis and at
            conferences and through targeted mailings.
        (2) Due to the advancements in treatment for PH, it is important
    that we also focus on educating cardiologists and pulmonologists. Our
    strategies for reaching cardiovascular specialists include:
      --Expansion of the first Pulmonary Hypertension Journal focused on
            educating a cardiologists and pulmonologists on issues related
            to the diagnosis and treatment of the illness.
      --Placement of additional detailed information on the illness on the
            web. The PH Journal and other publications will promote this
            availability.
      --Expansion of the medical section of PHA's international conference
            on pulmonary hypertension (the largest PH conference in the
            world).
      --Expansion of PHA's Pulmonary Hypertension Resource Network. This
            program is focused on increasing awareness and knowledge of PH
            among nurses, respiratory therapists, technicians and
            pharmacists through peer education.
        (3) Finally, PHA is committed to increasing PH awareness among the
    general public through the development of the following initiatives:
      --A series of 10, 15, and 30 second public service announcements on
            PH. These PSAs will be in both audio and video form.
      --A PH media relations manual.
      --An organ donation and transplant listing Awareness Campaign
            (unfortunately, many PH patients die before finding a suitable
            organ donor).
      --Expansion of awareness and information activities on PHA's web
            site.
      --Continuation of PH Awareness Month.
        PHA and CDC have engaged in an ongoing dialogue about these and
    other strategies designed to increase awareness of PH. We are grateful
    for CDC's support of a DVD focused on the diagnosis of PH. However,
    despite repeated encouragement from the subcommittee, CDC has not
    established an ongoing awareness and education initiative on this
    devastating disease. Therefore, for fiscal year 2006, we encourage you
    to provide $250,000 within CDC's Cardiovascular Disease program for the
    formal establishment of this important initiative.

                    NATIONAL HEART, LUNG AND BLOOD INSTITUTE

        Mr. Chairman, PHA commends the leadership of the National Heart,
    Lung and Blood Institute (NHLBI) for its support of PH research. Three
    years ago, two separate groups of scientists funded by NHLBI
    simultaneously identified a genetic mutation associated with primary
    pulmonary hypertension.
        The two groups independently reported that defects in the BMPR2
    gene, which regulates growth and development of the lung, are
    associated with PPH. The defects in the gene lead to the abnormal
    proliferation of cells in the lung characteristic on PPH.
        Although both studies suggest that only one gene is involved in
    PPH, neither group identified the defects in BMPR2 as the sole cause of
    PPH. In addition, since many people without a known family history of
    PPH get the disease, both groups suggested that other factors may
    interfere with control of the tissue growth. Now that we have
    pinpointed a gene, we can focus on learning how it works. Hopefully,
    that information will enable researchers to devise better treatments
    and perhaps eventually a preventive therapy or cure.
        We greatly appreciate NHLBI's commitment to advancing research to
    better understand and ultimately cure this disease. Morever, we applaud
    the subcommittee's strong support of PH research at the Institute. For
    fiscal year 2006, PHA recommends a 6 percent increase for NHLBI and the
    NIH overall. In addition, PHA recommends the establishment of three
    pulmonary hypertension ``Centers of Excellence'' at NHLBI to support
    the expansion of research, training and information dissemination.
    Finally, we encourage the establishment of a PH data system and
    clearinghouse at the Institute.

                    GIFT OF LIFE DONATION INITIATIVE AT HRSA

        Mr. Chairman, PHA applauds the success of the Department of Health
    and Human Services ``Gift of Life'' Donation Initiative. Currently,
    there are three drugs that PH patients can be prescribed to help
    improve the quality of life with PH. Eventually, many patients must
    move toward lung or heart and lung transplantation. PH is a difficult
    to diagnose illness and while patients often list soon after diagnosis,
    for many PH patients it is too late. This why PHA is developing the
    Bonnie's Gift Project.
        Bonnie's Gift was started in memory of Bonnie Dukart, one of PHA's
    most active and respected leaders. Bonnie was a PH patient herself. She
    battled with PH for almost 20 years until her death in 2001 following a
    double lung transplant. Prior to her death, Bonnie expressed an
    interest in the development of a program within PHA related to
    transplant information and awareness. PHA will use Bonnie's Gift as a
    way to disseminate information about PH, the importance of early
    listing, the importance of organ donation to our community and organ
    donation cards.
        PHA has entered into a partnership with the ``Gift of Life''
    Donation Initiative to increase awareness of the importance of organ
    donation and early listing within the PH community. For fiscal year
    2006, PHA supports an appropriation of $30 million for HRSA's Gift of
    Life program.

                                   CONCLUSION

        Mr. Chairman, once again thank you for the opportunity to present
    the views of the Pulmonary Hypertension Association. We look forward to
    continuing to work with you and the subcommittee to improve the lives
    of pulmonary hypertension patients. If you have any questions or would
    like additional information, please do not hesitate to contact me or
    the Pulmonary Hypertension Association's National Office.
                                     ______

             Prepared Statement of the Society of Nuclear Medicine

        The Society of Nuclear Medicine (SNM) appreciates the opportunity
    to submit written testimony for the official record regarding federal
    funding for biomedical research in fiscal year 2006.
        SNM is an international, scientific, and professional organization
    with more than 16,000 members dedicated to promoting the science,
    technology, and practical application of nuclear medicine. Over the
    last 50 years, since biomedical imaging first began, the Nuclear
    Medicine community has made groundbreaking discoveries thanks to the
    research and development that was facilitated at the National
    Institutes of Health (NIH). To that end, the Society strongly
    recommends sufficient levels of federal funding to sustain and seize
    new opportunities in biomedical research.
        The Society of Nuclear Medicine stands ready to work with
    policymakers at the local, state, and federal levels to advance
    biomedical research policies and programs that will reduce and prevent
    suffering from disease.

                           WHAT IS NUCLEAR MEDICINE?

        Nuclear Medicine is an established specialty that performs non-
    invasive molecular imaging procedures to diagnose and treat diseases,
    and also to determine the effectiveness of therapeutic treatments--
    whether surgical, chemical, or radiation. It contributes extensively to
    the treatments and diagnoses of patients with cancers of the brain,
    breast, blood, bone, bone marrow, liver, lungs, pancreas, thyroid,
    ovaries, and prostate. Molecular imaging continues to provide expert
    information to help doctors, technicians, and other health care
    personnel manage abnormalities of the heart, brain, and kidneys. In
    fact, recent advances in the detection and diagnosis of Alzheimer's
    disease can be attributed to Nuclear Medicine imaging procedures,
    specifically positron emission tomography (PET) scans. These advances--
    which were made possible by research from nuclear medicine
    professionals--helped lead the Centers for Medicaid and Medicare
    Services (CMS) to extend Medicare coverage to include PET scans for
    some beneficiaries who suffer from Alzheimer's and other dementia-
    related diseases.
        CMS Administrator Mark B. McClellan announced the coverage by
    saying: ``Together with outside experts and other agencies we examined
    the available data and determined that we ought to approve coverage for
    patients who've been worked up but whose diagnosis is uncertain.'' \1\
    ---------------------------------------------------------------------------
        \1\ CMS Press Release--Sept. 14, 2004--Medicare Posts Coverage
    Decision to Expand Coverage of PET Scans for Alzheimer's. http://
    www.cms.hhs.gov/media/press/release.asp?Counter=1200.
    ---------------------------------------------------------------------------
        CMS' decision was also explained by Dr. Sean Tunis, CMS' Chief
    Medical Officer. He said: ``The available evidence supports the
    conclusion that PET scans help to evaluate patients with progressive
    symptoms of dementia, but for whom a diagnosis remains unclear despite
    a thorough standard medical evaluation. We will also support the
    conduct of additional studies that will determine the value of PET
    scans required in a broader population of Medicare beneficiaries who
    develop symptoms of dementia.''
        The effect nuclear medicine has on people is far-reaching.
    Annually, more than 16 million men, women, and children require
    noninvasive molecular/nuclear medical procedures. These safe, cost-
    effective procedures include PET scans to diagnose and monitor
    treatments in cancer; cardiac stress tests that analyze heart function;
    bone scans for orthopedic injuries; and lung scans for blood clots. In
    addition, patients undergo procedures to diagnose liver and gall
    bladder functional abnormalities and to diagnose and treat
    hyperthyroidism and thyroid cancer.

                    SUSTAIN AND SEIZE RESEARCH OPPORTUNITIES

        For decades, Americans and people from across the world have
    benefited from the strong federal investment in nuclear medicine and
    biomedical research at the National Institutes of Health. We can safely
    say, in the words CMS Administrator McClellan, ``the technology is
    promising.'' \2\ The Society hopes that this subcommittee will continue
    its trend of forward thinking and federally fund NIH and the National
    Institute of Biomedical Imaging and Bioengineering (NBIB) and the
    National Cancer Institute (NCI) at sufficient levels for fiscal year
    2006.
    ---------------------------------------------------------------------------
        \2\ CMS Press Release--Sept. 14, 2004--Medicare Posts Coverage
    Decision to Expand Coverage of PET Scans for Alzheimer's. http://
    www.cms.hhs.gov/media/press/release.asp?Counter=1200.
    ---------------------------------------------------------------------------
        SNM is proud to join its colleagues in the public health community
    in recommending that in fiscal year 2006, NIH is funded at a level
    totaling $30.1 billion. This funding level will permit NIH to sustain
    and build upon its current research activities, which are a byproduct
    of the recent NIH budget doubling effort. Even a minimal decrease or
    slowed momentum of increased funding in NIH's budget could cause severe
    disruption in the research activities and capabilities.
        In 1946, the first successful nuclear magnetic resonance (NMR)
    experiments were performed. This led to the first nuclear magnetic
    resonance imaging (MRI) exam performed on a human being 31 years later
    in 1977. From the first MRI in 1977 to today, critical advances in
    technology have developed, allowing physicians, nuclear medicine
    technicians and other health care professionals to image in seconds
    what used to take hours, days, or even weeks. Research in biomedical
    imaging and bioengineering is progressing rapidly and recent
    technological advances have revolutionized the diagnosis and treatment
    of disease. In 2000, the National Institute of Biomedical Imaging and
    Bioengineering was created. This NIH institute, specifically focused on
    biomedical imaging and bioengineering, has made great strides in
    helping the health care community and its patients recognize and
    understand different diseases and disorders. Pancreatic
    transplantation, brain scans, improvement to epilepsy surgeries are
    just a few examples of how NIBIB research is helping diagnose and treat
    patients. In order for NIBIB to continue moving forward with its
    research, SNM requests $350 million in federal funding for fiscal year
    2006. This funding level will allow NIBIB to further its research,
    development, and application of emerging and breakthrough biomedical
    technologies that will facilitate improved disease detection,
    management, and prevention.
        In addition, SNM advocates that another arm of NIH that uses
    molecular imaging, NCI, receive sufficient funding--$5.21 billion--in
    fiscal year 2006. The American Cancer Society predicts that more than a
    million Americans will be diagnosed with cancer in 2005. We have made
    significant gains in the war on cancer, and there have been successful
    breakthroughs in diagnosing and treating this terrible disease.
    Currently PET scans are available to detect more than a dozen types of
    cancer. Cancer research is leading to new therapies that translate into
    longer survival and improved quality of life for cancer patients.
    Extraordinary advances in cancer research have resulted because of the
    strong commitment by the federal, state, and local governments in
    combating cancer. Effective prevention, early detection, and treatment
    methods for many cancers have resulted from this governmental interest,
    intervention and public education campaign. In order to continue making
    a strong case against cancer, SNM requests that the Committee allocate
    $5.21 billion in federal funds for the NCI in fiscal year 2006.

                                   CONCLUSION

        As outlined above, SNM has a strong and vested interest in making
    sure that biomedical research in the United States is sufficiently
    funded. It is in everyone's best interest that the federal government
    invests the needed dollars to continue the pursuit of medical
    breakthroughs in technology and science. Without the sufficient funding
    levels--which include $30.1 billion for NIH, $350 million for NIBIB,
    and $5.21 billion for NCI--the positive effects and results of research
    and development are seriously compromised.
        SNM stands ready to work with policymakers from both sides of the
    aisle to advance biomedical research and innovation to help reduce and
    prevent suffering from disease for all Americans. Again, on behalf of
    the members of SNM, I thank you for the opportunity to submit testimony
    regarding the absolute need for increased federal funding for
    biomedical research. I am available to answer any questions you may
    have.
                                     ______

         Prepared Statement of the Spina Bifida Association of America

        On behalf of the more than 70,000 individuals and their families
    who are affected by Spina Bifida, the Spina Bifida Association of
    America (SBAA) appreciates the opportunity to submit written testimony
    for the record regarding increased funding for the National Spina
    Bifida Program and other related Spina Bifida initiatives in fiscal
    year 2006. SBAA is the national voluntary health agency working on
    behalf of people with Spina Bifida and their families through
    education, advocacy, research, and service. The Association was founded
    in 1973 to address the needs of the Spina Bifida community and today
    serves as the representative of 57 chapters serving more than 125
    communities nationwide. SBAA stands ready to work with Members of
    Congress and other stakeholders to ensure that our Nation takes all the
    steps necessary to reduce and prevent suffering from Spina Bifida.

                           BACKGROUND ON SPINA BIFIDA

        Spina Bifida is a neural tube defect (NTD) and occurs when the
    spinal cord fails to close properly during the early stages of
    pregnancy, typically within the first few weeks of pregnancy and most
    often before the mother knows that she is pregnant. Over the course of
    the pregnancy--as the fetus grows--the spinal cord is exposed to the
    amniotic fluid which becomes increasingly toxic. It is believed that
    the exposure of the spinal cord to the toxic amniotic fluid erodes the
    spine and results in Spina Bifida. There are varying forms of Spina
    Bifida, from mild--with little or no noticeable disability--to severe--
    with limited movement and function. In addition, within each different
    form of Spina Bifida the effects can vary widely. Unfortunately, the
    most severe form of Spina Bifida occurs in 96 percent of children born
    with this birth defect.
        The result of this neural tube defect is that most children with it
    suffer from a host of physical, psychological, and educational
    challenges--including paralysis, developmental delay, numerous
    surgeries, and living with a shunt in their skulls, which helps to
    relieve cranial pressure associated with spinal fluid that does not
    flow properly. We are pleased to report that after decades of poor
    prognoses and short life expectancy, children with Spina Bifida are now
    living long enough to become adults with Spina Bifida. These gains in
    longevity are principally due to breakthroughs in research, combined
    with improvements generally in health care and treatment. However, with
    this extended life expectancy, our Nation and people with Spina Bifida
    now face new challenges--education, job training, independent living,
    health care for secondary conditions, aging concerns, among others.
    Despite these gains, individuals and families affected by Spina Bifida
    face many challenges--physical, emotional, and financial.
        Recent studies have shown that if all women of childbearing age
    were to consume 400 micrograms of folic acid daily prior to becoming
    pregnant and throughout the first trimester of pregnancy, the incidence
    of Spina Bifida could be reduced by up to 75 percent. However, even if
    we are successful in preventing the majority of Spina Bifida cases in
    the future, our Nation still must take steps to ensure that the tens of
    thousands of individuals living with Spina Bifida can live full,
    healthy, and productive lives. To ensure the highest quality-of-life
    possible, prevention interventions and treatment therapies must be
    identified, developed, and delivered to those in need.

                              COST OF SPINA BIFIDA

        It is important to note that the lifetime costs associated with a
    typical case of Spina Bifida--including medical care, special
    education, therapy services, and loss of earnings--are as much as $1
    million. The total societal cost of Spina Bifida is estimated to exceed
    $750 million per year, with just the Social Security Administration
    payments to individuals with Spina Bifida exceeding $82 million per
    year. Moreover, tens of millions of dollars are spent on medical care
    paid for by the Medicaid and Medicare Programs. Our Nation must do more
    to help reduce the emotional, financial, and physical toll of Spina
    Bifida on the individuals and families affected. Efforts to reduce and
    prevent suffering from Spina Bifida help to save money and save lives.

      IMPROVING QUALITY-OF-LIFE THROUGH THE NATIONAL SPINA BIFIDA PROGRAM

        Secondary conditions associated with Spina Bifida include full or
    partial paralysis, neurological disorders, bladder and bowel control
    difficulties, learning disabilities, depression, latex allergy,
    obesity, skin breakdown, and social and sexual issues. Children with
    Spina Bifida often have learning disabilities and may have difficulty
    paying attention, expressing or understanding language, and grasping
    reading and math. Early intervention with children who experience
    learning problems can help considerably to prepare them for school.
    With appropriate, affordable, and high-quality medical, physical, and
    emotional care, most people born with Spina Bifida likely will have a
    normal or near normal life expectancy. Ensuring access to these
    services is essential to improving the quality-of-life for those born
    with this birth defect.
        SBAA has worked with Members of Congress to ensure that our Nation
    is taking all the steps possible to prevent Spina Bifida and diminish
    suffering for those living with this condition. As part of this
    comprehensive effort, SBAA collaborated with Members of Congress and
    other interested parties to secure an essential increase in fiscal year
    2005 funding for the National Spina Bifida Program at the National
    Center for Birth Defects and Developmental Disabilities (NCBDDD) at the
    Centers for Disease Control and Prevention (CDC). SBAA thanks the
    Members of the Subcommittee for their expression of support for this
    new and integral program by allocating $3.6 million in fiscal year
    2005.
        The National Spina Bifida Program works on two critical levels--to
    reduce and prevent Spina Bifida incidence and morbidity and to improve
    quality-of-life for those living with Spina Bifida. The program seeks
    to ensure that what is known by scientists is practiced and experienced
    by the 70,000 individuals and families affected by Spina Bifida. For
    example, the program helps individuals with Spina Bifida and their
    families learn how to treat and prevent secondary health problems,
    which range from learning disabilities and depression to severe
    allergies and skin problems that make life difficult for these
    individuals. All of these problems can be treated or prevented, but
    only if those affected by Spina Bifida--and their caregivers--are
    properly educated and taught what they need to know to maintain the
    highest level of health and well-being possible.
        Second, the National Spina Bifida Program offers benefits to those
    who live with Spina Bifida and their families by working to improve the
    outlook for a life challenged by this complicated birth defect--
    principally identifying potentially valuable therapies from in-utero
    throughout the lifespan and making them available and accessible to
    those in need. These secondary prevention activities represent a
    tangible quality-of-life difference to the 70,000 individuals living
    with Spina Bifida. With the goal being living well with Spina Bifida,
    the secondary prevention initiatives are focused on the creation and
    implementation of strategies to improve the quality-of-life. These
    quality-of-life efforts center on reaching the general population with
    Spina Bifida, advancing treatment of Spina Bifida and its related
    conditions, and working with adolescents living with Spina Bifida to
    address their specific academic, psycho-social, and vocational needs.
    In addition, the National Spina Bifida Program will create and
    implement a comprehensive program to assist teens with Spina Bifida in
    the development of life skills for independence, self-reliance, and
    success in the world.
        SBAA advocates that the National Spina Bifida Program receive $5.5
    million in fiscal year 2006 so the NCBDDD can expand and continue to
    promote quality-of-life programs that support people with Spina Bifida
    so they can live fulfilling and productive lives. In its first three
    years, this program already has made a difference for our community and
    with additional resources it can expand its reach and provide
    additional assistance and hope to those with an affected loved one.
    Increasing funding for the National Spina Bifida Program will help
    ensure that our nation continues to mount a comprehensive effort to
    prevent and reduce suffering from Spina Bifida.

                            PREVENTING SPINA BIFIDA

        While the exact cause of Spina Bifida is unknown, over the last
    decade, medical research has confirmed a link between a woman's folate
    level before pregnancy and the occurrence of Spina Bifida. Sixty
    million women are at-risk of having a child born with Spina Bifida and
    each year approximately 3,000 pregnancies in this country are affected
    by Spina Bifida, resulting in 1,500 births. As mentioned above,
    research has found that the consumption of 400 micrograms of folic acid
    daily prior to becoming pregnant and throughout the first trimester of
    pregnancy can help reduce incidence of Spina Bifida up to 75 percent.
    There are few public health challenges that our Nation can tackle and
    conquer by three-fourths in such a straightforward fashion. However, we
    must still be concerned with addressing the 25 percent of Spina Bifida
    cases that cannot be prevented by folic acid consumption, as well as
    ensuring that all women of childbearing age--particularly those most
    at-risk for a Spina Bifida pregnancy--consume adequate amounts of folic
    acid.
        The good news is that progress has been made in convincing women of
    the importance of folic acid consumption and the need to maintain diet
    rich in folic acid. Since 1968, the CDC has led the Nation in
    monitoring birth defects and developmental disabilities, linking these
    health outcomes with maternal and/or environmental factors that
    increase risk, and identifying effective means of reducing such risks.
    Former CDC Director Jeff Koplan has stated that the agency's folic acid
    prevention campaign has reduced neural tube defect births by 20
    percent. This public health success should be celebrated, but it is
    only half of the equation as approximately 3,000 pregnancies still are
    affected by this devastating birth defect. The Nation's public
    education campaign around folic acid consumption must be enhanced and
    broadened to reach segments of the population that have yet to heed
    this call--such an investment will help ensure that as many cases of
    Spina Bifida can be prevented as possible.
        SBAA works collaboratively with CDC and other nonprofits to
    increase awareness of the benefits of folic acid, particular for those
    at elevated risk of having a baby with neural tube defects (those who
    have Spina Bifida themselves or those who have already conceived a baby
    with Spina Bifida). With additional funding in fiscal year 2006 these
    activities could be expanded to reach the broader population in need of
    these public health education, health promotion, and disease prevention
    messages. SBAA advocates that Congress provide additional funding to
    CDC to allow for a particular public health education and awareness
    focus on at-risk populations (e.g. Hispanic-Latino communities) and
    health professionals who can help disseminate information about the
    importance of folic acid consumption among women of childbearing age.
        In addition to a $5.5 million fiscal year 2006 allocation for the
    National Spina Bifida Program, SBAA supports a fiscal year 2006
    allocation of $135 million for the NCBDDD so the agency can enhance its
    programs and initiatives to prevent birth defects and developmental
    disabilities and promote health and wellness among people with
    disabilities.

            IMPROVING HEALTH CARE FOR INDIVIDUALS WITH SPINA BIFIDA

        The mission of the Agency for Healthcare Research and Quality
    (AHRQ) is to improve the outcomes and quality of health care; reduce
    its costs; improve patient safety; decrease medical errors; and broaden
    access to essential health services. The work conducted by the agency
    is vital to the evaluation of new treatments in order to ensure that
    individuals and their families living with Spina Bifida continue to
    receive the high quality health care that they need and deserve. SBAA
    recommends that AHRQ receive $440 million in fiscal year 2006 so that
    it can continue to conduct follow-up efforts to evaluate Spina Bifida
    treatments, promulgate associated standards of care, and further the
    provision of evidence-based care stemming from the outcomes of the 2003
    Spina Bifida Research Conference. A new partnership between the Centers
    for Disease Control and AHRQ to develop treatments for Spina Bifida
    brings new hope for families living with Spina Bifida.

             SUSTAIN AND SEIZE SPINA BIFIDA RESEARCH OPPORTUNITIES

        SBAA seeks to support individuals and families affected by Spina
    Bifida, maximize the prevention of Spina Bifida, and ensure that all
    babies born with Spina Bifida have the greatest chance of survival and
    the highest quality-of-life--through the lifespan. When families
    recently diagnosed with a Spina Bifida pregnancy contact SBAA, the
    organization puts them in touch with other families who have a child
    with the condition so they can learn of the joys and challenges of
    having a child with the birth defect. Unfortunately, traditionally when
    families are faced with a Spina Bifida diagnosis they have had two
    difficult options. The first is to continue the pregnancy with the
    expectation of multiple surgeries for the child after birth, uncertain
    life expectancy, and many physical and developmental challenges and
    complications. The second, unfortunately, is to terminate the
    pregnancy. Fortunately, now there may be an important and effective
    third option.
        Since the late 1990s, doctors at three U.S. hospitals--Children's
    Hospital of Philadelphia, Vanderbilt University Medical Center in
    Nashville, and the University of California at San Francisco--have been
    operating before birth on fetuses diagnosed with Spina Bifida. In 2003,
    the University of North Carolina became the fourth hospital in the
    Nation to perform the in-utero operations. By closing the spinal lesion
    early in pregnancy, physicians believe they can minimize the damage
    created by fluid leaking from the spine, as well as limit by the harm
    done due to the spinal cord's contact with the amniotic fluid. Surgeons
    have found that closing the hole in the spine in this fashion before
    birth may correct breathing problems in 15 percent of the children
    receiving the procedure and may reduce the need for a shunt to drain
    fluid from the brain by between 33 percent and 50 percent.
        To determine whether or not this new procedure is safer and more
    effective than the traditional post-birth surgery to address the
    condition, the National Institute of Child Health and Human Development
    (NICHD) is conducting a large study involving the Children's Hospital
    of Philadelphia, Vanderbilt University Medical Center, and the
    University of California at San Francisco. While these three
    institutions have undertaken preliminary studies of the in-utero
    surgery technique, the overall and long-term effectiveness of this
    approach as compared to traditional therapy remains unknown. Given the
    potential for this surgery to ameliorate many of the conditions
    associated with Spina Bifida, we must do a better job of studying and
    evaluating this procedure, educating health care providers about this
    surgery as a potential option, and making information about it
    available to more families facing a Spina Bifida pregnancy.
        Our Nation has benefited immensely from past federal investment in
    biomedical research at the National Institutes of Health (NIH). SBAA
    joins with the rest of the public health community in advocating that
    NIH receive $30.1 billion in fiscal year 2006. This funding will
    support applied and basic biomedical, psychosocial, educational, and
    rehabilitative research to improve the understanding of the etiology,
    prevention, cure and treatment of Spina Bifida and its related
    conditions. In addition, SBAA urges the NIH to explore the following as
    they relate to individuals with Spina Bifida: assistive technology, in
    utero surgery, cost of care, women's and men's health, tethered cord,
    hydrocephalus, latex allergies, and other related factors.

                                   CONCLUSION

        SBAA stands ready to work with policymakers to advance policies
    that will reduce and prevent suffering from Spina Bifida. Again, we
    thank you for the opportunity to present our views on funding for
    programs that will improve the quality-of-life for the 70,000 Americans
    and their families living with Spina Bifida and stand ready to answer
    any questions you may have.
                                     ______

        Prepared Statement of the Society for Investigative Dermatology

                  SUMMARY OF FISCAL YEAR 2006 RECOMMENDATIONS

        (1) A 6 percent increase for all of the National Institutes of
    Health and the National Institute of Arhtritis and Musculoskeletal and
    Skin Dieseases (NIAMS).
        (2) Encourage NIAMS to create and enhance academic and educational
    opportunities for the advancement of scientific investigation of skin
    health and dermatologic diseases.
        (3) Encourage NIAMS to sponsor further burden of skin disease
    research and epidemiology activities to investigate general and skin-
    disease specific measures in order to generate data surrounding the
    incidence, prevalence, economic burden, quality of life, disability and
    handicaps attributable to these diseases.
        (4) Promote the development of NIH-supported training resources
    dedicated to attract more individuals to careers in skin disease
    research.
        Mr. Chairman, and members of the subcommittee--I am very grateful
    for this opportunity to testify on behalf of the Society for
    Investigative Dermatology. I am Dr. Kevin Cooper, Professor of
    Dermatology, Chairman and Director of the Skin Diseases Research Center
    at the Department of Dermatology at Case Western Reserve University. I
    have been a physician and investigator serving the VA for 20 years in a
    part time capacity as a component of my academic work. I also serve as
    President of the Society for Investigative Dermatology.

                                   BACKGROUND

        The Society for Investigative Dermatology has over 2000 members
    worldwide dedicated to the advancement and promotion of the sciences
    relevant to skin health and disease through education, advocacy, and
    the scholarly exchange of scientific information. Members include
    scientists and physician researchers from universities, hospitals, and
    industries committed to the science of dermatology. Each member firmly
    believes that further research is critical to improved prevention,
    diagnosis, and treatment for the 3,000 different diseases of the skin,
    hair, and nails, which affect about 80 million Americans each year.
        My purpose in being here today is to emphasize the need for
    increased funding for the National Institutes of Health (NIH) and the
    National Institute of Arthritis and Musculoskeletal and Skin Diseases
    (NIAMS), and to encourage follow-up to the ``Burden of Skin Disease''
    workshop that took place in 2002. The workshop was held with the
    intention to investigate general and skin-disease specific measures in
    order to generate data surrounding the incidence, prevalence, economic
    burden, quality of life, disability and handicaps attributable to these
    diseases.
        Good health depends on healthy skin. Much of what we see on the
    outside of the body is a reflection of a person's health inside. From
    the yellow of hepatitis, to the deep purple lesions of Kaposi's
    sarcoma--a common side effect of AIDS, from the sizeable skin lesions
    of lupus erythematosus, to the painful deformed nails which may occur
    in patients with severe arthritis and psoriasis--health disorders often
    show up first as problems on the skin's surface. Skin samples are often
    used to make genetic diagnoses of internal disorders and in the future,
    the skin may be a target for gene replacement.
        Advances in cell biology allow us to understand the life cycle of
    skin and hair-producing cells and to explain how a malfunctioning
    immune system undermines the health of the body overall and the skin,
    in particular. Furthermore, the ongoing revolution in molecular and
    cell biology, genetics, immunology, information and laser technology
    provides unprecedented opportunities for achieving advances in basic
    research and medical treatment. We are becoming rapidly more adept at
    growing skin cells in the laboratory and at producing artificial skin.
    Increasingly, laser surgery is commonly replacing more invasive and
    traditional surgical methods.
        I would like to thank you for the increase in funding the
    subcommittee provided in fiscal year 2004 for NIH overall and for
    NIAMS. This year, we recommend a 6 percent increase for the NIH budget,
    and a similar percentage increase for NIAMS, which would lead to a
    funding level of $542 million for NIAMS. As the population ages and we
    live longer, dermatologists will be asked increasingly to treat cancers
    and other skin disorders that appear more often in aged individuals.
    Dermatologists will need to find new and better ways to help prevent
    and heal common conditions of the elderly, such as bed sores. Ulcers of
    the skin alone cost $8 billion per year to diagnose and treat.
        I would also like to thank the subcommittee for the inclusion of
    the conference report language in your fiscal year 2005 bill, calling
    for further attention to the numerous research opportunities and
    developments identified during the September 2002 Burden of Skin
    Disease workshop. Further exploration into the economic and social
    costs of skin disease in the U.S. population is necessary, as an
    analysis into many related areas has not been updated since 1979. More
    data must be collected to determine the prevalence of skin diseases and
    the disabilities they inflict upon those suffering from them. The
    translation of statistical data and methodology into improved bedside
    care must be a priority.
        The costs to society for medical care and lost wages due to
    conditions of the skin, hair and nails is estimated to be in the
    billions annually. However, the costs to those suffering from these
    debilitating conditions are immeasurable: they encounter discomfort and
    pain, physical disfigurement, disability, dependency and death. Skin
    conditions affect an individual's ability to interact with others and
    compromise the self-confidence of those inflicted.

                               RESEARCH ADVANCES

        The past two decades have seen explosive growth in technology and
    in increased sophistication in our understanding of the genetic and
    cellular mechanisms underlying many skin, hair and nail disorders. One
    consequence of these findings is a radical new paradigm shift in which
    the skin is now viewed as a complex organ that is intimately responsive
    to the immune system of the body. Several distinct cell types in the
    skin actively generate, regulate and perpetuate immune responses. Other
    important new research findings include the following:
      --A gene responsible for the inherited form of basal cell carcinoma
            has been identified and may lead to new information as to the
            origins of skin cancer.
      --A gene for an inherited form of hair loss has been discovered.
      --A new protein that links collagen and vascular defects in
            scleroderma has been identified.
      --Advances in the design of drug-delivery systems allow for sustained
            release of drugs through the skin, which will most likely lead
            to treatments that are more effective.
      --Methods to grow real and artificial skin in laboratories are used
            to prepare skin grafts for burn victims.
        The past two decades have focused on developing evaluation
    techniques such as clinical epidemiology, biostatistics, economics, and
    the quantitative social sciences used to determine the effectiveness of
    certain procedures and whether they contribute to the quality of life
    and health of both patients and society.
        As you know, medical research organizations such as the Society for
    Investigative Dermatology work closely with patient support and
    advocacy groups. We are pleased to say for many years we have worked
    with the Coalition of Skin Diseases for Skin Disease Research. The many
    organizations that participate in the Coalition have been the best
    possible advocates for increased funding, as they understand that
    unless major research efforts are undertaken, advances in understanding
    and improvements in the health of patients will not occur. Every year,
    we participate with these organizations in advocating increased funding
    for the NIH and NIAMS. We want to reiterate how deeply grateful we are
    for your leadership and that of the subcommittee on medical research
    matters, which means so much for the health of the people in our
    nation.
        I will be pleased to answer any questions you may have.
                                     ______

     Prepared Statement of the Society for Women's Health Research and the
                       Women's Health Research Coalition

        On the behalf of the Society for Women's Health Research and the
    Women's Health Research Coalition, we are pleased to submit testimony
    in support of increased funding for biomedical research, and more
    specifically women's health research.
        The Society is the only national non-profit women's health
    organization whose mission is to improve the health of women through
    research, education, and advocacy. Founded in 1990, the Society brought
    to national attention the need for the appropriate inclusion of women
    in major medical research studies and the need for more information
    about conditions affecting women disproportionately, predominately, or
    differently than men.
        The Coalition was created by the Society in 1999 as a way to
    strengthen our grassroots advocacy with scientists and researchers and
    clinicians from across the country who are concerned and committed to
    improving women's health research. The Coalition now has more than 620
    members from across the country, including leaders within the
    scientific community and medical researchers from many of the country's
    leading universities and medical centers, directors from various
    Centers of Excellence on Women's Health as well as leading voluntary
    health associations, and pharmaceutical and biotechnology companies.
        The Society and the Coalition are committed to advancing the health
    status of women through the discovery of new and useful scientific
    knowledge. We believe that sustained funding for the women's health
    research programs that are conducted across the federal research
    agencies is necessary if we are to accommodate the health needs of the
    population and advance the nation's research capability. We urge your
    support for all these federal agencies and programs described below
    that are working to meet these goals.

                         NATIONAL INSTITUTES OF HEALTH

        From decoding the human genome to elucidating the scientific
    components of human physiology, behavior, and disease, scientists are
    unearthing exciting new discoveries which have the potential to make
    our lives and the lives of our families longer, healthier, and safer.
    The National Institutes of Health (NIH) has made this all possible by
    conducting and supporting our nation's biomedical research. The world-
    class NIH researchers, scientists, and programs are dedicated to
    understanding how the human body works and to gain insight into
    countless diseases and disorders. Due to robust investment and support
    from Congress, NIH has made the United States the world leader in
    medical research and has had a direct and significant impact on women
    in science and on women's health research.
        In planning for fiscal year 2006 funding for the NIH, the
    Administration has proposed a 0.5 percent increase. This proposed
    amount however will not keep pace with the Biomedical Research and
    Development Price Index. It is vital that United States' commitment to
    medical research be sustained in order not to erode the foundation
    created over the past several years and to continue to build upon
    promising research to enhance the quality of life for all Americans
    touched by illness and disease.
        Therefore, to continue the momentum of scientific advancement and
    expedite the translation of research from the laboratory to the
    patient, the Society encourages an increase of six percent (6 percent)
    for the NIH, for a budget of at least $30 billion for fiscal year 2006.
    In addition, we request that you strongly encourage the NIH to assure
    that women's health research receives resources sufficient to meet the
    health needs of Americans.
        Scientists have long known of the anatomical differences between
    men and women, but only within the past decade have they begun to
    uncover significant biological and physiological differences. Sex
    differences have been found everywhere from the composition of bone
    matter and the experience of pain to the metabolism of certain drugs
    and the rate of neurotransmitter synthesis in the brain. Sex-based
    biology, the study of biological and physiological differences between
    men and women, has revolutionized the way that the scientific community
    views the sexes. The evidence is overwhelming, and as researchers
    continue to find more and more biological differences, they are gaining
    a greater understanding of the biological and physiological composition
    of both sexes.
        Much of what is known about sex differences is the result of
    observational studies, or is descriptive evidence from studies that
    were not designed to obtain a careful comparison between females and
    males. The Society has long recognized that the inclusion of women in
    study populations by itself was insufficient to address the inequities
    in our knowledge of human biology and medicine, and that only by the
    careful study of sex differences at all levels, from genes to behavior,
    would science achieve the goal of optimal health care for both men and
    women. This has given rise to sex-based biology.
        Many sex differences are already present at birth, whereas others
    develop later in life. These differences play an important role in
    disease susceptibility, prevalence, time of onset and severity and are
    evident in cancer, obesity, coronary heart disease, autoimmune, mental
    health disorders, and other illnesses. Physiological and hormonal
    fluctuations may also play a role in the rate of drug metabolism and
    the effectiveness of response in females and males. This research needs
    to be supported and encouraged. Congress recognizes this importance and
    should support NIH at an appropriate level of funding and direct NIH to
    continue and expand this research into sex-based biology.

                      OFFICE OF RESEARCH ON WOMEN'S HEALTH

        The NIH Office of Research on Women's Health (ORWH) has a
    fundamental role in improving women's health research at NIH. Within
    the Office of the Director, ORWH advises the NIH Director on matters
    relating to research on women's health; strengthens and enhances
    research related to diseases, disorders, and conditions that affect
    women; works to ensure that women are appropriately represented in
    biomedical and behavioral research studies supported by NIH; and
    develops opportunities for and supports recruitment, retention, re-
    entry and advancement of women in biomedical careers. ORWH works in
    partnership with the NIH Institutes and Centers to ensure that women's
    health research is part of the scientific framework and improve
    interdisciplinary research opportunities in women's health within NIH.
    ORWH's ambitious agenda encompasses issues that go far beyond
    reproductive capacity, cutting across and integrating scientific
    disciplines, medical specialties, psychosocial and behavioral factors,
    and environmental determinants in a multidisplinary and collaborative
    approach. ORWH endeavors to address sex and gender perspectives of
    women's health and women's health research, as well as differences
    among special populations of women across the entire life span, from
    birth through adolescence, reproductive years, menopausal years and the
    more advanced, elderly years.
        Two highly successful pioneering programs offered through ORWH that
    are critical to further advancing women's health research are Building
    Interdisciplinary Research Careers in Women's Health (BIRCWH) and
    Specialized Centers of Research on Sex and Gender Factors Affecting
    Women's Health (SCOR). These programs benefit both women's and men's
    health through sex and gender research, interdisciplinary scientific
    collaboration, and provide tremendously important support for young
    investigators in a mentored environment.
        The BIRCWH program is an innovative, trans-NIH career development
    program that provides protected research time for junior faculty by
    pairing them with senior investigators in an interdisciplinary mentored
    environment. What makes BIRCWH so unique is that it bridges advanced
    training with research independence, as well as across scientific
    disciplines. Since 2000, 177 scholars have been trained in the 24
    centers recording over 634 publications and 526 abstracts. The scholars
    have secured 40 NIH grants and 70 awards from industry and
    institutional sources.
        The BIRCWH program offered at Magee Women's Hospital in Pittsburgh,
    for example, has been able to successfully support the transition of
    eight young faculty at the beginning of their careers. In the current
    environment young faculty are expected to generate their income by
    teaching, clinical care or grant support. However, being that they are
    new, grant support for salary is unlikely and they end up with heavy
    clinical and/or teaching load's--at just the time in their careers when
    they should be perfecting their recently developed research skills. The
    BIRCWH program allows young researchers at Magee to become established
    and ready to apply for extramural funding and salary support. Magee has
    also been able to provide additional mentoring, courses, and career
    guidance to young investigators in women's health research.
        The SCOR program was established in 2001 and now has 11 centers
    throughout the country. ORWH, along with the National Institute of
    Arthritis and Musculoskeletal and Skin Diseases, the National Institute
    of Child Health and Human Development, the National Institute of
    Diabetes and Digestive and Kidney Diseases, the National Institute on
    Drug Abuse, the National Institute of Mental Health, and the National
    Institute of Environmental Health Sciences, published a request for
    applications to create these centers as a way to meet some of the
    health promotion and disease prevention objectives outlined in the
    ``Healthy People 2010'' initiative, a Public Health Service-led
    national activity for setting priority areas.
        The objective of the SCOR program is to expedite interdisciplinary
    development and application of new knowledge to human diseases, to
    learn more about the causes of these diseases, and to foster improved
    approaches to treatment and/or prevention. The program was designed to
    complement other federally supported programs addressing women's health
    issues such as BIRCWH.
        The Institutes and Centers at the NIH, working with the ORWH, have
    identified many research priority areas to be undertaken by SCORs. Some
    of these include studying the influence of toxic environmental factors
    on women's health; examining the sex and/or gender factors in acute and
    chronic pain conditions or syndromes; undertaking studies to examine
    kidney disorders, including the impact of pregnancy, diabetes, and
    hypertension on renal function; studying urologic and urogynecologic
    disorders; examining the biological and behavioral risk factors,
    including sex and/or gender factors, in the development of mental
    disorders such as addictive behaviors, schizophrenia, mood, anxiety,
    and eating disorders; and the developmental biology of the vascular
    system and the role of the fetal environment in programming lifelong
    cardiovascular function.
        We strongly encourage Congress to direct NIH to continue its
    support of ORWH and its programs. This step is needed to assure that
    advancements in discoveries of sex differences and, in particular,
    women's health that are long overdue are not lost. From the discovery
    and understanding of illness and diseases to the formulation of
    treatments, pain relief and potential cures, knowledge base gained from
    these important efforts must not be lost, as the benefits are of
    critical importance to all Americans, men and women.

     WOMEN'S HEALTH OFFICES WITHIN DEPARTMENT OF HEALTH AND HUMAN SERVICES

        In addition to the ORWH, there are several other offices throughout
    the Department of Health and Human Services (HHS) that enhance the
    focus of the government on women's health research. Agencies with
    offices, advisors or coordinators for women's health or women's health
    research are the Department of HHS, the Food and Drug Administration,
    the Centers for Disease Control and Prevention, the Agency for
    Healthcare Quality and Research, the Indian Health Service, the
    Substance Abuse and Mental Health Services Administration (SAMHSA), the
    Health Resources and Services Administration, and the Centers for
    Medicare and Medicaid Services. There is a vital need for these
    agencies to be funded at levels adequate for them to perform their
    assigned missions.
        We are grateful for the Committee's continuing support for the work
    of these entities. But with the exception of NIH and SAMSHA, none of
    these offices, advisors, or coordinators is statutorily authorized.
    Although an authorization does not guarantee an appropriation, having
    one makes it easier. The Society and its Coalition are addressing that
    issue in the appropriate venue through the Women's Health Office Act
    (H.R. 949 and S. 569). But, within your jurisdiction, we ask that the
    Committee Report clarify that Congress supports these offices and would
    like to see them continued and strengthened in the coming fiscal year.
        The focus on women's health within HHS has been of critical
    importance to the advances made in women's health in the last decade.
    As previously mentioned, prior to the early-mid 1990's biomedical
    research had been firmly rooted in the male model--the belief that male
    biology (outside of the reproductive system) was representative of the
    species, and that where female biology differed from male biology it
    was ``atypical'' or ``anomalous''. This led to a lack of knowledge
    about female biology that has significantly compromised women's health.
    It is the offices, advisors and coordinators in the agencies listed
    above who played an essential role in trying to make up for time lost
    in the last decade. We have only just scratched the surface of
    understanding female biology. Now is the time to press ahead and make
    those discoveries and educate women about their health and the
    misinformation they have been given for years and these offices are
    critical to the success of this effort.
        There are many wonderful programs that we could identify from these
    agencies but we would like to specifically mention two that have
    instrumental programs and initiatives that are vital to women's health.
    The HHS Office on Women's Health and the Agency for Healthcare Research
    and Quality each have a unique mission but are unified in advancing
    women's health research.

                          HHS OFFICE OF WOMEN'S HEALTH

        The HHS Office of Women's Health is the government's champion and
    focal point for women's health issues, and works to redress inequities
    in research, health care services, and education that have historically
    placed the health of women at risk. The HHS Office on Women's Health
    coordinates women's health efforts in HHS to eliminate disparities in
    health status and supports culturally sensitive educational programs
    that encourage women to take personal responsibility for their own
    health and wellness. A program initiated by the HHS Office on Women's
    Health that is critical to women's health is the National Centers of
    Excellence in Women's Health (CoEs). Developed in 1996, this program
    offers a new model for university-based women's health care. Selected
    on a competitive basis, the current twenty-one CoEs seek to improve the
    health of all women across the lifespan through the integration of
    comprehensive clinical health care, research, medical training,
    community outreach and public education, and medical school faculty
    leadership development.
        Located in leading academic health centers across the United States
    and Puerto Rico, these Centers are developing new models for women's
    health care that are setting standards beyond what is traditionally
    offered at hospital-sponsored women's clinical health centers. The CoEs
    are able to reach a more diverse population of women, including more
    women of color and women beyond their reproductive years. In addition,
    the CoEs have a strong commitment to integrating research, education,
    and clinical care than most traditional women's health centers.
        A recent evaluation of the CoEs conducted by HHS Office of Women's
    Health concluded that the CoEs provided comprehensive clinical
    preventive services, served a broader cross-section of women, reached
    underserved subpopulations, including minority and economically
    compromised communities, produced higher levels of patient
    satisfaction, and aided in mentoring more women in their professional
    roles as clinicians and/or researchers. However, the report also
    concluded that CoEs remain vulnerable to pressures including, obtaining
    adequate funding and having to compete for scarce resources.
        Coalition member and Director of the University of Illinois Chicago
    National Center of Excellence in Women's Health Stacie Geller, Ph.D.,
    strongly believes that her CoE has been instrumental in promoting
    advancement and leadership opportunites for female researchers on
    campus and beyond. In addition, the University of Illinois Chicago CoE
    has improved healthcare for women with a ``one-stop shopping'' model
    within the medical center by incorporating an adolescent clinic,
    midlife practice, and a clinic designed to meet the needs of
    perimenopausal and postmenopausal women in the same facility. The CoE
    also works to reduce barriers to health care for underserved urban
    women, and partners with surrounding communities to disseminate health
    information.
        Considering the advancements that have been made and those that
    still need to be achieved, we urge Congress to provide an increase of
    $1.5 million for the HHS Office on Women's Health to allow it to
    continue to sustain and expand the National Centers of Excellence in
    Women's Health.

                   AGENCY FOR HEALTHCARE AND RESEARCH QUALITY

        The Agency for Healthcare Research and Quality (AHRQ) is the lead
    Public Health Service agency focused on health care quality, including
    coordination of all federal quality improvement efforts and health
    services research. AHRQ's work serves as a catalyst for change by
    promoting the results of research findings and incorporating those
    findings into improvements in the delivery and financing of health
    care. This important information provided by AHRQ is brought to the
    attention of policymakers, health care providers, and consumers who can
    make a difference in the quality of health care women receive.
        Congress has had an active role in the Agency's work, providing
    funding while adding responsibilities. This has allowed AHRQ to enhance
    its research on how to: reduce deaths from medical errors; improve
    access and quality of care; promote evidence based health care;
    eliminate racial and ethnic disparities; compile the first national
    report on quality; and assist in improving emergency responsiveness.
        AHRQ has a valuable role in improving health care for women.
    Through AHRQ's research projects and findings, lives have been saved
    and underserved populations have been treated. For example, women
    treated in emergency rooms are less likely to receive life-saving
    medication for a heart attack. AHRQ funded the development of two
    software tools, now standard features on hospital electrocardiograph
    machines that have improved diagnostic accuracy and dramatically
    increased the timely use of ``clot-dissolving'' medications in women
    having heart attacks.
        While AHRQ has made great strides in women's health research, the
    Administration's budget for fiscal year 2006 could threaten life-saving
    research. If a budget request of $319 million were enacted, AHRQ would
    be flat funded at fiscal year 2005 levels. In reality, AHRQ's funding
    has been kept flat for two years as the recent $15 million increase is
    dedicated to a specific project. Flat funding prior to application of
    taps by Congress seriously jeopardizes the research and quality
    improvement programs that Congress demands or mandates from AHRQ.
    Congress through the Medicare Prescription Drug, Improvement, and
    Modernization Act of 2003 directed ARHQ to research comparative
    effectiveness of drugs and other products but provided no appropriated
    funds in fiscal year 2003 or 2004. In fiscal year 2005, AHRQ received
    $15 million to conduct such extensive and important research, far less
    than is needed to do the project.
        It is important that Congress continues its support for AHRQ by
    increasing their funding to $443 million for fiscal year 2006. This
    will ensure that adequate resources are available for high priority
    research, including women's health care, gender-based analyses,
    Medicare, and health disparities.
        In conclusion, Mr. Chairman, we thank you and this Committee for
    its strong record of support for medical and health services research
    and its unwavering commitment to the health of the nation through its
    support of peer-reviewed research. We look forward to continuing to
    work with you to build a healthier future for all Americans.
                                     ______

    Prepared Statement of the Upper County Branch of the Montgomery County,
                              Maryland Stroke Club

                      A STROKE SURVIVOR: A PERSONAL STORY

        My name is Susan Emery. I am the presiding officer of the Upper
    County Branch of the Montgomery County Stroke Club and I am a stroke
    survivor.
        Our club conducts education and support activities for stroke
    survivors, their family members, and caregivers. We serve people in the
    Maryland suburbs of Washington, D.C., and are fortunate to be in the
    same county as the National Institutes of Health. We have benefited on
    many occasions by the participation of NIH staff members in our
    membership meetings. They have been generous in sharing with us
    information about their research into stroke prevention and treatment.
        On December 26, 1965 at the age of 9, I was playing a new game with
    my brother and a few friends at the kitchen table. That is the last
    thing that I remember. I was unconscious for the next two days. My
    mother first learned, incorrectly, that I had spinal meningitis. I was
    transferred to another hospital where my mother was told that I had
    little chance of survival. Yet, I am here, more than 37 years later,
    and I have survived a stroke.
        People seldom associate strokes with children. These strokes are
    rare, but they do happen. There are about three cases of stroke per
    year in every 100,000 children under age 14. One of the difficulties in
    dealing with strokes in children is getting the right diagnosis
    quickly. There are often delays in diagnosis of childhood stroke.
        I spent 2 weeks in the hospital and the following 4 months in
    intensive physical therapy. My 10th birthday was spent in the hospital,
    and I have a picture in my photo album of myself with my mother and a
    new friend. My right eye is turned down, my mouth is turned down, but I
    am still smiling. During the 4 months in therapy at Holy Cross in
    Detroit, I learned the basics: how to walk, how to talk, and how to
    move the fingers on my right hand. My mother followed the doctor's
    instructions and sent me back to school very quickly, where classmates
    helped me button and unbutton my coat and carry my books, and teachers
    taped papers to the desk so I could learn to write again. I survived
    that 4 months, and would never wish to repeat it.
        I have been in therapy six times in my life. I need to tell you
    about the one time that was the most important to my family. I was 26
    years old and had just had my first child. I kept her safe, for I knew
    my limitations. I always used my left hand to support her. But when she
    was 6 months old, she got to be a little heavy, and twice, as I was
    putting her on the floor to change her diaper, my right hand slipped
    from under her buttocks. She fell only inches in both cases and did not
    even notice. But I noticed. I went in for 2 or 3 months of therapy
    close to Denver, Colorado, where I was living at the time. Here for the
    first time, they helped my right hand and arm dexterity through
    occupational therapy. I also learned that I had aphasia--the inability
    to speak, write or understand spoken or written language because of
    brain injury--because I called things like cornucopias, unicorns
    instead of fruit baskets. Instead of the word being the same, I picked
    a word that sounded the same. These therapists in Colorado worked with
    my mind and my body and I will forever be in their debt.
        Close to 15 years ago, I made a new life for myself in Maryland.
    Here, I have been an outpatient at the National Rehabilitation Hospital
    three times: once for my right foot, once for my Achilles tendon and
    once for my right knee. I have seen numerous physiatrists, all of whom
    are excellent in their field. I have also seen my fair share of
    therapists. Since I have had therapy off and on for most of my life, I
    can honestly say that the first few times you go in to see a therapist,
    you will come out hurting more than when you went in. But in the long
    run, they help tremendously.
        On a work related note, I received a Bachelor of Science in 1978
    from Michigan State University in Computer Science and worked for 12
    years in the field. I started working in the telecommunications
    industry in 1990, and got a Master of Science from the University of
    Maryland, University College in Telecommunications Management. I now
    work for ITT Industries as a senior engineer on a contract supporting
    the Federal Aviation Administration's leased telecommunications
    activities, and have worked there for more than 6 years. I have done
    more than survive. I have become a productive member of society.
        Stroke research has changed my life. Without the research carried
    out 40 to 50 years ago, I would not have benefited from electric shock
    therapy that made me understand the muscles that moved my fingers.
    Without research done 30 years ago, I may not have been able to
    understand how to exercise my hand for dexterity. Without research
    performed 10 years ago, the people around me would not understand that
    they need to get me to the hospital quickly if ever I have another
    stroke. Without current support, researchers may never understand how
    to stop strokes before they happen or how to make current stroke
    survivors live healthier lives.
        Stroke remains America's No. 3 killer and a major cause of
    permanent disability. An estimated 5.4 million Americans live with the
    consequences of stroke and about 1 in 4 is permanently disabled. Yet,
    stroke research continues to receive a mere 1 percent of the National
    Institutes of Health budget. I strongly urge you to significantly
    increase funding for the National Institutes of Health-supported stroke
    research, particularly for National Institute of Neurological Disorders
    and Stroke-supported stroke research. NIH stroke research is essential
    to prevent strokes from happening to children and adults in the first
    place, and to advance recovery and rehabilitation of those who survive
    this potentially devastating illness.
                                     ______

                            DEPARTMENT OF EDUCATION

           Prepared Statement of the Alamo Navajo School Board, Inc.

        The Alamo Navajo School Board, Inc. operates under resolution from
    the Alamo Navajo Community and from the Navajo Nation and was organized
    within the Alamo Navajo chapter community to establish and operate
    Federal and State programs that provide education, health and community
    development services to the people of Alamo under contracts, grants or
    cooperative agreements. We are responsible for operation of nearly all
    federal programs that serve the 2,000 Navajo people who live on the
    Alamo Reservation. Our 10-square mile reservation is isolated in south-
    central New Mexico, 250 miles from the Big Navajo Reservation, thus it
    is critical that we provide local services to persons living on the
    Alamo Reservation. On an annual basis, we operate over $13 million of
    federal and state supported programs.
        In summary our recommendations for the fiscal year 2006 Labor-HHS-
    Education and Related Agencies budget are:
      --Reject the Administrations proposal to de-fund the Perkins
            vocational program and provide at least a modest increase;
      --Direct the Department of Education to allow BIA-funded schools to
            apply directly for Library Literacy Grant funding;
      --Reject the Administration's proposal to de-fund the Safe and Drug
            Free schools program and provide at least a modest increase;
      --Allow Indian Head Start program to have the flexibly to allocate
            funds between their Early and regular Head Start programs;
      --Support a four percent tribal allocation under the Head Start
            Program;
      --Increase funding for the Workforce Investment Act;
      --Reject the proposal to consolidate Supplemental Youth Services
            funding into a block grant which would probably cause the loss
            of Indian SYS funding;
      --Reject the Administration's proposals to reallocate and/or rescind
            $92 million of already-appropriated fiscal year 2006 CPB funds
            and to end forward funding for the CPB.
      --Support continued and increased CPB support for Native radio.

                              VOCATIONAL EDUCATION

        We operate a very successful and much-needed program funded through
    the Carl Perkins Vocational and Applied Technology Act and we strongly
    oppose the Administration's proposal to totally de-fund the Carl
    Perkins vocational education program. We are pleased that the House and
    Senate authorizing committees are proceeding with reauthorizing the
    Perkins Act, which sends a clear signal to the White House that
    Congress finds this a valuable program that should be continued.
        We have been administering a Section 116 Perkins Act grant under
    which we are successfully helping Indian people access and complete
    postsecondary education. Our project is named Access-Retention-
    Completion (ARC) We are working toward development of a Navajo
    professional workforce that will enable people, if they so choose, to
    fill job needs on the Alamo Navajo Reservation that must now be filled
    by persons from outside the community. Under ARC, our students are able
    to gain academic and technical skills both on and off the reservation,
    via distance learning and on-site classes. The Alamo Navajo School
    Board has articulation agreements with several postsecondary
    institutions to offer classes both on and off reservation. We are able
    to help students with transportation to off-reservation education sites
    through the use of our 15-passenger van. We are making education more
    accessible and affordable for postsecondary students who are also
    parents. Our child care program provides pre-natal to early head start
    child care. We also have an after school tutoring program for older
    school-age children. Finally, we are providing support services to all
    postsecondary students through counseling, placement, advisement and
    facilitation.
        While we feel very good about the development of our Access-
    Retention-Completion project, it takes more than four years to fully
    develop this multifaceted program. We are currently serving 83
    students, with an 80 percent completion rate for on-site classes and
    100 percent completion rate for students taking off-reservation
    classes. Our placement rate is 80 percent for on-site and 90 percent
    for off-reservation. Our students are about evenly split between on and
    off reservation programs. We also believe that our ARC project has the
    very real potential to be a model for other isolated communities--both
    Indian and non-Indian--and having several more years of assured funding
    would bring the necessary additional experience to serve as a model
    program.

                  IMPROVING LITERACY THROUGH SCHOOL LIBRARIES

        The Alamo-Navajo School Board is excluded from applying for these
    much needed funds that would, as Congress intended, enable us to update
    our school library materials and media center equipment and assure an
    appropriately credentialed media specialist is on hand to assist our
    students. The Department of Education has taken the position that
    because the BIA-funded schools receive a 0.5 percent set-aside from the
    annual appropriations for this program, they cannot apply for
    discretionary grants as an LEA (local education agency) under the
    program operated by the Department. The average grant award under the
    Department's discretionary grant program ranges from $150,000 to
    $300,000.
        In fiscal year 2005, the Department of Education transferred
    $99,211 to the BIA for the use of the BIA-funded schools. The BIA,
    however, determined that instead of making the funds available--by
    discretionary or formula grant--to all of the 184 schools in the BIA
    school system, the entire fiscal year 2005 amount would be allocated to
    only two schools. The schools selected were on the BIA Center for
    School Improvement list for proposed restructuring, meaning they had
    not met adequate yearly progress (as required by the No Child Left
    Behind Act) despite earlier intervention.
        We understand that poorly performing schools require much
    assistance to enable them to help their students achieve academic
    success, and it is unlikely that the entire $99,000 would be sufficient
    to correct the deficiencies experienced by just one BIA-funded school.
    Nonetheless, it is unfair to all BIA schools if the Department of
    Education excludes BIA-funded schools from the discretionary program
    and the BIA adopts a policy to restrict funds made available to a
    select few. We urge the Congress to direct the Department of Education
    to reconsider its exclusionary practice and allow the BIA-funded
    schools to apply directly to the Department for the Library Literacy
    grant funding.

                   SAFE AND DRUG FREE SCHOOLS AND COMMUNITIES

        The Alamo-Navajo School Board strongly opposes the Administration's
    proposal to eliminate funding for the Safe and Drug Free Schools State
    Grants program ($437.4 million in fiscal year 2005). Under the 1
    percent set-aside for BIA-funded schools, we received $29,000 that
    partially funded a school-home liaison who works directly with parents
    and community on matters identified by the school that would aid in
    ensuring a healthy learning environment.
        As you are no doubt aware, alcohol and drug-related illnesses and
    crime levels in Native American communities greatly exceed the
    mainstream populations. By tapping all available sources of funds, we
    seek to provide our students the drug prevention and school safety
    programs that will help them develop the life skills that may enable
    them to live better, healthier lives. We urge Congress to reject the
    Administration's proposal to eliminate this valuable program and
    instead provide at least a modest increase.

                                   HEAD START

        The American Indian Head Start and Early Head Start programs
    receive a less than 3 percent share of the 13 percent set-aside for
    Indian, migrant, territorial, children with disabilities programs. In
    fiscal year 2004, that translated to $161.6 million for Indian Head
    Start (ages 3-5 years) and $27.5 million for Indian Early Head Start
    (ages 0-3 years), which served a combined total of nearly 24,000
    children. Under the Administration's proposal, our programs would
    receive none of the requested $45 million increase since all of it is
    targeted for pilot projects whereby states would consolidate Head Start
    and other state children's programs.
        Although level funding in these constrained budgetary times may be
    viewed as a success, programs such as ours which are located in very
    rural areas are faced with rising costs that are greater than those
    located in more metropolitan areas, i.e., fuel costs for
    transportation, food, staff training. Level funding also does not
    address the increasing costs related to higher salaries for staff who
    achieve the high quality staff requirements of the program nor the
    unfunded mandate to install small child restraints in program vehicles
    (which cost $6,000 but was not in our budget nor were we provided
    reimbursement from the national Head Start office).
        Further, with the myriad and increasingly stringent requirements,
    small programs such as ours are losing the flexibility to structure our
    services to best meet the needs of our children. We need to be able to
    structure our Early Head Start and Head Start programs to the changing
    dynamics of our community yet current Head Start policies restrict us
    from being able to allocate our program funds to provide the services
    in accordance with the demographic changes. For instance, this year our
    Early Head Start has a waiting list which could result in an additional
    classroom of students while our enrollment for the Head Start program
    is less than anticipated. The logical reaction would be to respond to
    the need and utilize program funds to establish the necessary
    additional Early Head Start class but we were informed by the Head
    Start Grant office that even though we receive our Early Head Start/
    Head Start funds in one grant document, we must expend the monies under
    two separate budgets. Therefore, a number of Early Head Start eligible
    children in our community are not being served since there are no other
    early education programs available in our isolated area.
        We ask that when Congress takes up the reauthorization of the Head
    Start Act, that (1) the Indian Head Start set-aside be increased from
    the present 2.8 percent to no less than 4 percent; and (2) provide
    program flexibility so that Indian Early Head Start/Head Start grant
    recipients may allocate funds between their Early and regular Head
    Start programs in the manner that best meet the needs of the population
    served.

                            WORKFORCE INVESTMENT ACT

        The Alamo Navajo School Board receives funding under the Workforce
    Investment Act's Section 116 Program and the Supplemental Youth
    Services program. The Administration has proposed level funding ($54.2
    million) for the Section 116 program which provides grants to Indian
    Tribes, Urban Indians, Hawaiians and Samoans. This program has been
    flat funded or years and we support the National Congress of American
    Indians request of $75 million for the Section 116 program.
        We oppose the Administration's proposal that the Supplemental Youth
    Services Program (of which the tribes receive $1.5 percent allocation,
    or about $15 million annually) be combined with three other streams of
    money and put into a block grant, with no obvious guarantee that the
    tribal money would be preserved. We are pleased that the House bill
    reauthorizing the WIA (H.R. 27) did not go along with this
    consolidation proposal and urge that the Appropriations Committee
    likewise reject this proposal and to provide an increase for
    Supplemental Youth Services which has been flat funded for years.

                      CORPORATION FOR PUBLIC BROADCASTING

        The Alamo Navajo School Board is the licensee for a community radio
    station--KABR-AM in Magdalena, NM--which receives a modest amount of
    funding from CPB. We commend CPB for increasing funding for rural sole
    source radio stations--of which we are one. We also appreciate that CPB
    has provided start-up funds for a Center for Native American Radio
    which is to provide technical and other service to Indian radio
    stations. Our radio signal reaches approximately 13,000 people,
    including the Alamo population of 2,072. Of the 432 Alamo households,
    only 25 percent have telephones, and there is no cell phone service. So
    you can see what an important role our community radio station plays at
    Alamo Navajo.
        There are currently 33 Indian-owned radio stations--all
    noncommercial--in thirteen states. Most are licensed to nonprofit
    organizations. We ask for this Committee's continued support of Native
    radio.
        We are extremely concerned about the Administration's proposal to
    rescind $10 million and divert an additional $82 million of already
    appropriated fiscal year 2006 CPB funds to digital conversion and
    satellite interconnection. Such a rescission/diversion of funds would
    be a terrible setback for our station, which already runs on a shoe
    string. Should Congress approve the Administration's request and if it
    were applied across-the-board, we would be faced with a 25 percent
    reduction of CPB funds.
        We ask Congress to again reject--as you have done the past four
    years--the Administration's proposal that the advance funding for CPB
    be eliminated.
        Thank you for your consideration of concerns and recommendations of
    the Alamo Navajo School Board.
                                     ______

     Prepared Statement of the American Association of Colleges of Nursing

        The American Association of Colleges of Nursing (AACN) respectfully
    submits this statement highlighting funding priorities for nursing
    education and research programs in fiscal year 2006. AACN represents
    over 580 senior colleges and universities with baccalaureate and
    graduate nursing programs, and over 190,000 students and 10,000 faculty
    members. These institutions are responsible for educating about half of
    our nation's registered nurses (RNs) and all of the nurse faculty and
    researchers. Nursing represents the largest health profession in the
    nation, with approximately 2.7 million dedicated, trusted professionals
    delivering primary, acute, and chronic care to millions of Americans
    daily across the spectrum of settings.

                        THE NATIONWIDE NURSING SHORTAGE

        Our country continues to be plagued by a shortage of nurses that is
    only expected to intensify in the future. While AACN is cognizant of
    the difficult budget environment in which the Subcommittee and the
    entire Congress must operate, patient safety is compromised without a
    sufficient number of RNs. Indeed, the American College of Healthcare
    Executives reported in 2004 that 72 percent of hospitals were
    experiencing a nursing shortage. Furthermore, the Joint Commission on
    Accreditation of Healthcare Organizations (JCAHO) found in 2002 that
    the nursing shortage contributes to nearly a quarter of all unexpected
    incidents that kill or injure hospitalized patients. Since nurses
    comprise the largest component of hospital staffs, shortages also
    result in emergency room overcrowding and diversions, increased wait
    time for or outright cancellation of surgeries, discontinued patient
    care programs or reduced service hours, and delayed discharges.
        The U.S. Bureau of Labor Statistics (BLS) has projected that by
    2012, our nation will need an additional 1.1 million new and
    replacement registered nurses. Despite nursing being identified by BLS
    as the fastest growing occupation, according to the Health Resources
    and Services Administration (HRSA), the United States still will be
    roughly 800,000 nurses short in 2020, unless there is a significant and
    sustained increase in the number of nurses graduating each year and
    entering the workforce. There are nursing vacancies throughout all
    sectors of health care, including long-term care, home care, and public
    health. These alarming predictions are coupled with little change in
    the multitude of contributing factors such as the aging of America's
    population, the aging nurse workforce, high numbers of RN retirements,
    and the increasing demand for more intensive health care services by
    chronically ill, medically complex patients. It is clear that federal
    support must continue to play a critical role in the nation's effort to
    address the nursing shortage.

                         NURSING WORKFORCE DEVELOPMENT

        Acknowledging the situation, Congress passed The Nurse Reinvestment
    Act of 2002. This legislation reauthorized and expanded Nursing
    Workforce Development programs, administered by HRSA under Title VIII
    of the Public Health Service Act, to address the inadequate supply and
    distribution of RNs across the country. These authorities fund nursing
    education and retention programs as well as support individual students
    in their nursing studies. The seven Title VIII grant and student
    programs stimulate innovation in nursing practice and bolster nursing
    education throughout the continuum, from entry-level preparation
    through graduate study. Thoughtful and well-written authorities, Title
    VIII programs are the largest source of federal funding for nursing
    education. In fiscal year 2004, these programs provided loan and
    scholarship support to over 28,000 student nurses.
        Given the demonstrated need for these outstanding programs, past
    funding levels have been insufficient, receiving only $150.67 million
    in fiscal year 2005. AACN respectfully requests $175 million for Title
    VIII Nursing Workforce Development in fiscal year 2006, an additional
    $24.33 million over fiscal year 2005. New monies would support these
    crucial Title VIII programs designed to help resolve the nursing
    shortage through education, recruitment, and retention efforts for the
    nursing workforce. During the last serious nursing shortage in 1974,
    Congress appropriated $153 million for nursing education programs.
    Translated into today's dollars, that appropriation would total $592
    million, almost 4 times the current level.

                          COLLEGES OF NURSING RESPOND

        The approximately 1,500 schools of nursing nationwide have been
    working diligently to expand enrollments. In fact, AACN found in a
    recent study that enrollments increased in 2004 by 15.5 percent for
    entry-level baccalaureate, master's, and doctoral nursing programs,
    over the 9.1 percent increase experienced in 2003. These increases are
    attributed to intensive marketing efforts by the private sector,
    public-private partnerships providing additional resources to expand
    capacity of nursing programs, and state legislation targeting funds
    towards nursing scholarships and loan repayment.
        While impressive, these increases still cannot meet the demand. In
    the November 2003 issue of Health Affairs, Dr. Peter Buerhaus reported
    that nursing school enrollments would have to increase by at least 40
    percent annually just to replace those nurses who retire, due to
    declining numbers of young RNs over the past 20 years. It is important
    to note that in spite of protracted efforts by colleges nationwide,
    AACN found that enrollments have increased only by a total of 53.5
    percent over the last 5 years in entry-level baccalaureate programs.
        In spite of increasing enrollments and the demonstrated need for
    RNs, U.S. colleges of nursing must still turn away eligible students.
    In 2004, AACN found that at least 32,797 qualified applicants were
    turned away, up sharply from over 18,000 in 2003. These students were
    turned away due to insufficient numbers of faculty, clinical sites,
    classroom space, clinical preceptors, and budget constraints. Over 75
    percent of the schools surveyed cited the faculty shortage as the
    primary barrier to increasing enrollments. Some of these qualified
    students are being placed on waiting lists that may be as long as 2
    years.

                  BOTTLENECK: THE COEXISTING FACULTY SHORTAGE

        AACN strongly believes that the most effective strategy for the
    resolution of the nursing shortage is addressing the underlying faculty
    shortage. HRSA reported in 2000 that just 9.6 percent of the RN
    workforce holds master's degrees, while only 0.6 percent holds
    doctorates. AACN found that more than half, 53.4 percent, of the nurse
    faculty vacancies in 2004 were for faculty positions requiring the
    doctoral degree. In 2003 AACN reported there were 10,500 full-time
    master's and doctorally prepared faculty teaching in baccalaureate and
    graduate nursing programs. Projections through 2012 show that the
    faculty pool will shrink by at least 2,000 as compared to 2003, even
    after accounting for retirements, resignations, and additional
    entrants. Note that these figures do not take into account the need for
    faculty in new or expanded programs, but represent only present
    staffing requirements. If the faculty vacancy rate holds steady, it is
    expected the deficit of nurse faculty will swell to over 2,600 unfilled
    positions in 2012.
        The situation is only expected to worsen with time. Faculty age
    continues to climb, narrowing the number of productive years nurse
    educators can teach. Significant numbers of faculty are expected to
    retire in the coming years, as the average age is 52. Likewise, there
    are not enough candidates in the pipeline to take their places. For
    example, an average of 410 individuals are awarded doctoral degrees in
    nursing each year, but almost a quarter, 23 percent, take jobs outside
    of academic nursing. Higher compensation in clinical and private sector
    settings lures current and potential nurse educators away from the
    classroom. The average salary of a nurse practitioner in an emergency
    department was $80,697, according to the 2003 National Salary Survey of
    Nurse Practitioners. In contrast, AACN found that the average salary
    for a nurse faculty member was $60,357 in 2003. Without sufficient
    nurse faculty, schools of nursing will not be able to expand their
    capacities to educate new generations of the nurses.

              REVERSING THE TREND: THE NURSE FACULTY LOAN PROGRAM

        This trend can be reversed--with your help. Additional
    appropriations for the Nurse Faculty Loan Program, Section 846A of
    Title VIII, will provide targeted assistance. Designed to help increase
    the number of nurse faculty, grants are provided to colleges of nursing
    in order to create a loan fund. To be eligible for these loans,
    students must be pursuing either a master's or doctoral degree on a
    full-time basis. Loan recipients will have up to 85 percent of their
    educational loans cancelled over a four-year period, if they agree to
    teach at a school of nursing. The loan is cancelled at a rate of 20
    percent for the first three years, increasing to 25 percent in the
    final year. A student may receive a maximum loan award of $30,000 per
    academic year for tuition, books, fees, laboratory expenses, and other
    reasonable educational costs. In fiscal year 2004, 61 grants were made
    to schools of nursing, which in turn supported a projected 419 future
    nurse faculty members. In fiscal year 2005, $4.83 million was
    appropriated.
        For example, if the current funding was doubled to almost $10
    million, based on this year's projections, colleges of nursing could
    educate over 800 future faculty. Though the student to faculty ratios
    vary by state, a common average is one faculty member for every ten
    students. Then one could surmise from that estimate that the doubled
    funding could help to educate over 800,000 future nurses.

                            OTHER SOURCES OF RELIEF

        AACN would like to highlight the following programs in addition to
    the Nurse Faculty Loan Program: the Advanced Education Nursing program,
    the Workforce Diversity program, and the Nurse Education, Practice, and
    Retention program.
        The Advanced Education Nursing program supports the majority of
    colleges of nursing that prepare graduate-level nurses to be primary
    care providers, some of whom become faculty. Receiving $58.17 million
    in fiscal year 2005, this grant program helps schools of nursing,
    academic health centers, and other nonprofit entities improve the
    education and practice of nurse practitioners, nurse-midwives, nurse
    anesthetists, nurse educators, nurse administrators, public health
    nurses, and clinical nurse specialists. Out of the 149 applications
    received for this program in fiscal year 2004, 82 new grants were
    awarded to institutions and 75 previous awarded grants were continued.
    In addition, 408 schools of nursing received traineeship grants, which
    in turn directly supported 8,925 individual student nurses.
        The health system's increasing demand for primary care, increased
    utilization of case management--particularly for chronic illnesses,
    prevention and cost-efficiency, and a shortage of physicians are
    driving the nation's need for nurse practitioners, certified nurse-
    midwives, and other RNs with graduate education and advanced clinical
    skills, known as advanced practice nurses (APNs). Mounting studies
    demonstrate the quality of APN care is at least equal to, and at times
    better than comparable physician services rendered by physicians, and
    often at lower cost. This is especially important, as the 78 million
    Baby Boomers age, their demand for health care services will skyrocket.
    AARP reported that the rate of physician office visits by those 65 and
    older jumped 22 percent from 1985 to 1999.
        Workforce Diversity grants prepare disadvantaged students to become
    nurses. As the United States becomes ever more heterogeneous, it is
    imperative that the composition of our nursing workforce mirrors this
    shift. According to the U.S. Census Bureau, roughly 30 percent of the
    population was reported as a racial or ethnic minority in 2000, but by
    2050 that percentage will jump to over 52 percent. This program awards
    grants to schools of nursing and other entities seeking to increase
    access to nursing education for disadvantaged students, including
    racial and ethnic minorities under-represented among RNs. The program
    provides scholarships or stipends, pre-entry preparation, and retention
    activities to enable students to complete their nursing education. In
    fiscal year 2004, 144 applications were submitted, from those 27 new
    grants were awarded and 35 previously awarded grants were continued.
    Under the scholarship program alone, 473 students each received $7,000
    scholarships. Workforce Diversity received $16.27 million in fiscal
    year 2005.
        The Nurse Education, Practice and Retention program helps schools
    of nursing, academic health centers, nurse-managed health centers,
    state and local governments, and health care facilities strengthen
    programs that provide nursing education, facilitate innovations in
    nursing practice, and retention of the nursing workforce. Education
    grants are made to enable schools to expand enrollments in
    baccalaureate nursing programs, develop internship and residency
    programs, and provide for new technology. Practice grants are made to
    expand arrangements in non-institutional settings to improve primary
    health care in medically underserved communities, provide care for
    underserved populations, enhance practitioner skills, and develop
    cultural competencies. Retention grants are made to the Career Ladder
    program, which supports efforts to assist people to obtain the
    necessary education to either enter the profession or to advance within
    it; enhance patient care delivery systems through incorporation of best
    practices, and improved communication. In fiscal year 2004, 336
    applications were submitted, from those, 40 new grants and 85
    continuation grants were awarded. Nurse Education, Practice, and
    Retention received a total of $36.48 million in fiscal year 2005.

                     NATIONAL INSTITUTE OF NURSING RESEARCH

        One of the 27 Institutes and Centers at the National Institutes of
    Health (NIH), the efforts of the National Institute of Nursing Research
    (NINR) improve patient care and foster advances in nursing and other
    health professions' practice. These practices must be must constantly
    updated and validated based on rigorous, peer-reviewed research. The
    outcomes-based findings derived from NINR research are important to the
    future of the health care system and its ability to deliver safe, cost-
    effective, and high quality care. Through grants, research training,
    and interdisciplinary collaborations, NINR addresses care management of
    patients during illness and recovery, reduction of risks for disease
    and disability, promotion of healthy lifestyles, enhancement of quality
    of life in those with chronic illness, and care for individuals at the
    end of life. To advance this research, AACN requests a funding level of
    $160 million in fiscal year 2006, an additional $21.91 million over the
    $138.09 million NINR received in fiscal year 2005.
    NINR Addresses the Need for Translational and Clinical Research
        NINR emphasizes translational research, the means by which basic
    findings relating to behavior, molecules, and genes are tested in the
    clinical setting and translated into innovative medical practices and
    improvements in public health. This effort is incorporated into the NIH
    Roadmap for Medical Research. Under the framework of the Roadmap
    Initiative, NINR and nurse researchers are addressing the development
    of new interdisciplinary research teams and enhanced clinical research
    to move the overall NIH portfolio of social, behavioral, and medical
    research forward in this coordinated and cohesive effort.
    NINR Addresses the Shortage of Nurse Researchers and Faculty
        NINR allocates 8 percent of its budget, a high proportion when
    compared to other NIH institutes, to research training to help develop
    the pool of nurse researchers. In fiscal year 2004, NINR training
    dollars supported 88 individual researchers and provided 186
    institutional awards, which in turn supported a number of nurse
    researchers at each site. Since nurse researchers often serve as
    faculty members for colleges of nursing, they are actively educating
    our next generation of RNs.

                   AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

        While NIH supports biomedical research that improves health care by
    focusing on disease cause, cure, and prevention; the Agency for
    Healthcare Research and Quality (AHRQ) supports research from a systems
    perspective, collecting evidence-based information on health care
    outcomes. AHRQ research findings are used by patients, clinicians,
    health system decision makers, and public policymakers to guide
    healthcare delivery systems and patient care. The research supported by
    AHRQ not only improves the quality of health care services, but also
    helps people make more informed decisions about their healthcare. AACN
    joins the Friends of AHRQ in recommending a funding level of $440
    million for fiscal year 2006, an additional $121 million over the
    fiscal year 2005 level of $318.7 million.
    Health Systems Research at AHRQ Addresses Nurses' Role in Patient
            Safety
        AHRQ research has demonstrated that inefficient work processes,
    overwhelming work loads, extended work hours, and poor workplace
    designs create obstacles to providing patients safe, cost-effective,
    and high quality health care. The New England Journal of Medicine
    published a study of over 6 million patients in May, 2002 that found
    hospitalized patients had better outcomes when the majority of their
    nursing care was provided by RNs. Decreased hours of RN care, stemming
    from the nursing shortage, correlated with longer hospital stays,
    increased incidence of urinary tract infections and gastrointestinal
    bleeding, as well higher rates of pneumonia, shock, and cardiac arrest.
    When patients received additional hours of RN care, the death rates
    dropped for pneumonia, shock or cardiac arrest, upper gastrointestinal
    bleeding, sepsis, and deep venous thrombosis.
    AHRQ Research Demonstrates that Nurse Education Affects Patient
            Outcomes
        Another AHRQ study found that by employing a greater proportion of
    more highly educated nurses reduced the mortality and failure to rescue
    rates from life threatening complications. This extensive study in the
    September 2003 issue of the Journal of the American Medical Association
    found that surgical patients have a ``substantial survival advantage''
    if treated in hospitals with higher proportions of nurses educated at
    the baccalaureate or higher degree level. In hospitals, a 10 percent
    increase in the proportion of nurses holding BSN degrees decreased the
    risk of patient death and failure to rescue by 5 percent.

                                   CONCLUSION

        Nurses can no longer simply give care to a patient at the bedside.
    They must evaluate research that promotes evidence-based practice and
    utilize technical innovations to provide quality patient care. To
    achieve this level of excellence, AACN recognizes that our nation
    desperately needs a dedicated, long-term vision for educating the new
    nursing workforce. Strategies must encompass state support, public-
    private sector initiatives, and increased federal funding for nursing
    education and research. Title VIII Nursing Workforce Development
    programs enable colleges of nursing to innovate and prepare students
    for the realities of caring for our nation's diverse population in many
    health care settings across the lifespan. NINR, NIH, and AHRQ provide
    the research that supports the evidence base for safe practice and
    quality care delivery. We ask the Subcommittee to graciously consider
    our appropriations requests for fiscal year 2006.
                                     ______

              Prepared Statement of the American Chemical Society

        Chairman Specter and other members of the Labor, Health and Human
    Services and Education Subcommittee, I appreciate the opportunity to
    submit written testimony on behalf of the American Chemical Society.
    The American Chemical Society (ACS) is the world's largest scientific
    society with over 159,000 members. We represent individual chemists and
    engineers in academia, industry, and government.
        Mr. Chairman, the ACS recognizes that ensuring the continued
    economic supremacy and homeland security of this nation depends upon
    maintaining our global technological leadership. This leadership has
    resulted from the ready availability of a domestic workforce of highly
    trained scientists, technicians, engineers, and mathematicians (the
    STEM workforce). But today's high school students are not performing
    well in math and science overall, and a decreasing number of American
    students are pursuing college degrees in STEM fields. At the elementary
    school level, the recent PISA test showed that America's 15 year-olds
    perform below average in mathematics problem solving compared to their
    peers in other developed countries.
        Thanks to your leadership, the Department of Education budget has
    increasingly reflected a commitment to remedy this situation through
    investments in a number of STEM initiatives from the K-12 to
    postsecondary level. These programs must continue to receive strong
    support in order to ensure a globally competitive U.S. workforce.
        Central to this quest is ensuring the supply of qualified K-12
    science and mathematics teachers. As you know, the Math and Science
    Partnerships, authorized in the No Child Left Behind Act at an
    increasing annual level to reach $450 million by fiscal year 2007, are
    the sole source of dedicated DoEd K-12 math and science funding. This
    program supports valuable long-term, content-based continuing education
    for math and science teachers--the type of training that research shows
    is most effective in improving student achievement.
        Chairman Specter, we greatly appreciate your past support of the
    Partnership program which has grown from $12.5 million in fiscal year
    2002 to $180 million in fiscal year 2005. We applaud you for this and
    urge you to work toward the authorized level by funding the program at
    the level of $400 million in fiscal year 2006. Reaching the authorized
    level is critical, as the No Child Left Behind Act requires science
    testing to begin in the 2007-2008 school year.
        ACS also urges you to reject the Administration's proposal to
    earmark its requested $120 million increase in the program for a new
    high school mathematics initiative. This proposal strays from the
    intent of the No Child Left Behind Act, which seeks to address the
    equally critical needs in both math and science. A similar proposal was
    made by the Administration in the fiscal year 2005 budget and, in our
    view, wisely rejected by your Committee.
        The ACS recognizes the value of encouraging chemists retiring early
    or those desiring a change from industry work to consider and train for
    a second career in high school teaching. To that end, we support the
    president's Adjunct Teacher Corps initiative, which brings experienced
    professionals with subject-matter knowledge into the classroom to teach
    part or full-time in areas of high need, including science and math.
    These professionals can offer valuable insights into the content and
    practical applications of their subject areas. We recommend that
    funding be provided to ensure adequate teacher development and to
    ensure effective communication of their expertise to their students.
        On another front, the ACS opposes the Administration's proposal to
    eliminate the Vocational and Technical Education program. We feel it
    would have a very negative impact upon our technological leadership. In
    addition to scientists and engineers, the STEM workforce relies on
    highly trained technicians, of whom many enter the workforce through
    tech-prep programs that are currently supported under the Vocational
    and Technical Education program ($110.7 million in fiscal year 2005).
    It is unrealistic to expect states to assume the burden of funding
    tech-prep programs through the new High School Intervention program,
    due to its emphasis on meeting academic state standards.
        At the post-secondary level, the Department of Education provides
    incentives to students to pursue science and engineering occupations.
    The Graduate Assistance in Areas of National Need program (GAANN) is
    one such example. GAANN provides graduate and doctoral students with
    enhanced fellowship opportunities. We believe this program should
    support at least 1,200 fellowships, up from the 850 in fiscal year 2004
    and the 721 fellowships that would be supported under the current
    budget request. This increased support is vital at a time when our
    nation must have the intellectual resources to respond to homeland
    security threats and maintain our economic growth.
        Furthermore, we strongly support programs such as the Minority
    Science and Engineering Improvement program in order to increase the
    participation of underrepresented minorities in scientific and
    technological careers.
        In closing, we appreciate your past support and leadership on
    behalf of the Department of Education's programs. We strongly believe
    that proactively investing in STEM education today, will pay real
    dividends with a more competitive, innovative and successful American
    workforce tomorrow.
                                     ______

           Prepared Statement of the American College of Rheumatology

        The American College of Rheumatology (ACR) is pleased to provide
    this statement for the record in support of the several important
    agencies and programs that address arthritis within the Department of
    Health and Human Services.
        The ACR is an organization of physicians, health professionals and
    scientists that serves its members through programs of education,
    research and advocacy that foster excellence in the care of people with
    arthritis, rheumatic and musculoskeletal diseases.
        Arthritis means swelling, pain and loss of motion in the joints of
    the body. There are more than 100 rheumatic diseases that cause this
    condition, which can sometimes be fatal, in both children and adults of
    all ages. One in three adults, or 70 million people in the United
    States, are affected by arthritis and other rheumatic conditions
    according to the Centers for Disease Control and Prevention (CDC).
    Arthritis and other chronic joint problems are the leading cause of
    disability among adults in the United States, costing more than $86
    billion a year in medical costs and lost productivity. These numbers
    and related costs are expected to increase as the U.S. population ages.
        This burden will surely increase, possibly uncontrollably, as the
    baby boomer group continues to age. Although some forms of arthritis
    are predominant in older individuals, arthritis also affects children
    and adults of all ages. The number of individuals affected, as well as
    associated costs, will increase as the size of our elderly population
    continues its upswing.
        Current research is providing breakthrough advances that have the
    potential to revolutionize our understanding of arthritis and rheumatic
    diseases, leading to more effective treatments, decreased costs and
    increased quality of life for patients suffering from these conditions.
    The federal government is doing critical medical research into the
    causes, treatment and prevention of arthritis and rheumatic diseases.
    The ACR urges the subcommittee to increase its investment in research
    and arthritis programs to further progress made in preventing,
    diagnosing and treating these prevalent diseases.

                       THE NATIONAL INSTITUTES OF HEALTH

        The ACR supports a 2006 appropriation of $30 billion for the
    National Institutes of Health (NIH) in order for it to carry out its
    goal to acquire new knowledge to help prevent, detect, diagnose, and
    treat disease and disability. The NIH disperses funding to the
    different institutes within it, including the National Institute of
    Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the
    National Institute of Allergy and Infectious Diseases (NIAID).
    Therefore, overall funding for NIH is extremely important to the
    federal medical research effort in arthritis and rheumatic diseases.

       THE NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN
                                    DISEASES

        The ACR strongly supports a 2006 appropriation of $541.6 million
    for the National Institute of Arthritis and Musculoskeletal and Skin
    Diseases (NIAMS), which leads the federal medical research effort in
    arthritis and rheumatic diseases. The NIAMS conducts research related
    to the causes, treatments and prevention of diseases of the bone,
    joints, muscle, skin and other connective tissues. The NIAMS sponsors
    research and research training at universities and medical centers
    throughout the United States. Research sponsored by the NIAMS leads to
    the development of more effective treatments, which leads to decreased
    costs and improved quality of life for patients suffering from
    rheumatic diseases.

           THE NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

        The ACR recommends a 2006 appropriation of $4.667 billion for the
    National Institute of Allergy and Infectious Diseases (NIAID), which
    conducts research that strives to understand, treat, and ultimately
    prevent the myriad of infectious, immunologic, and allergic diseases.
    The NIAID's research focuses on the basic biology of the immune system
    and mechanisms of immunologic diseases including autoimmune disorders.
    To accomplish its goals, the NIAID carries out a wide range of basic,
    applied, and clinical investigations within its own laboratories, and
    provides research grant, contract, and cooperative agreement support to
    scientists at universities and other research institutions throughout
    the country and the world.

                 THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

        The ACR supports a 2006 appropriation of $440 million for the
    Agency for Healthcare Research and Quality (AHRQ) to carry out its
    mission to improve the quality, safety, efficiency, and effectiveness
    of health care for all Americans. AHRQ's health services research
    complements the biomedical research of the NIH by helping physicians,
    hospitals, purchasers and other stakeholders in health care delivery
    make informed decisions about what treatments work best, for whom,
    when, and at what costs.

                       THE NATIONAL ARTHRITIS ACTION PLAN

        The ACR recommends a 2005 appropriation of $15 million for the
    National Arthritis Action Plan (NAAP). The NAAP, housed within the CDC
    National Center for Chronic Disease Prevention and Health Promotion,
    helps deliver the advances made in the biomedical research system to
    millions of Americans who have arthritis. The NAAP is designed to
    increase recognition among the general public, people with arthritis
    and their families, medical care providers, and policy makers, of the
    impact of arthritis, what can be done to prevent or delay its onset,
    and what effective interventions and are available to reduce disability
    and improve the quality of life. The NAAP has made a tremendous impact
    in how state public health departments address this national health
    problem, and with increased funding, programs could be established in
    more states and existing programs could be expanded.

              IMPACT OF CONTINUING RESOLUTIONS ON MEDICAL RESEARCH

        The ACR urges Congress to recognize the difficulties imposed on
    researchers by interruptions in the medical research funding cycle
    caused by delays in the federal appropriations process. Use of the
    continuing resolution mechanism to fund government operations in the
    absence of the normal appropriations process often causes federally
    funded researchers to halt their research until the appropriations
    process is resolved. These disruptions have the potential to not only
    significantly compromise the validity of the basic medical research
    being conducted, but can result in the unnecessary expenditure of
    federal funds to reactivate specific research studies. In order to
    preserve the integrity of federally supported medical research, the ACR
    urges Congress to minimize the use of continuing resolutions.

                                    SUMMARY

        The ACR appreciates the subcommittee's support for these important
    programs in recent years. As physicians involved in both research and
    specialized patient care, ACR members are acutely aware of the
    magnitude of the challenges that disease and disability place on the
    health care delivery system. The ACR encourages the subcommittee to
    provide a strong investment in the programs listed above for 2006 so
    that necessary research and programs to combat arthritis and related
    diseases can continue. These programs are critical to the development
    of more effective treatments, decreasing costs and improving the
    quality of life for patients suffering from rheumatic diseases.
                                     ______

        Prepared Statement of the American Dental Education Association

        The American Dental Education Association (ADEA) is grateful for
    the opportunity to provide testimony with regard to fiscal year 2006
    appropriations for Federal programs that help to educate the future
    dental workforce, encourage the prevention of dental disease and
    provide access to oral health care for underserved populations. These
    programs are critical to academic dental institutions in fulfilling
    their primary mission to educate, conduct research and provide patient
    care. ADEA strongly urges Congress to enhance funding for the programs
    and preserve their fundamental structure.
        ADEA is the premier national organization that speaks for dental
    education. It is dedicated to serving the needs of all 56 U.S. dental
    schools, nearly 730 dental residency programs and 550 allied dental
    programs, as well as the tens of thousands of faculty, dental residents
    and students engaged in training. It is at dental education
    institutions that future practitioners and researchers gain their
    knowledge; the majority of dental research is conducted; and
    significant dental care is provided to underserved low-income
    populations, including individuals covered by Medicaid and the State
    Children's Health Insurance Program (SCHIP).
        Academic dentistry endeavors to address the oral health needs of
    the nation's uninsured, underinsured and publicly insured citizens.
    Profound disparities in the oral health of the nation's population have
    resulted in what the Surgeon General \1\ called a ``silent epidemic''
    of dental and oral diseases affecting the most vulnerable among us.
    These disparities, combined with the current shortage of dental school
    faculty, the scarcity of underrepresented minority dentists, and the
    need for targeted incentives to draw dentists to practice in rural and
    underserved communities, make our funding recommendations critically
    important.
    ---------------------------------------------------------------------------
        \1\ Oral Health in America: A Report of the Surgeon General, 2000.
    ---------------------------------------------------------------------------
        The Administration's fiscal year 2006 budget proposal reduces by
    approximately 96 percent funding for Title VII Health Professions
    Programs and eliminates 100 percent of the funding for pediatric,
    general and public health dental residency programs. Title VII programs
    embody the federal government's commitment to educating the nation's
    future health care providers. Such programs focus on wide-ranging and
    important matters including interdisciplinary training, geriatric and
    rural health care, allied health education, advanced training for
    dental, allopathic and osteopathic residents. Eliminating funding for
    the programs will gravely weaken the health infrastructure of the
    nation.
        Zeroing out funding for the dental residency training programs
    means that essential advanced education for dental residents and the
    oral health services they provide to underserved communities will be
    eliminated. Abandoning these programs will intensify and contribute to
    the growing crisis in accessing oral health services as more states
    reduce Medicaid dental benefits for adults, the frail elderly and
    compromised patients. Furthermore, restrictions in Medicaid and SCHIP
    enrollment and eligibility have reduced access to oral health care for
    children.
        As Congress wrestles with the fiscal year 2006 appropriations for
    federal agencies and programs of importance to dental education and
    research, ADEA respectfully urges that the following programs' funding
    be restored and enhanced at the levels recommended:

      $15 million for title vii general dentistry and pediatric dentistry
                          residency training programs
        ADEA recommends that Congress restore and enhance funding for
    dental residency training programs. These programs are instrumental in
    educating dentists who work in underserved communities and treat
    Medicaid, SCHIP or other underserved populations, particularly those
    with special needs. Furthermore, dentists training in Title VII funded
    programs staff clinics that provide treatment at low or no cost.

    $19 million for the ryan white hiv/aids dental reimbursement program of
                        the ryan white care act (part f)
        The Dental Reimbursement and the Community-based Dental
    Partnerships programs, the smallest component of the CARE Act, are
    successful in increasing access and educating and training dental
    students, dental residents and allied dental students in the provision
    of care for patients afflicted with the disease. The Dental
    Reimbursement Program (DRP) accomplishes significant benefits for both
    patient care and education of future oral health practitioners.
        Academic dental institutions (ADI) are safety net providers of oral
    and dental care for low-income, uninsured or underinsured
    immunocompromised patients who are prone to oral infections. A recent
    study \2\ found that providing HIV/AIDS patients with regular
    diagnostic and preventive care reduced the need for more complex and
    costly services. Thus, two federal objectives--service to patients of
    limited means and education of future providers--are accomplished with
    this modest but important program.
    ---------------------------------------------------------------------------
        \2\ Journal of the American Dental Association (133 JADA 1343).
    ---------------------------------------------------------------------------
      $420 million for the national institute for dental and craniofacial
                                research (nidcr)
        NIDCR is the only Institute within the National Institutes of
    Health (NIH) whose mission is to improve oral, dental and craniofacial
    health through research, research training, and the dissemination of
    health information. Oral disease affects nearly every American. It is
    essential that Congress increase support for NIDCR's diverse and
    critical research initiatives. Of paramount importance is funding for
    clinical research and dental school research infrastructure. Among the
    ongoing research projects being conducted by dental researchers is work
    on saliva as a reliable diagnostic fluid to detect systemic diseases in
    a non-invasive way, including the detection of cancer-associated
    molecules associated with oral squamous cell carcinoma as well as
    research on how to engineer teeth in the laboratory and transplant them
    into the mouth to replace a missing or damaged tooth. In any future NIH
    reorganization NIDCR should remain independent.

              THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)

    $18 million for the CDC Oral Health Program
        The CDC Oral Health Program supports state and community-based
    programs that work to prevent oral disease and reduce disparities in
    oral health. The program works with states to establish surveillance
    systems that provide valuable health information to assess the
    effectiveness of programs and target them to populations at greatest
    risk. Grants have been used to support basic state oral health
    services, including support for program leadership, monitoring oral
    health risk factors, and developing and evaluating prevention programs
    such as community fluoridation and school-based sealant programs.
    Federal funding is essential to maintain these programs.
    $130 million for the CDC Prevention Block Grant
        $3.5 million of this amount is for oral health projects. The
    President's budget eliminates the program completely. The funding is 50
    percent of the CDC money that flows back to states for oral health
    programs. It is used by states to purchase and replace fluoridation
    equipment and to maintain a state dental presence.
     $10 million for the dental health improvement act enacted as part of
       the health care safety net amendments of 2002 (public law 107-251)
        The Dental Health Improvement Act will help, when funded, to
    eliminate the disparities in oral health status and assure access to
    oral health services for low-income children. The law authorized $50
    million over 5 years for innovative state oral health care grants.
    Congress has not yet provided funding for this important federal-state
    partnership. The American Dental Association (ADA) and the American
    Academy of Pediatric Dentists (AAPD) join ADEA in requesting $10
    million for this program in fiscal year 2006.
        Grants can be used for a variety of state initiatives including
    loan forgiveness programs for dentists serving in dental health
    professions shortage areas (HPSAs); grants or low-interest loans for
    dentists participating in Medicaid; dental faculty recruitment
    programs; and establishment or augmentation of a state dental officer
    position to coordinate oral health and access issues in the state. The
    program, when funded, will be a shining example of a true federal-state
    partnership, as states must agree to match at least 40 percent of any
    federal contributions under this grant.
    $135 million for the minority and disadvantaged assistance programs in
             the health professions education and training programs
        The infrastructure that has been established by previous federal
    investment requires sustained and increased support to meet the
    challenges of diversifying the health care workforce, addressing
    student indebtedness, eliminating faculty shortages, and eradicating
    oral health care disparities in underserved communities.
        The President's fiscal year 2006 budget eliminates funding for the
    Centers of Excellence (COE) program, the Health Careers Opportunity
    Program (HCOP), and the Faculty Loan Repayment Program (FLRP) and
    reduces by nearly 80 percent the funding for Scholarships for
    Disadvantaged Students (SDS). These programs are crucial if we are to
    address concerns with health disparities. The COE, HCOP and SDS
    programs are essential in assisting economically disadvantaged students
    enter and graduate from health professions schools. Underrepresented
    minority recruitment and retention in the health professions is a
    serious problem. In 2004, the first-year enrollment of underrepresented
    minority students in dental school was just 11.3 percent of the total
    first year dental student enrollment. In 1990, the percentage of
    underrepresented minority students in the first year class was 13.8
    percent of the total first year enrollment. While the FLRP assists in
    recruiting and retaining faculty, it is of particular importance to
    academic dentistry as there is currently a faculty shortage. ADEA
    strongly urges Congress to continue investing in HCOP, COE, SDS, and
    FLRP so that the health professions can make strides in diversifying
    the future health care workforce.
           $213 million for the national health service corps (nhsc)
        The National Health Service Corps Scholarship and Loan Repayment
    Programs assist students with financing their health professions
    education while promoting primary care access to underserved areas. It
    is critical that the NHSC receive increased funding to meet the growing
    health care needs in the nation's rural and underserved communities.
    The President's budget proposal cuts $5 million from the NHSC budget at
    a time when it is crucial to maintain a pipeline of health providers in
    health professions shortage areas.
        $108 million for the indian health service (ihs) dental programs
        Maintaining the health care infrastructure and supporting the
    health care workforce that provides care to the Alaska Native/American
    Indian (AN/AI) population is essential in meeting the needs of Indian
    people. The IHS Loan Repayment Program makes payments on health care
    worker's student loans while they provide care at one of 280 hospital
    sites located around the country. The IHS Scholarship program provides
    both hope and financial support to AN/AI students pursuing careers in
    the health professions. Without these programs access to care as well
    education for the AN/AI population will surely worsen.
    $1 million for a medicaid commission to study and recommend changes to
                                    medicaid
        ADEA supports the amendment in the Senate's fiscal year 2006 Budget
    Resolution that halts further cuts to Medicaid and instead establishes
    a reserve fund of $1 million to establish a Medicaid Commission to
    study and recommend changes needed in Medicaid. While expenditures on
    dental care account for less than 1 percent of all Medicaid
    expenditures, 25 million children enrolled in Medicaid are eligible for
    needed dental care under the program. Medicaid accounts for almost a
    quarter of all dental expenditures for children under age 6 and
    provides the only guarantee of relief from dental pain and infections,
    restoration of teeth and dental health for millions of children on
    Medicaid. The Medicaid program is the only access that many of the
    poorest and sickest adults have to critical emergency oral health care.
        In conclusion, the American Dental Education Association
    appreciates consideration of our fiscal year 2006 budget
    recommendations for dental education and research. A sustained federal
    commitment is needed to help meet the challenges oral disease poses
    among the nation's most vulnerable citizens including children. So too
    is the development of a partnership between the federal government and
    dental education programs to implement a national oral health plan that
    guarantees access to dental care for everyone, ensures continued dental
    health research, eliminates disparities, and eliminates workforce
    shortages.
                                     ______

            Prepared Statement of the American Geological Institute

        To the Chairman and Members of the Subcommittee: Thank you for this
    opportunity to provide the American Geological Institute's perspective
    on fiscal year 2006 appropriations for the Department of Education's
    Mathematics and Science Partnership program.
        In 1999, the Third International Math and Science Study found that
    the longer U.S. students are in school, the farther they fall behind in
    math and science proficiency in international comparisons. That
    prompted President Bush to propose the National Math and Science
    Partnership (MSP) program as part of No Child Left Behind. The goal of
    the partnership program is to strengthen K-12 science and math
    education by promoting a vision of education as a continuum that begins
    with the youngest learners and progresses through adulthood with
    teacher training. Among its activities, the program supports
    partnerships that unite K-12 schools, institutions of higher education
    and private industry.
        Congress took the president's suggestion and authorized an MSP
    program at the National Science Foundation (NSF) and another
    partnership program at the Department of Education in 2002. These two
    acts of Congress were meant to fund two different types of partnerships
    to achieve the overall goal of highly qualified math and science
    teachers ensuring that all students have the basic knowledge to compete
    in the ever changing and competitive job market. The funds allocated
    for the NSF's MSPs go to the highest quality proposals chosen through a
    competitive peer-reviewed grant program. The program focuses on
    modeling, testing and identification of effective math-science
    activities. The funds allocated for the Department of Education MSPs go
    directly to the states as formula grants, providing funds to all states
    to replicate and then implement the best of the NSF partnerships
    throughout the country. Once states receive the money, they make
    competitive grants to local partnerships.
        At a hearing in October 2003, the House Science Committee found
    that these new partnership programs are ``on the right track toward
    improving math and science education.'' Testifying before the
    committee, M. Susana Navarro, executive director of the El Paso
    Collaborative for Academic Excellence MSP, said: ``What the MSP now
    provides is an opportunity to bring together partners across the
    community, K-16, toward the shared development and implementation of
    high quality math and science content and instructional practices aimed
    at improving student achievement among all students.''
        Just 3 months after that hearing, President Bush released his
    budget proposal for fiscal year 2005, which phased out the NSF
    partnership programs and shifted the funding to the MSP companion
    program at the Department of Education. However, the $120 million
    increase requested for 2005 was not slated to fund additional MSPs on
    the local level; instead it would have financed a new program focused
    on accelerating the math education of secondary-school students,
    especially those who are at risk of dropping out of school because they
    lack basic skills in math.
        The Senate Labor, Health and Human Services and Education did not
    go along entirely with the President's plan last year. The MSPs would
    have received $200 million, 4.5 percent less than the President
    requested but $51 million or 34 percent more than fiscal year 2004
    funding in the Senate version of the bill. The report stated, ``These
    funds will be used to improve the performance of students in the areas
    of math and science by bringing math and science teachers in elementary
    and secondary schools together with scientists, mathematicians, and
    engineers to increase the teachers' subject-matter knowledge and
    improve their teaching skills.''
        We applauded the Subcommittee because it did not choose to fund
    math over science and, ultimately, Congress did not chose to fund math
    over science. In last year's omnibus bill, the Math and Science
    Partnership budget increased 16 percent over fiscal year 2004 levels to
    $179 million and none of those funds were set-aside for one subject.
        This year, the President has proposed something similar. The fiscal
    year 2006 budget proposal increases the MSPs to $269 million, an
    increase of $90.4 million, or 51 percent, over the fiscal year 2005
    level. Although a large increase has been proposed, the President's
    plan restricts $120 million for the Secondary Education Mathematics
    Initiative, a competitive grant program to be administered by the
    Department of Education. This creates a net decrease in funding
    available to the states in fiscal year 2006 compared to the fiscal year
    2005 allocations.
        The $120 million in funds for Secondary Education Mathematics
    Initiative is part of the overall High School Initiative, which will
    expand the application of No Child Left Behind principles to improve
    high school education and raise achievement, particularly the
    achievement of students most at risk of failure. This new initiative
    combines a number of categorical programs in order to give states and
    districts more flexibility and contains stronger accountability
    mechanisms.
        AGI believes the two MSPs are the most effective approach to
    rapidly improving the abilities of all students to enhance their future
    prospects regardless of their ultimate career goals. The two programs,
    designed and authorized by Congress, are complementary. AGI supports
    funding at NSF for competitive grants for teaching tools and teacher
    training and funding at the Department of Education for formula grants
    for implementation of these tools in K-12 education. The peer-review
    process in the NSF program should be safeguarded as should the formula
    grants for all states as administered by the Department of Education.
    Moreover, the program within the Department of Education should not
    suffer a net reduction in funding in order to support a new initiative
    for mathematics. These funds should serve the Math and Science
    Partnership with no earmarks or set-asides.
        Thank you for the opportunity to present this testimony to the
    Subcommittee. If you would like any additional information, please
    contact me at 703-379-2480, ext. 228 voice, 703-379-7563 fax,
    rowan@agiweb.org, or 4220 King Street, Alexandria VA 22302-1502.
                                     ______

     Prepared Statement of the American Indian Higher Education Consortium

        Mr. Chairman and Members of the Subcommittee, on behalf of this
    Nation's 34 Tribal Colleges and Universities (TCUs), which compose the
    American Indian Higher Education Consortium (AIHEC), thank you for the
    opportunity to share our fiscal year 2006 funding requests for programs
    within the U.S. Department of Education, and the U.S. Department of
    Health and Human Services--Head Start program.
        This statement will cover two areas: (a) background on the tribal
    colleges, and (b) justifications for our funding recommendations.

                        I. BACKGROUND ON TRIBAL COLLEGES

        The Tribal College Movement began in 1968 with the establishment of
    Navajo Community College, now Dine College, in Tsaile, Arizona. Rapid
    growth of tribal colleges soon followed, primarily in the Northern
    Plains region. In 1972, the first six tribally controlled colleges
    established AIHEC to provide a support network for member institutions.
    Today, AIHEC represents 34 Tribal Colleges and Universities located in
    12 states, which were begun specifically to serve the higher education
    needs of American Indians. Annually, these institutions serve upwards
    of 30,000 full-and part-time students from over 250 Federally-
    recognized tribes.
        Currently, all but one of our colleges is accredited by
    independent, regional accreditation agencies and like all institutions
    of higher education, must undergo stringent performance reviews on a
    periodic basis to retain their accreditation status. In addition to
    college level programming, TCUs provide much needed high school
    completion (GED), basic remediation, job training, college preparatory
    courses, and adult education. Tribal colleges fulfill additional roles
    within their respective reservation communities functioning as
    community centers, libraries, tribal archives, career and business
    centers, economic development centers, public-meeting places, and child
    care centers. Each TCU is committed to improving the lives of its
    students through higher education and to moving American Indians toward
    self-sufficiency.
        Tribal colleges provide access to higher education for American
    Indians and others living in some of this Nation's most rural and
    economically depressed areas. These institutions, chartered by their
    respective tribal governments, were established in response to the
    recognition by tribal leaders that local, culturally based institutions
    are best suited to help American Indians succeed in higher education.
    TCUs combine traditional teachings with conventional postsecondary
    courses and curricula. They have developed innovative means to address
    the needs of tribal populations and are successful in overcoming long-
    standing barriers to higher education for American Indians. Since the
    first tribal college was established on the Navajo reservation, these
    vital institutions have come to represent the most significant
    development in the history of American Indian higher education,
    providing access to and promoting achievement among students who may
    otherwise never have known postsecondary education success.
        Despite their remarkable accomplishments, tribal colleges remain
    the most poorly funded institutions of higher education in the country.
    Persistently inadequate funding remains the most significant barrier to
    their success. Funding for basic institutional operations of 26
    reservation based colleges is provided through Title I of the Tribally
    Controlled College or University Assistance Act (Public Law 95-471).
    Funding under the Act was first appropriated in 1981. Almost 25 years
    later, the funding level is at just 75 percent of the authorized level
    of $6,000 per Indian student, which is defined as an enrolled member of
    a Federally recognized tribe. In fiscal year 2005, these colleges are
    receiving $4,447 per full-time equivalent Indian student toward their
    institutions operating budgets. While mainstream institutions have had
    a foundation of stable state tax-based support, TCUs must rely on year-
    to-year Federal appropriations for their basic institutional operating
    funds. Because TCUs are located on Federal trust territories, states
    have no obligation to fund them even for the non-Indian state-resident
    students who account for approximately 20 percent of TCU enrollments.
    Yet, if these same students attended any other public institution in
    the state, the state would provide basic operating funds to the
    institution.
        Inadequate funding has left many of our colleges with no choice but
    to continue to operate under severely distressed conditions. Although
    facilities initiatives of the last few years have resulted in
    widespread renovation and construction at TCUs, many colleges began in
    surplus trailers; cast-off buildings; and facilities with crumbling
    foundations, faulty wiring, and leaking roofs, and therefore have a
    long way to go. Sustaining quality academic programs is a challenge
    without a reliable source of facilities maintenance and construction
    funding.
        As a result of more than 200 years of Federal Indian policy--
    including policies of termination, assimilation and relocation--many
    reservation residents live in abject poverty comparable to that found
    in Third World nations. Through the efforts of tribal colleges,
    American Indian communities receive services they need to reestablish
    themselves as responsible, productive, and self reliant.

                               II. JUSTIFICATIONS

    A. Higher Education Act
        The Higher Education Act Amendments of 1998 created a separate
    section within Title III, Part A, specifically for the Nation's Tribal
    Colleges and Universities (Section 316). Titles III and V programs
    support institutions that enroll large proportions of financially
    disadvantaged students and have low per-student expenditures. TCUs
    clearly fit this definition as they are among the most poorly funded
    institutions in America, yet they serve some of the most impoverished
    areas of the country. TCUs are victims of their own success. This year
    two new tribal colleges are eligible to compete for funding under Title
    III. Despite the increase in the size of the pool of eligible
    institutions, the President's fiscal year 2006 Budget recommends level
    funding for this vital program. We urge the Subcommittee to fund
    section 316 at $32 million, an increase of $8.2 million over fiscal
    year 2005 and the President's request, and we ask that report language
    included in since fiscal year 2003 be restated clarifying that funds
    not needed to support continuation grants or new planning or
    implementation grants be available for facilities renovation and
    construction grants.
        The importance of Pell grants to our students cannot be overstated.
    Department of Education figures show that at the majority of all tribal
    college students receive Pell grants, primarily because student income
    levels are so low and our students have far less access to other
    sources of aid than students at mainstream institutions. Within the
    Tribal College system, Pell grants are doing exactly what they were
    intended to do--they are serving the needs of the lowest income
    students by helping people gain access to higher education and become
    active, productive members of the workforce. We urge Congress to fund
    this critical program at the highest possible level.

    B. Carl D. Perkins Vocational & Applied Technology Education Act
        Tribally-Controlled Postsecondary Vocational Institutions.--Section
    117 of the Perkins Act provides basic operating funds for two of our
    member institutions: United Tribes Technical College in Bismarck, North
    Dakota, and Crownpoint Institute of Technology in Crownpoint, New
    Mexico. We urge that Congress fund this program at $8.5 million.
    Included in both the House and Senate reauthorization bills, which are
    being considered in the 109th Congress is language waiving section 117
    grantees from having to utilize a restricted indirect cost rate, since
    the timeline for enactment of the reauthorizing legislation is
    uncertain, we ask that you reiterate the language that has been
    included in this appropriations measure since fiscal year 2002 stating
    that Section 117 Perkins grantees need not utilize restricted indirect
    cost rate.
        The President's fiscal year 2006 budget once again proposes the
    elimination of the Native American Program Section 116, which reserves
    1.25 percent of appropriated funding to support Indian vocational
    programs. We strongly urge Congress to continue this program, which is
    vital to the survival of vocational education programs being offered at
    TCUs.

    C. Greater Support of Indian Education Programs
        American Indian Adult and Basic Education.--This section supports
    adult education programs for American Indians offered by TCUs, state
    and local education agencies, Indian tribes, institutions, and
    agencies. Despite a lack of funding, TCUs must find a way to continue
    to provide basic adult education classes for those Indians that the
    present K-12 Indian education system has failed. Before many
    individuals can even begin the course work needed to learn a productive
    skill, they first must earn a GED or, in some cases, learn to read.
    According to a 1995 survey conducted by the Carnegie Foundation for the
    Advancement of Teaching, 20 percent of the participating students had
    completed a tribal college GED program before beginning higher
    education classes at the tribal college. At some schools, the
    percentage is even higher. Clearly, there is a tremendous need for
    basic educational programs, and TCUs need funding to support these
    crucial activities. Tribal colleges respectfully request that Congress
    appropriate $5 million to meet the ever increasing demand for basic
    adult education and remediation program services.
        American Indian Teacher Corps.--American Indians are severely
    under-represented in the teaching and school administrator ranks
    nationally. These competitive programs, aimed at producing new American
    Indian teachers and school administrators for schools serving American
    Indian students, support the recruitment, training, and in-service
    professional development programs for Indians to become effective
    teachers and school administrators, and in doing so excellent role
    models for Indian children. We believe that the TCUs are the ideal
    catalysts for these initiatives because of our current work in this
    area and the existing articulation agreements TCUs hold with 4-year
    degree awarding institutions. We request that Congress support these
    programs at $10 million and $5 million, respectively, to increase the
    number of qualified American Indian teachers and school administrators
    in Indian Country.

    D. Department of Health and Human Services/Administration for Children
            & Families/Head Start
        Tribal Colleges and Universities (TCU) Head Start Partnership
    Program.--The TCU/Head Start partnership has made a lasting investment
    in our Indian communities by creating and enhancing associate degree
    programs in Early Childhood Development and related fields. New
    graduates of these programs can help meet the mandate that 50 percent
    of all program teachers earn an associate degree in Early Childhood
    Development or a related discipline. More importantly, this program has
    afforded American Indian children Head Start programs of the highest
    quality. A clear impediment to the ongoing success of this partnership
    program is the erratic availability of discretionary funding made
    available for the TCU/Head Start partnership. Since fiscal year 1999,
    the first year of the program, a total of just 15 tribal colleges have
    been able to participate in this valuable program. Some colleges were
    awarded 3-year grants, others 5-year grants, and in fiscal year 2002
    there were no new grants funded at all. In fiscal year 2003, funding
    for eight new grants was made available, but in fiscal year 2004, only
    two new awards could be made because of the lack of adequate funds. The
    President's fiscal year 2006 budget includes a total request of $6.9
    billion for Head Start Programs. We request Congress direct the Head
    Start Bureau to designate a minimum of $5 million for the TCU/Head
    Start Partnership program, to ensure that this critical program can be
    continued and be expanded so that all TCUs might participate in the
    TCU- Head Start partnership program.

                                III. CONCLUSION

        Tribal colleges and universities are bringing education to
    thousands of American Indians. The modest Federal investment in the
    TCUs has paid great dividends in terms of employment, education, and
    economic development, and continuation of this investment makes sound
    moral and fiscal sense. Tribal colleges need your help if they are to
    sustain and grow their programs and achieve their missions.
        Thank you again for this opportunity to present our funding
    recommendations. We respectfully ask the Members of this Subcommittee
    for their continued support of the Nation's tribal colleges and
    universities and full consideration of their fiscal year 2006
    appropriations needs and recommendations.
                                     ______

     Prepared Statement of the Association of Minority Health Professions
                                    Schools

        Mr. Chairman, thank you very much for the opportunity to present
    the views of the Association of Minority Health Professions Schools
    (AMHPS). I am Dr. John E. Maupin, President of Meharry Medical College
    in Nashville, Tennessee and President of AMHPS.
        AMHPS is comprised of the nation's 12 historically black medical,
    dental, pharmacy, and veterinary. Combined, our institutions have
    graduated 50 percent of African-American physicians and dentists, 60
    percent of all the nation's African-American pharmacists, and 75
    percent of the African-American veterinarians.
        Mr. Chairman, historically black health professions institutions
    are addressing a pressing national need in carrying out their mission
    of training minorities in the health professions. While African-
    Americans represent approximately 15 percent of the U.S. population,
    only 2-3 percent of the nation's health professions workforce is
    African-American. Studies have demonstrated that when African Americans
    and other minorities are trained in minority institutions, they are
    much more likely to: (1) serve in medically underserved areas, (2) care
    for minorities, and (3) accept patients who are Medicaid dependent or
    otherwise poor.
        This is important Mr. Chairman because the gap in health status
    between our nation's minority and majority populations continues to
    widen due in part to the lack of access to quality health care services
    in minority communities. As a result, we believe it is imperative that
    the federal commitment to training African Americans and other
    minorities in the health professions remains strong.
        In spite of our proven success in training health professionals,
    and the important contribution these professionals make, our
    institutions continue to face a financial struggle inherent to our
    mission. The financial challenges facing the majority of our students
    affect our institutions in numerous ways. For example, we are unable to
    depend on tuition as a means by which to respond to any discontinuation
    of federal support. Moreover, the patient populations served by the
    AMHPS institutions are overwhelmingly poor. As a result, our
    institutions cannot rely on patient care income at a time when the
    average medical school gets 40-60 percent of its operating revenue from
    health care services.
        Mr. Chairman, before I present AMHPS's appropriations
    recommendations for fiscal year 2006, I would like to express my
    sincere appreciation for your leadership in restoring funding for the
    Health Resources and Services Administration's health professions
    training programs in fiscal year 2005. For many of our schools, support
    from these programs represent the difference between our doors being
    open or closed. We cannot overstate our gratitude for your leadership
    in this area.

     FISCAL YEAR 2006 RECOMMENDATIONS FOR FEDERAL PROGRAMS OF INTEREST TO
                                     AMHPS

    Health Resources and Services Administration
                Health Professions Training
        The health professions training programs administered by the Health
    Resources and Services Administration are the only federal initiatives
    designed to address the longstanding under-representation of minority
    individuals in health careers. HRSA's Minority Centers of Excellence,
    Health Careers Opportunity Program, and Scholarships for Disadvantaged
    Students, support health professions institutions with a historic
    mission and commitment to increasing the number of minorities in the
    health professions.
        Mr. Chairman, our schools and students greatly appreciate the
    subcommittee's consistent support of these important programs. However,
    we are very disappointed that the administration's budget all but
    eliminates funding again this year for health professions programs
    focused on diversity in the workforce. For fiscal year 2006, AMHPS
    joins with the Health Professions Nursing and Education Coalition in
    recommending a funding level of at least $300 million for Title VII
    health professions training programs.
        For the health professions programs specifically focused on
    enhancing minority representation in the health care workforce AMHPS
    recommendations are as follows:

                Minority Centers of Excellence
        The purpose of the Minority Centers of Excellence program (COE) is
    to assist schools that train minority health professionals by
    supporting programs of excellence in health professions education at
    those institutions. The COE program focuses on improving student
    recruitment and performance; improving curricula and cultural
    competence of graduates; facilitating faculty/student research on
    minority health issues; and training students to provide health
    services to minority individuals by providing clinical teaching at
    community-based health facilities.
        For fiscal year 2006, AMHPS recommends a funding level of $40
    million for Minority Centers of Excellence (an increase of $6.1 million
    over fiscal year 2005).

                Health Careers Opportunity Program
        Grants made to health professions schools and educational entities
    under the Health Careers Opportunity Program (HCOP) enhance the ability
    of individuals from disadvantaged backgrounds to improve their
    competitiveness to enter and graduate from health professions schools.
    HCOP funds activities that are designed to develop a more competitive
    applicant pool through partnerships with institutions of higher
    education, school districts, and other community based entities. HCOP
    also provides for mentoring, counseling. primary care exposure
    activities and information regarding careers in a primary care
    discipline. Sources of financial aid are provided to students as well
    as assistance in entering into the health professions school
        For fiscal year 2006, AMHPS recommends a funding level of $40
    million for the Health Careers and Opportunities Program (an increase
    of $4.1 million over fiscal year 2005).

                Scholarships for Disadvantaged Students
        The Scholarships for Disadvantaged Students program was established
    to make scholarship funds available to eligible students from
    disadvantaged backgrounds who are enrolled (or accepted for enrollment)
    as full-time students. To be eligible for funding, a school must have
    in place a program to recruit and retain students from disadvantaged
    backgrounds (including racial and ethnic minorities) and demonstrate
    that the program has achieved success based on the number or percentage
    of disadvantaged students who graduate from the school.
        For fiscal year 2006, AMHPS recommends a funding level of $55
    million for the Scholarships for Disadvantaged Students program (an
    increase of $7.5 million over fiscal year 2005).

                       HEALTHY COMMUNITIES ACCESS PROGRAM

        Mr. Chairman, as you know, Congress passed legislation last year in
    2003 to reauthorize the Community Health Centers program. Included in
    this important measure was a provision which established a
    demonstration authority within the Healthy Community Access Program to
    foster greater collaboration between historically black health
    professions and federally qualified CHC's. Specifically, this
    provision:
        (1) Establishes a demonstration program for the development of
    research infrastructure at historically black health professions
    schools affiliated with federally qualified Community Health Centers.
        (2) Establishes joint and collaborative programs of medical
    research and data collection between historically black health
    professions schools and federally qualified Community Health Centers
    with the goal of improving the health status of medically underserved
    populations.
        (3) Supports the cost of patient care, data collection, and
    academic training resulting from these partnerships.
        Mr. Chairman, Meharry Medical College and other members of our
    Association successfully applied for funding under this new
    demonstration authority in fiscal year 2005. These funds are making an
    important contribution at all of our institutions. For fiscal year
    2006, we encourage the subcommittee to restore funding for the Health
    Communities Access Program to $83 million.

                         NATIONAL INSTITUTES OF HEALTH

    The National Center on Minority Health and Health Disparities
        Established in 2000 by the Minority Health and Health Disparities
    Research and Education Act (Public Law 106-525), the National Center on
    Minority Health and Health Disparities at NIH is charged with
    addressing the longstanding health status gap between minority and
    majority populations. The National Center has the authority to:
      --Directly support biomedical research, training, and information
            dissemination focused on eliminating health status disparities.
      --Serve in a leadership capacity in developing a comprehensive plan
            for minority health research at NIH.
      --Participate as an equal when NIH institute and center directors
            meet to determine research policy.
      --Support the enhancement of biomedical research capacity at minority
            health professions institutions through a ``Research
            Endowment'' program.
      --Support the development of health professions institutions with a
            history and mission of serving minority and medically
            underserved communities through a ``Centers of Excellence''
            program.
        For fiscal year 2006, AMHPS recommends a funding level of $250
    million for the National Center. This is an increase of $53 million.
    This new funding will enable the Center to support all of its new
    programs and begin to meet the challenge of eliminating health status
    disparities within minority and medically underserved communities.
    Extramural Facilities Construction
        Mr. Chairman, if we are to take full advantage of the historic
    increases in biomedical research funding that Congress has provided to
    NIH, it is critical that our nation's research infrastructure remain
    strong.
        Under legislation passed in 2001, the authorization level for the
    Extramural Facility Construction program at the National Center for
    Research Resources was increased from $150 million to $250 million. In
    addition, the law maintains the 25 percent set-aside for Institutions
    of Emerging Excellence (many of which are minority institutions) for
    funding up to $50 million and allows the NCRR director to waive the
    matching requirement for participation in the program.
        Unfortunately, funding for the Extramural Facility Construction
    program was cut from $119 million in fiscal year 2004 to $30 million in
    fiscal year 2005. AMHPS encourages the subcommittee to prioritize
    support for this important program in fiscal year 2006 by restoring
    funding to the fiscal year 2004 level.

    Research Centers at Minority Institutions
        The Research Centers at Minority Institutions program (RCMI) at the
    National Center for Research Resources has a long and distinguished
    record of helping our institutions develop the research infrastructure
    necessary to be leaders in the area of health disparities research.
    Although NIH has received unprecedented budget increases in recent
    years, funding for the RCMI program has not increased by the same rate.
    Therefore, AMHPS recommends that funding for this important program
    grow at the same rate as NIH overall in fiscal year 2005.

     STRENGTHENING HISTORICALLY BLACK GRADUATE INSTITUTIONS--DEPARTMENT OF
                                   EDUCATION

        The Department of Education's Strengthening Historically Black
    Graduate Institutions program (Title III, Part B, Section 326) is
    extremely important to AMHPS institutions. The funding from this
    program is used to enhance educational capabilities, establish and
    strengthen program development offices, initiate endowment campaigns,
    and support numerous other institutional development activities.
        For fiscal year 2006, AMHPS recommends an appropriation of $65
    million (an increase of $6.5 million over fiscal year 2005) to continue
    the vital support that this program provides to historically black
    graduate institutions.

                         HHS OFFICE OF MINORITY HEALTH

        The HHS Office of Minority Health (OMH) has the potential to play a
    critical role in addressing health status disparities throughout the
    country. Unfortunately, the office does not currently have the
    authority or resources necessary to support activities that will truly
    make a difference in closing the health gap between minority and
    majority populations. For fiscal year 2006, AMHPS recommends a funding
    level of $65 million for the Office, with $10 million designated for
    the following programs focused on medically underserved communities and
    capacity building for the training of minorities in health professions:
        (1) OMH sponsored programs to assist medically underserved
    communities with the greatest need in solving health disparities and
    attracting and retaining health professionals;
        (2) Assistance to minority institutions in acquiring real property
    to expand their campuses to increase the capacity to train minorities
    for medical careers;
        (3) Support of conferences for high school and undergraduate
    students to pursue health professions careers; and
        (4) Support for cooperative agreements with minority institutions
    for the purpose of strengthening their capacity to train more
    minorities in the health professions.
        Once again, thank you for the opportunity to present the views of
    the Association of Minority Health Professions Schools. We look forward
    to working with you in support of these important programs.
                                     ______

        Prepared Statement of the Association of University Centers on
                                  Disabilities

        Mr. Chairman, on behalf of the Association of University Centers on
    Disabilities, I am pleased to submit this written testimony for the
    record both as a means to thank you for the Committee's support of our
    Centers in fiscal year 2005, and as a way of alerting you to the
    exciting developments happening now across the national network of
    University Centers for Excellence in Developmental Disabilities,
    Education, Research and Service (UCEDDs). The network of UCEDDs is a
    showcase for unique and effective models for developing approaches and
    gathering new knowledge in the field of developmental disabilities and
    sharing this knowledge both nationally and internationally, as well as
    in our own states to improve the lives of people with developmental and
    other disabilities. I am Fred Palmer, Director of the Boling Center for
    Developmental Disabilities, Tennessee's University Center for
    Excellence in Developmental Disabilities at the University of Tennessee
    Health Science Center, and President of the Association of University
    Centers on Disabilities.
        The mission of the UCEDDs is to advance policy and practice, for
    and with people with developmental and other disabilities, their
    families and communities. As a network of 61 interdisciplinary Centers
    across the United States and its Territories, we work to ensure full
    participation in all aspects of living for individuals with
    disabilities.
        Since the early 1960s, when Congress established a small number of
    research centers to study mental retardation, we have grown into a
    national network where each University Center has developed its own
    area(s) of expertise based on the needs of the local community, state,
    and evolving expectations of people with disabilities nationwide to be
    more included in community life. Authorized by the Developmental
    Disabilities Assistance and Bill of Rights Act (Public Law 106-402) we
    currently focus our work on serving as a national education and
    training, service and information resource and research entity for our
    nation.
        We are extremely grateful that in fiscal year 2005, the Congress
    increased funding for the UCEDDs by $5 million, bringing our current
    funding to $31.5 million. This increase has provided us with an
    opportunity that has not existed in over a decade--the opportunity to
    increase the number of Centers in our network in order to better serve
    people with disabilities. With this money, we will establish three new
    Centers in states where there is a large minority population and/or
    difficulties reaching people with disabilities due to geographic
    hardships. The increased funding also provides each current Center with
    additional dollars to conduct research and provide community supports
    and services as outlined in the DD Act, essentially funding each
    current Center at the level authorized in 2000. Additionally, the
    increased funding allows the Administration on Developmental
    Disabilities to compete one or two small National Training Initiative
    grants which allow the grantee to conduct community-based training on a
    topical area of national significance.
        We are respectfully seeking an appropriation of $37 million for the
    network of Centers for fiscal year 2006. This increase will allow
    funding for the three new Centers to be increased to the same funding
    as the existing 61 Centers, as well as to continue our ability to
    establish additional Center grants in the five states that currently
    have unserved and underserved populations, and support for four new
    Centers that specialize in minority health disparities and education
    issues.
        AUCD believes that all people with disabilities must have the
    opportunity to maximize their potential, and have equal and meaningful
    access to all programs that help people be part of community life. We
    have been honored and pleased to work with President Bush and his
    Administration to carry out initiatives established in the New Freedom
    Initiative. Through Executive Order 12317, ``Community-Based
    Alternatives for Individuals with Disabilities'' we are working at the
    state and national level to implement programs and secure funding to
    rebalance the system of care for individuals with disabilities and
    their families. We believe that the country is at a turning point in
    time that can truly change the way that individuals with disabilities
    are perceived and treated. By helping states rebalance their service
    systems to serve people in the community first, as opposed to
    institutional settings, we are truly working to achieve the President's
    goals set forward in the Executive Order.
        The UCEDDs focus their work in a concerted effort through the areas
    of education and training at the university and community level;
    research, both basic and applied; and service provision at the
    individual and family level. Please allow me this opportunity to
    provide you with some examples.
        Education.--Quality of life in the community for individuals with
    disabilities depends upon well-trained professionals. Positioned within
    the university, UCEDDs educate professionals-in-training in
    interdisciplinary approaches and provide continuing education for
    professionals practicing in multiple fields relating to disabilities.
    Whether the focus is on leadership, direct service, clinical or other
    personnel training, these pre-service and continuing education programs
    are geared to the needs of students, fellows, and practicing
    professionals and have been essential in raising and defining the
    educational standards of service across health, education, employment
    and social service systems. Further, they have increased the capacity
    of States to be responsive to the needs of individuals with
    disabilities.
        Each year, UCEDDs provide education and training to approximately
    500,000 health, education, mental health, and policy-making
    professionals, as well as people with disabilities and their families.
    UCEDDs in communities nationwide provide this essential education and
    training.
        For example, one issue that Centers focus on nationally is positive
    behavioral supports. One UCEDD in Oregon houses the Center on Positive
    Behavioral Intervention and Support. The Center assists local schools
    in identifying, adapting, and sustaining effective behavioral
    practices, including school-wide discipline programs. Results from
    their replication efforts in over 400 schools nationwide indicate that
    their technical assistance and research has enhanced schools' capacity
    to address behavioral challenges, diminish disruptions, reclaim
    instructional time, and enhance quality and effectiveness of
    instruction.
        Through a partnership with the Centers for Disease Control and
    Prevention (CDC), the network of UCEDDs are designing and disseminating
    training materials on Down Syndrome and Spina Bifida. Educational
    modules are being designed for use in medical schools for training
    physicians in recognition and recommended treatments for these two
    conditions. Materials from these efforts will be disseminated to
    medical schools throughout the country.
        Research.--UCEDDs engage in cutting edge research on a wide variety
    of issues related to individuals with developmental disabilities and
    their families. From basic research to applied research and policy
    analysis, University Centers work to link research to public policy and
    professional practice. By studying areas such as brain development,
    autism spectrum disorders, and early literacy, UCEDD researchers are
    learning how children and adults learn and how best to teach them.
    UCEDDs lead in developing and evaluating new ideas and promising
    practices that improve the lives of children and adults with
    disabilities and their families and increase their access to quality
    services. Many participate in federally established research projects
    to study and disseminate information on the causes and prevention of
    disabilities and chronic conditions.
        One example of how research impacts upon policy and practice is a
    collaborative effort between one UCEDD and its state Department of
    Education and Department of Health and Human Services. Together they
    are studying the issues of access to, and retention in, high quality
    childcare for all children throughout the state. This multi-year,
    interdepartmental initiative is studying ways to develop a coordinated
    system of inclusive childcare and early education for all children,
    including those who are at risk due to poverty, disability, social-
    emotional and behavioral challenges, abuse, or language and cultural
    differences. By implementing and studying various systems of support
    for childcare providers, the UCEDD will be able to inform policymakers
    in areas such as staff development and retention of childcare staff,
    providing childcare support to TANF families, inclusive childcare
    support for children with disabilities, and supporting children in
    foster care.
        Service.--UCEDDs provide direct services and supports to people
    with developmental and other disabilities, their families, and
    communities, including state-of-the-art diagnosis, evaluation, and
    support services for children and adults with disabilities in health
    care, cognitive development, behavior disorders, education, daily
    living, and work skills. Moreover, through technical assistance to
    other providers, they magnify the impact of their programs, reducing
    disparities among individuals and communities.
        In Ohio, one UCEDD is working with families living in rural
    counties of Ohio who encounter many barriers to accessing quality care
    for their children. Because most services for children with
    disabilities are in urban areas, families in Appalachia were traveling
    100 miles to the city for multiple evaluations by individual
    disciplines. This resulted in a great expense in time and money for the
    family. The Center now sends teams of providers to rural areas to
    provide interdisciplinary care to families. They provide evaluation of
    children, training for local healthcare providers, and support for the
    families through a system of rural clinics. These clinics are improving
    access of needed services to families and providers and help local
    providers to better diagnose developmental disabilities such as
    cerebral palsy, fetal alcohol syndrome, autism and other genetic
    disorders.
        UCEDDs also lead in improving the lives of people with disabilities
    through new technologies. More than 20 UCEDDs including those in
    Pennsylvania, Iowa, Texas, and Utah provide services that help
    individuals assess their technology needs and get the equipment they
    need to read, hear, speak, write, learn, work, play, and fully
    participate in their communities.
        Responding to National Needs.--UCEDDs are equipped to respond
    quickly to emerging national needs. We are currently expanding our work
    in the area of aging and disability. As we continue to see people with
    disabilities living longer, aging parents need community support to
    ensure the safety and well-being of their adult aged children when they
    can no longer care for them and communities must be prepared. UCEDDs
    are working in communities on many aging-related projects and working
    with the White House Conference on Aging to ensure that aging and
    disability is part of the national dialogue. We continue to work with
    the federal government on policies and initiatives on emergency
    preparedness for people with developmental and other disabilities
    sharing much of our expertise and experience that came with the
    September 11 disaster. Other national issues that have been addressed
    by UCEDDs have included treatment and diagnosis of Autism and Related
    Spectrum Disorders, reading disorders in children, design and
    dissemination of training programs for direct support personnel in
    developmental disabilities, provision of training in methods to support
    employment for individuals with disabilities and improvement of housing
    options for individuals with disabilities and their families.
        I again ask that you consider our request for $37 million for the
    network of UCEDDs so that we may expand our network to more adequately
    serve our nation's growing population of Americans with developmental
    and related disabilities and to address our nation's health
    disparities.
        Thank you for the opportunity to share this information about the
    UCEDDs. Your careful consideration of our appropriation requests is
    appreciated and we are happy to share more detailed information with
    you at your request.
                                     ______

     Prepared Statement of the Charles R. Drew University of Medicine and
                                    Science

                SUMMARY OF RECOMMENDATIONS FOR FISCAL YEAR 2006

        1. A 6 percent increase for all institutes and centers at the
    National Institutes of Health (NIH), specifically the National Center
    for Research Resources (NCRR), the National Center for Minority Health
    and Health Disparities (NCMHD), and the National Cancer Institute
    (NCI).
        2. Urge NCI to continue to support the establishment of
    collaborative minority health comprehensive cancer centers at
    historically minority institutions in collaboration with existing NCI
    cancer centers. Continue to urge NCRR and NCMHD to collaborate on the
    establishment of a cancer center at a historically minority
    institution.
        3. Urge the Department of Health and Human Services, particularly
    the Office of Minority Health (OMH), to develop a focused effort on
    faculty support to address the residency training programs at minority
    medical institutions.
        Mr. Chairman and members of the subcommittee, thank you for the
    opportunity to present you with testimony. Charles R. Drew University
    is one of four predominantly minority medical schools in the country,
    and the only one located west of the Mississippi River.
        Charles R. Drew University of Medicine and Science is located in
    the Watts-section of South Central Los Angeles, and has a mission of
    rendering quality medical education to underrepresented minority
    students, and, through its affiliation with the University of
    California Los Angeles (UCLA) at the co-located King-Drew Medical
    Center, Drew provides valuable health care services to the medically
    underserved community. Through innovative basic science, clinical, and
    health services research programs, Drew University works to address the
    health and social issues that strike hardest and deepest among inner
    city and minority populations.
        The population of this medically underserved community is
    predominately African American and Hispanic. Many of these people would
    be without health care if not for the services provided by the King-
    Drew Medical Center and Charles R. Drew University of Medicine and
    Science. This record of service has led Charles R. Drew University (in
    partnership with UCLA School of Medicine) to be designated as a Health
    Resources and Services Administration Minority Center of Excellence.

                        A RESPONSE TO HEALTH DISPARITIES

        Racial and ethnic disparities in health outcomes for a multitude of
    major diseases in minority and underserved communities continue to
    plague this nation that was built on a premise of equality. As
    articulated in the Institute of Medicine report entitled ``Unequal
    Treatment: Confronting Racial and Ethnic Disparities in Health Care'',
    this problem is not getting better on its own. For example, African
    American males develop cancer fifteen percent more frequently than
    white males. Similarly, African American women are not as likely as
    white women to develop breast cancer, but are much more likely to die
    from the disease once it is detected. In fact, according to the
    American Cancer Society, those who are poor, lack health insurance, or
    otherwise have inadequate access to high-quality cancer care, typically
    experience high cancer incidence and mortality rates. Despite these
    devastating statistics, we are still not doing enough to try to combat
    cancer in our communities.
        In response to these findings and the high cancer rate in our own
    community, Charles R. Drew University of Medicine and Science proposes
    that a Minority Health Comprehensive Cancer Center be built on its
    campus.
        The Center would specialize in providing not only medical treatment
    services for the community, but would also serve as a research
    facility, focusing on prevention and the development of new strategies
    in the fight against cancer.
        Mr. Chairman, the support that this subcommittee has given to the
    National Institutes of Health (NIH) and its various institutes and
    centers has and continues to be invaluable to our University and our
    community. The dream of a state of the art facility to aid in the fight
    against cancer in our underserved community would be impossible without
    the resources of NIH.
        To help facilitate the establishment of a Minority Health
    Comprehensive Cancer Center at Charles R. Drew University of Medicine
    and Science, the University is seeking support from the National
    Institutes of Health's National Center for Research Resources (NCRR),
    the National Center for Minority Health and Health Disparities (NCMHD),
    and the National Cancer Institute (NCI).

               ACADEMIC RENEWAL AND CLINICAL FACULTY RECRUITMENT

        Some of the major challenges faced in sustaining high quality
    graduate medical education programs in ``safety-net'' medical centers
    with missions focused on the medically underserved, are directly
    related to the lack of sufficient numbers of clinical faculty highly
    trained in academic medicine. To address these challenges, a plan for
    academic enrichment is proposed.
        The plan is a strategic initiative to position Charles R. Drew
    University in the first decade of the 21st Century, as a leader in
    Urban Academic Health Sciences with an emphasis on training physicians
    and other health professionals to meet the needs of the medically
    underserved. The Plan for Academic Enrichment is an opportunity to
    enhance the impact of Charles R. Drew University as a national center
    of excellence in meeting the national, state, and local challenge of
    preparing a diverse complement of excellent physicians and other health
    professionals to close the health disparity gap by affording culturally
    sensitive quality care to the medically underserved and economically
    disadvantaged. A central component of the plan is the enrichment of
    academic excellence through the recruitment of new, highly qualified
    clinical teaching faculty, with solid research skills, to be members of
    the Charles R. Drew College of Medicine faculty to strengthen both the
    graduate and undergraduate medical education programs.

                                   CONCLUSION

        Despite our knowledge about racial/ethnic, socio-cultural and
    gender-based disparities in health outcomes, the ``gap'' continues to
    widen in most instances. Not only are minority and underserved
    communities burdened by higher disease rates, they are less likely to
    have access to quality care upon diagnosis. As you are aware, in many
    minority and underserved communities preventive care and/or research is
    completely inaccessible either due to distance or lack of facilities
    and expertise. This is a critical loss of untapped potential in both
    physical and intellectual contributions to the entire society.
        Even though institutions like Drew are ideally situated (by
    location, population, and institutional commitment) for the study of
    conditions in which health disparities have been well documented,
    research is limited by the paucity of appropriate research facilities.
    With your help, this cancer center will facilitate translation of
    insights gained through research into greater understanding of
    disparities in cancer incidence, morbidity and mortality and ultimately
    to improved outcomes.
        We look forward to working with you to lessen the burden of cancer
    for all Americans through greater understanding of cancer, its causes,
    and its cures. We also look forward to working with the Department of
    Health and Human Services to address the residency training program
    issues at Charles R. Drew University.
        Mr. Chairman, thank you for the opportunity to present on behalf of
    Charles R. Drew University of Medicine and Science.
                                     ______

    Prepared Statement of the Council of State Administrators of Vocational
                             Rehabilitation (CSAVR)

        Mr. Chairman and Members of the Senate Appropriations Subcommittee:
    This testimony is submitted on behalf of the Council of State
    Administrators of Vocational Rehabilitation (CSAVR) in conjunction with
    the hearing held on March 2, 2005 before the Senate Subcommittee on
    Labor, Health and Human Services, Education and Related Agencies.
        The CSAVR is composed of the chief administrators of the State
    Vocational Rehabilitation (VR) Agencies serving individuals with
    physical and/or mental disabilities in the United States, the District
    of Columbia and the Territories. These agencies constitute the state
    partners in the State-Federal Program of Rehabilitation Services
    provided under Title 1 of the Rehabilitation Act of 1973, as amended.
    State VR agencies provide individualized services and supports to
    eligible individuals with significant disabilities that are required
    for them to go to work. These services may include, but are not limited
    to, counseling and guidance, job training, higher education, physical
    and mental restoration services, and assistive technology. Over 1
    million individuals with disabilities are served annually. In fiscal
    year 2004, these agencies placed over 213,000 individuals with
    disabilities into competitive employment.
        The CSAVR, founded in 1940 to furnish input into the State-Federal
    Rehabilitation Program, provides a forum for state administrators to
    study, deliberate, and act upon matters affecting the rehabilitation
    and employment of individuals with disabilities. The Council serves as
    a resource for the formulation and expression of the collective points
    of view of state rehabilitation agencies on all issues affecting the
    provision of quality employment and rehabilitation services to persons
    with significant disabilities.
        For fiscal year 2006, CSAVR recommends an increase in the
    Vocational Rehabilitation (VR) appropriation of $125 million above the
    President's budget request for fiscal year 2006. While the President's
    budget proposes a 3.2 percent increase in funding for the Public VR
    program, an increase of approximately 1.2 percent above the mandated
    CPI called for in law, this increase is based on the elimination of
    several smaller programs (Supported Employment (SE), Projects With
    Industry (PWI), and Migrant and Seasonal Farm Workers (MSFW), with an
    assumption that VR will continue to provide services, under Title 1 of
    the Rehabilitation Act, to the individuals previously served under
    these programs. The President's budget request for fiscal year 2006 is
    between $22 and $25 million less than the consolidated funding for
    these three programs; thus, VR would need additional funding for
    services to accommodate for the elimination of these programs. In
    addition to the proposed elimination of the SE, PWI, and MSFW programs,
    which CSAVR does not support, H.R. 27, the House bill to reauthorize
    the Workforce Investment Act (WIA), expands the requirements for VR to
    provide transition services to students with disabilities. CSAVR also
    anticipates that S. 9, the Senate bill to reauthorize the WIA, will
    include expanded transition requirements, when it is reintroduced as a
    free-standing bill. Based on the significant internal and external
    challenges facing the Public VR Program, (i.e., staffing shortages,
    state budget shortfalls, increased numbers of consumers seeking
    services, and increased service expectations, the CSAVR believes that
    an increased appropriation of $125 million above the President's budget
    request for VR, for fiscal year 2006, is an appropriate recommendation.

                  THE PUBLIC VOCATIONAL REHABILITATION PROGRAM

        The Public VR Program is one of the most cost-effective programs
    ever created by Congress. It enables hundreds of thousands of
    individuals with disabilities to go to work each year and become tax-
    paying citizens. In fiscal year 2004, the VR Program assisted over 1
    million individuals with disabilities who wanted to work, by providing
    them with the job skills, training and support services they needed to
    become employed. Of those served, more than 213,000 entered into
    competitive employment. Funding for the VR Program requires a state
    match of 21.3 percent, and creates a state-federal partnership that has
    worked effectively for more than 85 years, and has assisted over 15
    million individuals with disabilities to engage in employment and
    become tax-paying citizens.
        The Rehabilitation Act mandates that the annual Federal
    appropriation for the VR Program grow at a rate at least equal to the
    change in the Consumer Price Index (CPI) over the previous fiscal year.
    While the mandate was intended to create a floor for the VR
    appropriation, Congress has not appropriated funds above the mandated
    CPI increase since 1999. This is particularly problematic because the
    formula used to distribute these funds, which is based on a state's per
    capita income and population, results in significant variations in the
    increases in individual State's allotments. When the increase is
    limited to the CPI increase and the formula is applied, not all states
    receive increases that are equal to the annual rate of inflation. In
    fiscal year 2005, 30 states did not receive the 1.977 percent required
    CPI increase in their state allotment.

                    CHALLENGES FACING THE PUBLIC VR PROGRAM

        Over the last several years, the Public VR Program has faced a
    number of external challenges that have been compounded by the minimal
    increases in Federal funding.

    Special Education
        Between 1990 and 2004, the federal appropriation for special
    education increased by approximately 333 percent. During the same time
    period, the federal appropriation for the Public VR Program increased
    by only 22 percent. As a result of these very significant increases in
    special education funding, an ever-increasing number of special
    education students are exiting the education system and seeking adult
    services, including Vocational Rehabilitation, in order to participate
    in post secondary education, job training, and/or to go to work. In
    addition, the House passed the Job Training Improvement Act in March
    2005, which adds additional responsibilities to State VR agencies for
    the provision of transition services, beyond those presently required
    by current law. The Senate bill, S. 9, is also anticipated to add new
    transition responsibilities for VR when it is reintroduced. These
    additional requirements, if implemented effectively, will place a
    tremendous burden on the fiscal and personnel resources of State VR
    agencies, many of which are already sorely under-funded to meet the
    needs of adults with significant disabilities who are seeking
    employment.

    Impact of the Workforce Investment Act of 1998 (WIA)
        The Public VR Program is a mandatory partner in the WIA and, as
    such, is required to contribute significant resources to support the
    infrastructure and other costs associated with the operation of the
    One-Stop Centers. While VR's involvement in State Workforce Investment
    Systems is critically important, WIA has placed yet another financial
    burden on an already strained program, further reducing the percentage
    of VR funds that are available to provide services and supports to
    eligible individuals with disabilities. In addition, the House bill to
    reauthorize the WIA, H.R. 27, proposes to take significant resources
    from the Public VR Program far beyond the resources contributed to the
    One-Stop Centers under current law. The Senate bill, S. 9, also
    requires additional resources from VR to fund the infrastructure costs
    and other common costs associated with the operation of One-Stop
    Centers.

    Impact of the Ticket to Work and Work Incentives Improvement Act of
            1999 (TWWIIA)
        The TWWIIA was designed to address disincentives to work found in
    the Social Security Disability Insurance Program (SSDI) and the
    Supplemental Security Income Program (SSI), and to increase employment
    opportunities for individuals enrolled in these programs. Research has
    shown that less than one-half of one percent of these individuals
    leaves the Social Security disability rolls each year as a result of
    paid employment. The provisions in TWWIIA that provide extended
    Medicare and Medicaid coverage to such individuals, when they enter or
    return to the workforce, are expected to encourage more beneficiaries
    to seek employment. Despite the establishment of a network of private
    providers to offer employment services to beneficiaries, the majority
    of beneficiaries, 90 percent, continue to seek services from State VR
    Agencies. With only minimal increases in VR funding over the last
    decade, this situation creates yet another challenge for the Public VR
    Program.

    Temporary Assistance for Needy Families (TANF)
        Most states have had significant success in reducing their TANF, or
    welfare to work caseloads. While TANF caseloads have been shrinking,
    the composition of the remaining caseload has changed. A 2002 General
    Accounting Office (GAO) report found that individuals with disabilities
    and their family members represent approximately 44 percent of the
    remaining TANF population. Since many of these individuals have
    multiple and significant barriers to employment, state welfare agencies
    are increasingly turning to State VR Agencies for assistance in serving
    these individuals. With only minimal increases in funding, and 42 State
    VR Agencies operating under an Order of Selection, a system of
    prioritization whereby individuals with the most significant
    disabilities are served first, it is becoming increasingly difficult,
    if not impossible, for State VR Agencies to serve the increased numbers
    of TANF referrals.
        As stated earlier, the Public VR Program is one of the most cost-
    effective programs ever created by Congress. Evidence of its success is
    further established by:
      --A 2002 Longitudinal Study of the Public VR Program which provided
            evidenced based research that the VR Program is effective in
            putting people with disabilities to work in good jobs with
            opportunities for advancement.
      --A fiscal year 2005 Program Assessment Rating Tool (PART), developed
            by the Office of Management and Budget (OMB) to rate program
            performance, rated the VR Program favorably, and in general,
            successful in meeting its program goal.
      --A report by the Social Security Administration, released annually,
            that provides detailed information on the funds disbursed to
            State VR Agencies, based on their successfully serving
            beneficiaries on Social Security Disability Insurance (SSDI)
            and Supplemental Security Income (SSI). In fiscal year 2004 SSA
            projected a $470.3 million savings to the Trust Fund by the VR
            Program, and established that every $1.00 that SSA spends on VR
            results in a $6.00 savings.
        In this era of federal and state budget deficits, and an increase
    in the unemployment rate for individuals with disabilities, we urge you
    to consider an increase in funding for the Public VR Program, through
    which you can be assured to have positive outcomes, based on the three
    factors mentioned above.
        Our nation's ability to be competitive in a global economy depends
    on the quality of our workforce. According to a report released by the
    Department of Labor, Employment & Training Administration, during the
    fiscal year 2005 Budget Briefing, the American workforce will be vastly
    different than it is today, as the 21st century unfolds. Integrating
    all available workers into the workforce, including workers with
    significant disabilities, will be required for employers to meet the
    demands of the 21st century economy. Significant numbers of large and
    small employers have acknowledged that hiring individuals with
    disabilities makes good business sense. It provides them with
    dependable workers and access to a market of individuals with spending
    power, which has historically been untapped. These same employers also
    have long-standing, positive relationships with VR, to whom they look
    to provide them with qualified workers with disabilities. Integrating
    all available workers into the workforce, including workers with
    disabilities, will require significant resources. VR's positive
    relationships with employers, who rely heavily on the Public VR Program
    to meet their hiring needs, further emphasizes and documents the need
    for additional resources for VR.
                                     ______

           Prepared Statement of the Florida Department of Education

        Chairman Specter, and other distinguished members of the
    Subcomittee: My name is Carlos R. Saavedra. I am the Director of the
    Adult Migrant Program and Services Section of the Florida Department of
    Education and submit my testimony for consideration by the Subcommittee
    regarding the Workforce Investment Act, Title I, Section 167 National
    Farmworker Jobs Program. The Florida Department of Education is the
    grantee for the National Farmworker Jobs Program and has operated this
    program successfully for past years, under the aegis of the Office of
    Economic Development, the Comprehensive Employment and Training Act,
    and the Jobs Training Partnership Act.
        As you are aware, the President's budget for 2006 proposes to
    eliminate the National Farmworker Jobs Program. This action appears to
    be prompted by a reduction in the United States Department of Labor's
    Employment and Training budget; the conviction that farmworkers will
    receive similar services through the One-Stop Centers and the local
    One-Stop Systems; and the belief that the National Farmworker Jobs
    Program is ineffective and duplicates other programs.
        There are many issues that remain to be addressed and resolved
    first if the One-Stop Centers and the One-Stop Systems are to fulfill
    the mandate to serve migrant and seasonal farmworkers as part of their
    universe of clients. At the very least, state and local workforce
    boards will need to deal with issues of program performance and the
    manner for reaching farmworkers with services. Farmworkers live and
    work in the margins of small rural towns, where the One-Stop Systems
    have limited representation.
        As regards performance, local workforce boards and their service
    providers currently receive few, if any, incentives from the state
    workforce boards to serve farmworkers and other populations with
    special needs. Consequently, providers feel obliged to job place many
    clients in the shortest time possible, with little consideration of
    their need for remedial education and customized skills training, which
    farmworkers and other special population with special needs require.
    Under current conditions, local workforce boards and their providers
    see little or no benefit to enrolling individuals with extremely low
    education levels and high mobility rates, as is the case with migrant
    farmworkers. This is the current state of services to migrant and
    seasonal farmworkers via the One-Stop Centers and the One-Stop Delivery
    System in many states where farmworkers are a significant part of the
    overall workforce.
        As regards farmworkers' access to services, the degree and mix of
    employment, training and supportive services that farmworkers receive
    in their communities today is possible because of funding by the
    National Farmworker Jobs Program. The National Farmworker Jobs Program
    supports customized service strategies with bilingual and bicultural
    staff that serve as a bridge between the farmworker community and the
    services and those educational programs offered by community and faith-
    based organizations and public institutions that are attuned to the
    needs of youth and adult learners. It is worth noting that the National
    Farmworker Jobs Program has high performance standards and outcome
    measures that are consistently met or exceeded. The outcomes for the
    Farmworker Jobs and Education Program, as Florida's National Farmworker
    Jobs Program is known, compares very favorably with national, state and
    local outcomes of other employment and training programs.
        In closing, I would like to share with the Subcommittee the story
    of one individual who benefited from Florida's Farmworker Jobs and
    Education Program and who was recently recognized by the Florida
    Department of Education as an ``All American Success''.
        Thank your for the opportunity to address this issue and ask that
    the Subcommittee consider farmworkers among those for whom continued
    federal support is essential.
                                     ______

                   Prepared Statement of Gallaudet University

        Mr. Chairman and members of the Committee: I would like to express
    my appreciation to you and to Congress for the generous support that we
    received in fiscal year 2005 to continue maintaining and enhancing
    academic programs and salaries at Gallaudet University. I am especially
    grateful that Congress continues to support us during these challenging
    times. I would like to provide you with some details concerning our
    request for fiscal year 2006. In my testimony last year, I discussed
    ongoing efforts by Gallaudet to diversify our sources of revenue and
    support, and I also want to bring you up to date on this issue.
        It is important to note that the proportion of the Federal
    appropriation for Gallaudet University as a part of our total budget
    was 17 percentage points less in 2004 than it was in 1981. During the
    1980's and 1990's, we coped with limitations on Federal support by
    increasing our tuition charges at a rate that exceeded growth in the
    Consumer Price Index (CPI) during that period. However, in light of
    concerns expressed by members of Congress and others, we have limited
    the increase in tuition charges for fiscal year 2006 to 3 percent,
    commensurate with general inflation. Very significantly, we have also
    reduced staffing since 1989 by 20 percent. In addition, we have changed
    our strategy for funding major construction and renovation projects.
    When I became President in 1988, every building on the Kendall Green
    campus had been constructed with 100 percent Federal funding. Since I
    became President, every major construction or renovation project we
    have conducted has been supported either by cost-sharing with the
    Federal government or by private fundraising alone. For example, the
    buildings constructed here most recently, the Kellogg Conference Hotel
    at Gallaudet University and the Student Academic Center, were
    constructed without any additional Federal appropriations. In 2003, we
    completed a 4-year, $40 million capital campaign, and much of that
    funding went to support construction of the Student Academic Center and
    growth in our endowment. We have begun fundraising for a much-needed
    new facility to house our language and communication programs, and I am
    pleased to inform you that in November of last year we received a $5
    million gift for this project from the Sorenson family of Utah. I
    believe, therefore, that we have been very responsible in our requests
    for Federal support and that we have done everything we could to seek
    additional sources of funding during a period when Congress has faced
    funding limitations.
        Because of Congress' ongoing support of Gallaudet in fiscal year
    2005, we have been able to maintain a competitive pay structure for our
    employees while retaining the flexibility to meet the needs of a
    changing student body. Given the unique student population we serve and
    the communication skills our employees are expected to possess,
    retaining skilled employees is very critical to our mission. Gallaudet
    employees received general pay increases of 2 percent in fiscal year
    2003, 3 percent in fiscal year 2004, and 2 percent in fiscal year 2005,
    increases that are below what Federal employees in the region received
    during the same timeframe, but in line with increases in the CPI. It
    will be important for Gallaudet to ensure that our employees receive a
    3 percent pay increase in fiscal year 2006, commensurate with current
    increases in inflation. We are also requesting support for inflationary
    increases in non-salary areas, especially in the cost of utilities,
    insurance, and other professional fees.
        The administration budget for fiscal year 2006 includes $104.557
    million for Gallaudet, the same as our current year fiscal year 2005
    appropriation. I have carefully analyzed our fiscal year 2006 funding
    needs and have determined that in order to award a 3 percent salary
    increase to our faculty and staff, and to meet other inflation-driven
    increases, we need an increase of only $3.1 million, 3 percent above
    our current appropriation.
        While this minimal increase would allow us to continue with current
    programs, it would not allow us to invest in programs that the
    University considers of critical importance. Our three priorities for
    fiscal year 2006 include the following:
    Initiatives to increase accessibility to information from outside and
            from within the University campus--$975,000
        Information technology continues to be the ``great equalizer'' that
    levels the playing field for those who are deaf or hard of hearing.
    Ever-increasing access to visual media and the growing proliferation of
    text-based communication provides more opportunities for deaf and hard
    of hearing people in different aspects of society. Therefore, it is
    essential that Gallaudet continue to invest in information technology
    that will provide these kinds of opportunities for our students.
        This funding will support the replacement of computers used daily
    by students in the digital learning center at the Student Academic
    Center, in student services programs, and in classrooms. It will also
    support upgrades to the University's Web presence and to student e-
    portfolio systems, which allow students to document their academic
    progress, receive feedback from their instructors, and present
    themselves electronically to potential employers.
        Finally, Gallaudet owns the largest and most unique collection of
    deafness-related materials in the world. Support will be given to the
    digitization of Gallaudet's unique archives. Digitizing these archives
    will make them more accessible to scholars and students at the
    University, as well as scholars from outside the Gallaudet community.
    Initiatives to enhance University programs for deaf students from non-
            traditional and diverse backgrounds--$300,000
        Gallaudet continues to seek ways to reach out to and create a more
    positive educational climate for deaf students from non-traditional and
    diverse backgrounds. Demographic trends point to a growing number of
    students of color as well as a growing number of deaf students who are
    placed in educational settings where sign language is not the primary
    mode of communication.
        Gallaudet recognizes that teacher preparation is essential in
    supporting students of color. In order for the teachers to capitalize
    on the expertise that Gallaudet has to offer, we seek to offer a
    regional distance education degree program that will allow teachers to
    receive training and earn a degree from Gallaudet without their having
    to come to Washington, D.C. to earn all their credits.
        In public education today, more deaf students are placed in
    educational settings where sign language is not the primary mode of
    communication. We believe it is important to have sufficient support
    for students with such backgrounds who come to Gallaudet to help them
    make the transition to a direct communication environment. It is also
    important for those who are undecided about which college to attend to
    understand that there is a strong program in place to help with such
    transition. The additional funding will let Gallaudet study optimal
    ways to enhance real-time captioning. In addition, it will support
    upgrading of the New Signers Program that provides sign language
    instruction to new students with weak or no signing skills.
    Improvements to the Theatre Arts Department, including renovations of
            the Elstad Auditorium and Annex--$950,000
        Funding will enhance student learning by improving and expanding
    the Theatre Arts program at Gallaudet and by updating and expanding the
    Elstad Auditorium and Annex. As an institution that promotes the visual
    arts, we must provide a solid theatre arts experience to our students.
    Further, as the world's only university in which all programs and
    services are specifically designed to accommodate deaf and hard of
    hearing students, Gallaudet needs a first rate arena to promote direct
    access for a broad audience.
        Changes in technology in the last thirty years have been very
    significant, and we are falling behind in our technical theatre.
    Lighting and sound systems are outdated, as are computer programming,
    costume shop equipment, and the set workshop. The building is not wired
    for classrooms to have direct access to the information network, and
    the box office is not wired to enable the use of effective and
    efficient ticketing programs.
        Access to theatre for deaf and hard of hearing people is often
    limited to one or two interpreted performances in area productions. The
    improvements to the Gallaudet University Theatre Arts program and
    facilities would enable direct access by a broader audience, as well as
    allow for opportunities for us to partner with other theatre companies,
    such as the nationally acclaimed Arena Stage, to produce unique visual
    performances. Students would experience ``smart'' classrooms and learn
    how to use state-of-the-art theatrical technology. In addition, the
    deaf and hard-of-hearing community would have direct access to many
    theatrical performances. Finally, hearing audiences would be attracted
    to and exposed to deaf theatre.
    Total Program Requests--$2,225,000
        The total request for Gallaudet University, including these three
    critical program priorities is $109.9 million, representing a 5 percent
    increase from our fiscal year 2005 appropriation. This increase would
    have a significantly positive impact on the University's ability to
    meet the increasing and changing needs of our students and those in the
    field of deaf education.
        I appreciate the challenges that Congress faces in making
    appropriations decisions for fiscal year 2006, but experience has shown
    that Gallaudet provides an outstanding return on the Federal dollars
    that are invested here in terms of the educated and productive deaf
    community that the nation enjoys as a result.
                                     ______

         Prepared Statement of the Medical Library Association and the
               Association of Academic Health Sciences Libraries

                SUMMARY OF RECOMMENDATIONS FOR FISCAL YEAR 2006

        (1) A 6 percent increase for the National Library of Medicine at
    the National Institutes of Health and support for NLM'S urgent facility
    construction needs.
        (2) Continued support for the Medical Library community's role in
    NLM'S outreach, telemedicine and health information technology
    initiatives.
        Mr. Chairman, thank you for the opportunity to testify today on
    behalf of the Medical Library Association (MLA) and the Association of
    Academic Health Sciences Libraries (AAHSL) regarding the fiscal year
    2006 budget for the National Library of Medicine. I am Logan Ludwig,
    Associate Dean for Library and Telehealth Services at Loyola University
    Strich School of Medicine in Maywood, Illinois.
        Established in 1898, MLA is a nonprofit, educational organization
    of more than 1,100 institutions and 3,600 individual members in the
    health sciences information field, committed to educating health
    information professionals, supporting health information research,
    promoting access to the world's health sciences information, and
    working to ensure that the best health information is available to all.
        AAHSL is comprised of the directors of libraries of 142 accredited
    United States. and Canadian medical schools belonging to the
    Association of American Medical Colleges. Together, MLA and AAHSL
    address health information issues and legislative matters of importance
    to the medical community through a joint task force.
        Mr. Chairman, the National Library of Medicine, on the campus of
    the National Institutes of Health in Bethesda, Maryland, is the world's
    largest medical library. The Library collects materials in all areas of
    biomedicine and health care, as well as works on biomedical aspects of
    technology, the humanities, and the physical, life, and social
    sciences. The collections stand at 5.8 million items--books, journals,
    technical reports, manuscripts, microfilms, photographs and images.
    Housed within the library is one of the world's finest medical history
    collections of old and rare medical works. The Library's collection may
    be accessed in the reading room or requested on interlibrary loan. NLM
    is a national resource for all U.S. health science libraries through a
    National Network of Libraries of Medicine. Increasingly, it is becoming
    an international resource for world-wide research collaboration.
        With respect to the Library's budget for the coming fiscal year, I
    would like to touch briefly on four issues: (1) the growing demand for
    NLM's basic services; (2) NLM's outreach and education services; (3)
    NLM's telemedicine and informatics activities; and (4) NLM's facility
    needs.

                  THE GROWING DEMAND FOR NLM'S BASIC SERVICES

        Mr. Chairman, it is a tribute to NLM that the demand for its
    services continues to steadily increase each year. An average of 500
    million Internet searches are performed annually on NLM's MEDLINE
    database, which provides access to the world's most up-to-date health
    care information. MEDLINEplus, NLM's extensive electronic information
    resource for the general public, is viewed approximately 200 million
    times a year. This activity dwarfs previous usage of NLM's
    bibliographic services, whether electronic or print. Moreover,
    researchers, scholars, librarians, physicians, healthcare providers
    from around the world, and the general public rely heavily on NLM and
    its National Network of Libraries of Medicine to deliver health care
    information everyday that is necessary to improve the quality of our
    nation's healthcare system.
        NLM also plays a critical role in maintaining the integrity of the
    world's largest collection of medical books and journals. Increasingly,
    this current and historical information is in digital form. This has
    fundamentally changed how the library operates--how and what it
    collects, how it preserves information, and how it disseminates
    biomedical knowledge. NLM, as a national library responsible for
    preserving the scholarly record of biomedicine, is developing a
    strategy for selecting, organizing, and ensuring permanent access to
    digital information. Regardless of the format in which the materials
    are received, ensuring their availability for future generations
    remains the highest priority of the Library.
        Mr. Chairman, simply stated, NLM is a national treasure. I can tell
    you that without NLM our nation's medical libraries would be unable to
    provide the quality information services that our nation's healthcare
    providers, educators, researchers and patients have come to expect.
        Recognizing the invaluable role that NLM plays in our health care
    delivery system, the Medical Library Association and the Association of
    Academic Health Sciences Libraries join with the Ad Hoc Group for
    Medical Research Funding in recommending a 6 percent increase for NLM
    and NIH overall in fiscal year 2006.

                             OUTREACH AND EDUCATION

        NLM's outreach programs are of particular interest to both MLA and
    AAHSL. These activities, designed to educate medical librarians, health
    care professionals and the general public about NLM's services, are an
    essential part of the Library's mission.
        The Library has taken a leadership role in promoting educational
    outreach aimed at public libraries, secondary schools, senior centers
    and other consumer-based settings. NLM's emphasis on outreach to
    underserved populations assists the effort to reduce health disparities
    among large sections of the American public. We were pleased that the
    Committee again last year recognized the need for NLM to coordinate its
    outreach activities with the medical library community.

    PubMed Central
        The medical library community also applauds NLM for its leadership
    in establishing PubMed Central, an online repository for life science
    articles. Introduced in 2000, PubMed Central was created by NLM's
    National Center for Biotechnology Information and evolved from an
    electronic publishing concept proposed by former NIH Director Dr.
    Harold Varmus. The site houses articles from some 100 journals
    including the Proceedings of the National Academy of Sciences and
    Molecular Biology of the Cell.
        The medical library community believes that health sciences
    librarians should continue to play a key role in further development of
    PubMed Central and we are pleased that medical librarians are members
    of the NLM PubMed Central Advisory Committee. Because of the high level
    of expertise health information specialists have in the organization,
    collection and dissemination of medical literature, we believe our
    community can assist NLM with issues related to copyright, fair use,
    and information classification on the PubMed Central site. We look
    forward to continuing our collaboration with the Library as this
    exciting project continues to evolve this year.

    MEDLINEplus
        NLM estimates that the public conducts 30 percent of all MEDLINE
    searching. MEDLINEplus [http://www.nlm.nih.gov/medlineplus/], a source
    of authoritative, full-text health information resources from the NIH
    institutes and a variety of non-Federal sources, has grown tremendously
    in its coverage of health and its usage by the public. In January 2003,
    two million unique users searched more than 600 ``health topics'' that
    contain detailed consumer-focused information on various diseases and
    health conditions. Recent additions to MEDLINEplus include illustrated
    interactive patient tutorials, a daily news feed from the public media
    on health-related topics, and the NIHSeniorHealth site [http://
    nihseniorhealth.gov/], a collaborative project between NLM and the
    National Institute on Aging.

    Clinical Trials
        Mr. Chairman, I also want to comment on another relatively new
    service offered by NLM--its clinical trials database [http://
    www.clinicaltrials.gov]. This listing of more than 7,000 federal and
    privately funded trials for serious or life-threatening diseases was
    launched in February of 2000 and currently logs more than 2 million
    page hits per month. The clinical trials database is a free and
    invaluable resource to patients and families interested in
    participating in cutting edge treatments for serious illnesses. The
    medical library community congratulates NLM for its leadership in
    creating ClinicalTrials.gov and looks forward to assisting the Library
    in advancing this important initiative.
        Mr. Chairman, we applaud the success of NLM's outreach initiatives
    and look forward to continuing our work with the Library again in
    fiscal year 2006 on these important programs.

                      TELEMEDICINE AND MEDICAL INFORMATICS

        Mr. Chairman, telemedicine continues to hold great promise for
    dramatically increasing the delivery of health care to underserved
    communities across the country and throughout the world. NLM has
    sponsored over 50 innovative telemedicine related projects in recent
    years, including 21 multi-year projects in various rural and urban
    medically underserved communities. These sites serve as models for:
      --Evaluating the impact of telemedicine on cost, quality, and access
            to health care;
      --Assessing various approaches to ensuring the confidentiality of
            health data transmitted via electronic networks; and
      --Testing emerging health data standards.
        It is clear that telemedicine and medical informatics program such
    as the Visible Human Project [http://www.nlm.nih.gov/research/visible/
    visible_human.html]--male and female data sets consisting of MRI, CT,
    and photographic cryosection images totaling 50 gigabytes and licenses
    to scientists at more than 1,700 institutions around the world--will
    play a major role in the delivery of health care and research in the
    21st Century.
        We are pleased that NLM has begun a new program to support
    informatics research that addresses information management problems
    relevant to disaster management. Medical librarians and health
    information specialists have an important role to play in supporting
    these cutting edge technologies, and we encourage Congress and NLM to
    continue their strong support of telemedicine and other medical
    informatics initiatives.

                              NLM'S FACILITY NEEDS

        Mr. Chairman, over the past two decades NLM has assumed several new
    responsibilities, particularly in the areas of biotechnology, health
    services research, high performance computing, and consumer health. As
    a result, the Library has had tremendous growth in its basic functions
    related to the acquisition, organization, and preservation of an ever-
    expanding collection of biomedical literature.
        This increase in the volume of biomedical information as well as
    expansion of personnel (NLM currently houses over 1,100 people in a
    facility built to accommodate 650) has resulted in a serious shortage
    of space at the Library. In addition, NLM's National Center for
    Biotechnology Information [http://www.ncbi.nlm.nih.gov] builds
    sophisticated data management tools for processing and analyzing
    enormous amounts of genetic information critical to advancing the Human
    Genome Project.
        In order for NLM to continue its mission as the world's premier
    biomedical library, a new facility is urgently needed. The NLM Board of
    Regents has assigned the highest priority to supporting the acquisition
    of a new facility. The medical library community is pleased that
    Congress appropriated the necessary architectural and engineering funds
    for facility expansion at NLM in 2003.
        We encourage the subcommittee to continue to provide the resources
    necessary to acquire a new facility and to support the Library's health
    information programs.
        Mr. Chairman, thank you again for the opportunity to present the
    views of the medical library community.
                                     ______

     Prepared Statement of the National Association of Children's Hospitals

                                    OVERVIEW

        The National Association of Children's Hospitals (N.A.C.H.) is
    pleased to have the opportunity to submit the following statement for
    the hearing record in support of the Children's Hospitals' Graduate
    Medical Education (CHGME) Payment Program in the Health Resources and
    Services Administration (HRSA).
        On behalf of the nation's 60 independent children's teaching
    hospitals, N.A.C.H. very much appreciates the Subcommittee's early and
    continuing commitment over several years to provide full, equitable GME
    funding for these hospitals, giving them a level of federal support for
    their teaching programs that seeks to be comparable to what all other
    teaching hospitals receive through Medicare.
        We also appreciate the Subcommittee's support for level funding of
    $303 million for fiscal year 2005--the amount requested by President
    Bush and recommended by N.A.C.H. Ultimately, this funding was reduced
    to $301 million, or less than level funding, by a 0.8 percent across
    the board reduction in non-defense, non-homeland security discretionary
    spending programs in the final conference report.
        For fiscal year 2006, we respectfully request an adjustment
    recognizing the cost of inflation for CHGME, which would result in
    total funding of $309 million, so that these institutions will have the
    resources necessary to train and educate the nation's pediatric
    workforce. Such an adjustment is important for a program with both
    wage-related and medical teaching costs associated with it. Given the
    challenges that the Subcommittee faces, we hope that at a minimum the
    program can at least be maintained at level funding and not lose
    further ground in fiscal year 2006.
        N.A.C.H. is a not-for-profit trade association, representing more
    than 125 children's hospitals across the country. Its members include
    independent acute care children's hospitals, acute care children's
    hospitals organized within larger medical centers, and independent
    children's specialty and rehabilitation hospitals. N.A.C.H. seeks to
    serve its member hospitals' ability to fulfill their four-fold missions
    of clinical care, education, research and advocacy devoted to the
    health and well being of all children in their communities.
        Children's hospitals are regional and national centers of
    excellence for children with serious and complex conditions. They are
    centers of biomedical and health services research for children, and
    they serve as the major training centers for future pediatric
    researchers, as well as a significant number of our children's doctors.
    These institutions are major safety net providers, serving a
    disproportionate share of children from low-income families, and they
    are also advocates for the public health of all children.
        Although they represent less than 5 percent of all hospitals in the
    country, the three major types of children's hospitals provide 41
    percent of the inpatient care for all children, 42 percent of the
    inpatient care for children assisted by Medicaid, and the vast majority
    of hospital care for children with serious conditions such as cancer or
    heart defects.

               BACKGROUND: THE NEED FOR CHILDREN'S HOSPITALS GME

        While they account for less than 1 percent of all hospitals, the
    independent children's teaching hospitals alone train nearly 30 percent
    of all pediatricians, half of all pediatric specialists and a majority
    of future pediatric researchers. They also provide required pediatric
    rotations for many other residents. They train about 4,000 residents
    annually, and the need for these training programs is even more
    heightened by the growing evidence of shortages in pediatric
    specialists around the country.
        Prior to initial funding of the CHGME program for fiscal year 2000,
    these hospitals were facing enormous challenges to their ability to
    maintain their training programs. The increasingly price competitive
    medical marketplace was resulting in more and more payers failing to
    cover the costs of care, including the costs associated with teaching.
        The independent children's hospitals were essentially left out of
    what had become the one major source of GME financing for other
    teaching hospitals, Medicare, because they see few if any Medicare
    patients. They received only 1/200th (or less than 0.5 percent) of the
    federal GME support that all other teaching hospitals received under
    Medicare.
        This lack of GME financing, combined with the financial challenges
    stemming from their other missions, was threatening their teaching
    programs, as well as other important services.
        Integral Safety Net Institutions.--In addition to their teaching
    missions, the independent children's hospitals are a significant part
    of the health care safety net for low-income children. In fiscal year
    2003, children assisted by Medicaid represented, on average, 47 percent
    of all discharges from free-standing acute care children's hospitals
    and accounted for about 50 percent of all inpatient days of care. Yet
    Medicaid, on average, reimbursed 80 percent of the cost of care
    provided. Without disproportionate share hospital payments, those
    reimbursements would only cover, on average, 73 percent of the cost of
    care. The shortfalls in Medicaid payments for outpatient and physician
    care are even greater. . The independent children's hospitals also are
    essential providers of care for seriously and chronically ill children.
    They devote more than 75 percent of their care to children with one or
    more chronic or congenital conditions. They provide the vast majority
    of inpatient care to children with many serious illnesses--from
    children with cancer or cerebral palsy, for example, to children
    needing heart surgery or organ transplants. In some regions, they are
    the only source of pediatric specialty care. The severity and
    complexity of illness and the services and resources that these
    institutions must maintain to assure access to this quality care for
    all children are also often inadequately reimbursed.
        Mounting Financial Pressures.--The CHGME program, and its
    relatively quick progress to full funding in fiscal year 2002, came at
    a critical time. In 1997, when Congress first considered establishing
    CHGME, a growing number of independent children's teaching hospitals
    had financial losses, and many more faced mounting financial pressures.
    More than 10 percent had negative total margins, more than 20 percent
    had negative operating margins, and nearly 60 percent had negative
    patient care margins. Some of the nation's most prominent children's
    hospitals were at financial risk. Thanks to the CHGME program, these
    hospitals have been able to maintain and strengthen their training
    programs.
        Continuing this critical CHGME funding is more important for these
    hospitals than ever in light of state budget shortfalls in many states
    and the resulting pressures for significant reductions in state
    Medicaid spending. Because children's hospitals devote such a
    substantial portion of their care to children from low-income families,
    they are especially affected by cutbacks in state Medicaid programs.
        Pediatric Workforce Development.--The important role the CHGME
    program plays in the continual development of our nation's pediatric
    workforce is not lost on the larger pediatric community, including the
    American Academy of Pediatrics and Association of Medical School
    Pediatric Department Chairs The pediatric community supports this
    program and recognizes that CHGME is critical not only to the future of
    the individual hospitals, but also to provision of children's health
    care and advancements in pediatric medicine overall.
        Lastly, many of the independent children's hospitals are a vital
    part of the emergency and critical care services in their communities
    and regions. They are part of the emergency response system that must
    be in place for public health emergencies. Expenses associated with
    preparedness add to their continuing costs in meeting children's needs.

                             CONGRESSIONAL RESPONSE

        In the absence of any movement toward broader GME financing reform,
    Congress in 1999 authorized the Children's Hospitals' GME discretionary
    grant program to address the existing inequity in GME financing for the
    independent children's hospitals. The legislation was reauthorized in
    2000 through fiscal year 2005 and provided $285 million through fiscal
    year 2001 and such sums as may be necessary in the years beyond.\1\
    Congress passed the initial authorization as part of the ``Healthcare
    Research and Quality Act of 1999'' and the reauthorization as part of
    the ``Children's Health Act of 2000.''
    ---------------------------------------------------------------------------
        \1\ The Lewin Group, an independent health policy analysis firm
    calculated in 1998 that independent children's teaching hospitals
    should receive approximately $285 million in federal GME support for
    nearly 60 institutions to achieve parity with the financial
    compensation provided through Medicare for GME support to other
    teaching hospitals.
    ---------------------------------------------------------------------------
        With the support of this Subcommittee, Congress appropriated
    initial funding for the program in fiscal year 2000, before the
    enactment of its authorization. Following enactment, Congress moved
    substantially toward full funding for the program in fiscal year 2001
    and completed that goal, providing $285 million in fiscal year 2002,
    $290 million in fiscal year 2003, $303 million in fiscal year 2004 and
    $301 million in fiscal year 2005. (In the last 2 fiscal years, the
    funding levels are net of across-the-board reductions in all non-
    defense, non-homeland security discretionary appropriations.) The
    annual CHGME appropriations represent an extraordinary achievement for
    the future of children's health care as well as for the nation's
    independent children's teaching hospitals.
        Health Resources and Services Administration.--The CHGME funding
    appropriated by Congress is distributed through HRSA to 60 children's
    hospitals according to a formula based on the number and type of full-
    time equivalent (FTE) residents trained, in accordance with Medicare
    rules, as well as the complexity of care and intensity of teaching the
    hospitals provide. Consistent with the authorizing legislation, HRSA
    allocates the annual appropriation in bi-weekly periodic payments to
    eligible independent children's hospitals.
        ``Adequate'' Rating From Administration.--The Office of Management
    and Budget gave CHGME an ``adequate'' rating in 2003, using its Program
    Assessment Rating Tool (PART). The PART review said CHGME has a ``clear
    purpose,'' is ``effectively targeted,'' has specific ``long-term
    performance measures'' that focus on outcomes, and holds grantees
    ``accountable for cost, schedule, and performance results.''

                            FISCAL YEAR 2006 REQUEST

        N.A.C.H. respectfully requests that the Subcommittee continue
    equitable GME funding for the independent children's hospitals by
    providing $309 million for the program in fiscal year 2006, which would
    provide an adjustment for inflation over current funding. We, of
    course, hope that such an adjustment could be provided, since it is
    particularly important for a program that includes both wage-related
    and medical teaching costs. Given the challenges that the Subcommittee
    faces, we hope that the program at least can be maintained at level
    funding and not lose further ground in fiscal year 2006.
        Adequate, equitable funding for CHGME is an ongoing need.
    Children's hospitals continue to train new pediatric residents and
    researchers every year. Children's hospitals have appreciated very much
    the congressional support they have received, including the attainment
    of the program's authorized full funding level in fiscal year 2002 and
    continuation of full funding with an inflation adjustment in fiscal
    year 2003 and fiscal year 2004. Now, N.A.C.H. asks Congress to maintain
    this progress by providing $309 million in fiscal year 2006.
        Support for a strong investment in GME at independent children's
    teaching hospitals is consistent with the repeated concern the
    Subcommittee has expressed for the health and well-being of our
    nation's children--through education, health and social welfare
    programs. It also is consistent with the Subcommittee's repeated
    emphasis on the importance of enhanced investment in the National
    Institutes of Health (NIH) overall, and in NIH support for pediatric
    research in particular, for which we are very grateful.
        The CHGME funding has been essential to the ability of the
    independent children's hospitals to sustain their GME programs. At the
    same time, it has enabled them to do so without sacrificing support for
    other critically important services that also rely on hospital subsidy,
    such as many specialty and critical care services, child abuse
    prevention and treatment services, poison control centers, services to
    low-income children with inadequate or no coverage, mental health and
    dental services, and community advocacy, such as immunization and motor
    vehicle safety campaigns.
        In conclusion, the Children's Hospitals GME Payment Program is an
    invaluable investment in children's health. The future of the pediatric
    workforce and children's access to quality pediatric care, including
    specialty and critical care services, could not be assured without it.
    Again, N.A.C.H. and the nation's independent children's teaching
    hospitals are deeply grateful to the Chairman and the Subcommittee for
    your continuing leadership on behalf of the teaching missions of
    children's hospitals.
        For further information, please contact Peters D. Willson, vice
    president for public policy, N.A.C.H., at 703/797-6006 or
    pwillson@nachri.org.
                                     ______

              Prepared Statement of the National AHEC Organization

                  SUMMARY OF FISCAL YEAR 2006 RECOMMENDATIONS

        1. Increase funding for the health professions and nursing
    education programs under Title VII and Title VIII of the Public Health
    Service Act to at least $550 million for fiscal year 2006.
        2. Restore funding for Area Health Education Centers (AHECs) to
    fiscal year 2003 level of $33.1 million.
        3. Restore funding for Health Education Training Centers (HETCs) to
    fiscal year 2003 level of $4.3 million.
        Mr. Chairman, and members of the subcommittee, I am pleased to
    present testimony on behalf of the National AHEC Organization.
        I am Linda Kanzleiter, and I work for the Pennsylvania Statewide
    AHEC Program and am a member of the National AHEC Organization (NAO).
    NAO is the professional organization representing the Area Health
    Education Centers (AHECs) and Health Education Training Centers
    (HETCs). Together, we seek to enhance access to quality health care,
    particularly primary care and preventative care, by improving the
    supply and distribution of health care professionals through
    community--academic partnerships

                         PERSISTENT WORKFORCE SHORTAGES

        Mr. Chairman, contrary to what may be commonly understood,
    persistent and severe shortages exist in a number of health
    professions. Chronic shortages exist for all health professions in many
    of our nation's underserved communities, and substantial shortages
    exist in all communities for some professions such as nursing,
    pharmacy, and certain allied health fields. While the supply of
    physicians in the non-primary care specialties may well be adequate,
    supply and distribution problems for primary care physicians, nurses,
    and many allied health professionals are undermining access and quality
    in many of our nation's communities.
        Historically, the supply of and demand for health care
    professionals has waxed and waned in a manner that produced cycles of
    shortage and excess. However, it is reasonable to believe that the
    current shortages are of a different and more persistent nature. First,
    the breadth and depth of shortages are greater than at any time in the
    past. More disciplines are in short supply, more sites of care
    (hospitals, nursing homes, home care agencies, and clinics) are
    experiencing shortages, and the duration of vacancies is longer.
    Second, the demand for health care services is steadily and inexorably
    increasing due to the aging population and the advances in medical
    technology. Third, the health care provider population is aging itself.
    Fourth, the resources with which the health care industry might respond
    to shortages are inadequate to the challenges. Due to the squeeze of
    managed care, provider institutions are unable to increase salaries,
    and due to cuts in government funding, educational institutions are
    unable to expand class sizes. Finally, the career opportunities
    available to women, who dominate the health care professions, have
    expanded greatly.
        Health care workforce shortages are occurring in a context of an
    increasingly aged population with greater needs for health care
    services. In addition, health technology steadily produces advances
    that require a higher level of training and sophistication on the part
    of health care providers. These trends are occurring at time when the
    number and the level of academic preparedness of students entering the
    health professions are decreasing.
        In addition, minority and disadvantaged populations are egregiously
    under represented in the health professions. Given the demographic
    trends in the United States, minority populations constitute a major
    untapped source of future health care professionals.

                               THE ROLE OF AHECS

        Mr. Chairman, the AHEC/HETC network is the federal government's
    most flexible and efficient mechanism for addressing a wide and
    evolving variety of health care issues on a local level. Through AHECs
    and HETCs, national initiatives can be targeted to the areas of
    greatest need and molded to the particular issues confronting
    individual communities. Whether the issue is the nursing shortage,
    bioterrorism preparedness, access for the uninsured, or recruiting
    under-represented minority students into the health professions, AHECs
    and HETCs, where they exist, can assemble the appropriate local
    collaboration and apply federal, state, and local resources in a
    precise and cost-effective manner.
        Since our inception almost thirty years ago, AHECs have partnered
    with local, state, and federal initiatives and educational institutions
    in providing clinical training opportunities to health professions and
    nursing students in rural and underserved communities. We bring the
    resources of academic health centers to bear in addressing the health
    care needs of these communities. Currently, there are 48 AHEC programs
    and 180 centers located in 43 states and the District of Columbia. AHEC
    programs are based at schools of medicine, which are the federal AHEC
    grant recipients, and are implemented through the regional offices
    (centers), each of which serves a defined geographic area.

                  AHEC PROGRAMS PERFORM FOUR BASIC FUNCTIONS:

        1. They develop and support the community based training of health
    professions students, particularly in underserved rural and urban
    areas. Exposing health professions students to underserved communities
    increases the likelihood that they will return to these communities to
    practice.
        When considering access, Pennsylvania faces some unique challenges.
    For example, The Pennsylvania Department of Health estimates that about
    1,259,441 people in our Commonwealth do not have health insurance of
    any kind. Of that number, 109,883 are persons within the five counties
    we serve. The National Association of Community Health Centers
    estimates that, in Pennsylvania, at least 1,479,087 people are
    ``without a primary care provider''. This figure represents more than
    12 percent of Pennsylvania's total population (12,281,054). This number
    is likely higher because eight counties, including Carbon & Lehigh,
    were not included in their data.
        Pennsylvania AHECs have developed a network of over 972 health care
    training sites, 3,632 students and residents, and 1,045 on-site
    preceptors providing service to patients at these training centers.
        2. They provide continuing education and other services that
    improve the quality of community-based health care. Improving the
    quality of care also enhances the retention of providers in underserved
    communities, particularly community health centers.
        A crucial part of our mission in Pennsylvania involves linking
    fourth year medical students with Medical Preceptors, mentors and
    teachers in the community. Our goal is to help facilitate the process
    that allows the students to become familiar with the issues encountered
    in rural communities. The student can also begin to establish
    relationships, which will prove beneficial should they decide to
    practice in a rural area. In this way, Pennsylvania AHECs support the
    viability and, often, the continued, independent existence of small
    community hospitals.
        The Northeast Pennsylvania Area Health Education Center surveyed
    physicians in the rural counties it serves to clarify issues
    surrounding continuing education. The overwhelming response was that
    there was a desire for more information about bioterrorism, and that it
    should be accessible online. The Pennsylvania Department of Health
    subsequently created the Learning Management System (LMS), a web-based
    system for education and information-sharing regarding bioterrorism and
    other public health issues. The LMS delivers emergency preparedness
    training and access to up to date information to the hands of health
    professionals, day or night. The LMS serves as an information library,
    a forum for discussion groups, and means of surveying program content
    online.
        3. They recruit under-represented minority students into the health
    professions through a variety of programs targeted at elementary
    through high schools. Minority students are grossly under-represented
    in the health professions and are more likely to practice in
    underserved communities.
        The Northwest Pennsylvania AHEC has developed a program called the
    Great Hospital Adventure Puppet Presentation. The multi-media
    presentation includes a live puppet show, video movie, coloring book,
    classroom poster, and an interactive question and answer session. This
    program promotes health career awareness and encourages healthy
    behaviors for children aged four to nine. The classroom materials and
    activities emphasize non-traditional gender roles and multi-cultural
    images. The goal of the presentation is to attract children of all
    genders, backgrounds and cultures to health professions.
        The Northeast Pennsylvania AHEC established a summer camp called
    ``Exploring Careers in Health'' for high school students who
    demonstrate a strong interest in medicine or health care. The camp is a
    weeklong program held on the campus of Keystone College. Students must
    apply for admission, and the camp provides an in-depth look at the
    health care field by participation in workshops with health
    professionals, hands-on activities, and field trips. Students are
    encouraged to explore numerous career choices as health professionals.
        Additionally, the Northeast Pennsylvania sponsors a program for
    area teachers and guidance counselors called ``Seeds for Success.'' The
    program offers an overview of health career opportunities at colleges,
    universities and post-secondary institutions in the surrounding area.
    The response to the program was overwhelmingly positive.
        4. They facilitate and support practitioners, facilities, and
    community based organizations in addressing critical local health
    issues in a timely and efficient manner.
        Only 13 percent of primary care physicians in Pennsylvania serve in
    rural communities. However, 42 of the state's 67 counties are
    predominantly rural and 7 counties are completely rural. These
    startling facts are the driving force behind the health care
    professions workforce development resolution.

                               THE ROLE OF HETCS

        The HETC programs were created to address the public health needs
    of severely underserved populations in border and non-border areas.
    Currently, HETC programs exist in 12 states and are supported by a
    combination of federal, state, and local funding, the majority of which
    comes from non-federal sources.
        Because the majority of preventable health problems are due to
    health behaviors and the environment, HETCs focus on community health
    education and health provider training programs in areas with severely
    underserved populations. HETCs target minority groups, disadvantaged
    communities, and communities with diverse culture and languages.

                             COLLABORATIVE EFFORTS

        Virtually all AHEC and HETC programs are collaborative in nature.
    They routinely partner with a wide variety of federal, state, and
    locally funded programs. Examples of these collaborations include
    health professions schools, primary care residency programs, community
    health centers, primary care associations, geriatric education centers,
    the National Health Service Corps, public health departments, health
    career opportunity programs, school districts, and foundations.
        Additionally, AHECs and HETCs often go beyond their core functions
    to undertake a wide variety of innovative programs, tailored to
    specific health issues affecting the communities they serve. Because
    health issues vary from community to community, the programs of each
    AHEC and HETC also vary considerably. AHECs and HETCs respond to
    changing health and health workforce needs in a flexible and timely
    manner. Examples of current issues for which we are directing our
    resources are:
        1. The nursing shortage.--Currently, AHECs and HETCs are working
    with schools of nursing, state nursing associations, and others to
    increase the number of qualified applicants to nursing schools,
    increase minority enrollment in nursing schools, expand the number of
    community-based nursing training sites, and re-train nurses who wish to
    re-enter the profession.
        The Northcentral Pennsylvania AHEC facilitated the Nursing Forum,
    titled Joining Healing Hands: Communication, Collaboration, and
    Teambuilding, to enhance regional nursing recruitment and retention
    efforts within their 10 county region on Friday, February 27, 2004 in
    Lewisburg, Union County. Participating nurses, nurse administrators,
    healthcare representatives, and nursing educators explored ways to
    strengthen communication, leadership skills, and teamwork to create a
    shared vision and commitment to quality healthcare. Skill sets
    encouraged at the forum promoted a shared commitment to quailty
    healthcare, fostered positive outcomes, encouraged inclusion of
    collaborative educational efforts, and supported the recruitment and
    retention of a diversified workforce.
        2. Bioterrorism education.--Currently, AHECs and HETCs are working
    with public health departments to educate health and public health
    professionals on surveillance, reporting, risk communication,
    treatment, and other responses to the threat of bioterrorism.
        3. The National Health Service Corps (NHSC).--AHECs and HETCs
    undertake a variety of programs related to the placement and support of
    NHSC scholars and loan repayment recipients.
        The Pennsylvania State University AHEC has actively supported the
    NHSC ``SEARCH'' program by interviewing prospective students,
    recommending community preceptors, and monitoring placements of
    students each summer in rural and underserved sites.
        4. Expansion of community health centers.--AHECs and HETCs are
    collaborating with health professions schools, primary care
    associations, and community health centers to increase the supply of
    providers willing and able to work in community health centers. In
    addition, AHECs/HETCs are working directly with CHC providers to
    improve the quality of care.

                   JUSTIFICATION FOR FUNDING RECOMMENDATIONS

        Mr. Chairman, I respectfully ask the Subcommittee to support our
    recommendations to increase funding for the health professions and
    nursing education programs under Title VII and Title VIII of the Public
    Health Service Act to at least $550 million for fiscal year 2006. Our
    recommendations are consistent with those of the Health Professions and
    Nursing Education Coalition (HPNEC).
        The AHEC and HETC programs improve access to primary and
    preventative care through community partnerships, linking the resources
    of academic health centers with local communities. AHECs and HETCs have
    proven to be responsive and efficient models for addressing an ever-
    changing variety of community health issues.
        However, AHECs and HETCs have not yet fully realized their
    potential to be a nationwide infrastructure for local training and
    information dissemination. In order to realize that potential
    additional federal investment is required. That is why we are
    requesting that in fiscal year 2006, you restore funding to fiscal year
    2003 levels of $33.4 million for AHECs and $4.3 million for HETCs.
                                     ______

       Prepared Statement of the State Educational Technology Directors
                              Association (SETDA)

         NCLB TITLE II, PART D: ENHANCING EDUCATION THROUGH TECHNOLOGY

        On behalf of SETDA representing all fifty states, DC, and American
    Samoa, we encourage you to restore NCLB Title II, Part D--Enhancing
    Education through Technology (EETT) program to its fiscal year 2004
    funding level of $692 million. In fiscal year 2005, this program
    sustained a 28 percent cut, which has not yet been realized in schools
    across the country due to the grant award cycle. This testimony
    documents how states leverage EETT funding to ensure the ability of
    states, districts, and schools to implement all Titles within NCLB,
    specifically:
      --Enhancing data systems to ensure that educators can utilize real-
            time data to inform sound instructional decisions and ensure
            that states are able to meet AYP.
      --Closing the achievement gap by providing access to software, online
            resources, and virtual learning aligned to academic standards
            for instruction and learning.
      --Supporting the development of highly qualified teachers by
            providing online courses, communities of practice, and virtual
            communication that ensure flexibility and access.
        The data and examples illustrate how forty-nine states and DC
    (representing 99 percent of federal education technology funding)
    utilize EETT funding. 81 percent of school districts in this country
    receive and use EETT funding. States maintain 5 percent for technical
    assistance and administration and disseminate the remaining 95 percent
    equally between two programs:
        1. The Formula Grant Program by which high need districts receive
    an allotment based upon poverty rates.
        2. The Competitive Grant Program through which states establish
    areas of focus for districts to compete for the grants. Each grantee
    must include at least one high need district.

                                THE MYTH OF EETT

        Some believe that EETT is utilized primarily to purchase computers
    or ``the boxes in the back of the classroom.'' The SETDA National
    Trends Report and examples provided demonstrate that this is not the
    case. The majority of this funding supports the purchase of curriculum,
    provides professional development to ensure teachers are highly
    qualified, and builds systems for assessment, data and accountability
    mechanisms. Some grantees may use small amounts of the funding to
    purchase hardware integral to the students' education, i.e. laptops
    that children in rural areas bring home to expand learning
    opportunities; however the overwhelming majority of the funding is
    utilized to support the successful implementation of NCLB that is
    highlighted below.
       meeting ayp and improving student achievement through data systems

    Key Facts
        Data management and accountability requirements are steadily rising
    and states have a limited capacity for meeting these requirements. EETT
    funds are the only source of federal funding for most states to use in
    developing the data systems needed to report AYP results mandated
    through NCLB. These funds are being used toward data systems that
    impact both instructional and administrative aspects of education. On
    the instructional side, the National Trends Report cites many examples
    of EETT funds being used to train teachers in understanding how to use
    data effectively to individualize learning and to make real-time
    modifications to instruction in order to best meet the needs of every
    learner. The report also cites multiple examples of state and district-
    wide data management systems that allow for increased accountability
    and reporting.
        While professional development and student achievement are still
    extremely important in EETT, the program has seen a tremendous increase
    in the number of states (78 percent) that are using these technology
    funds for three other key NCLB priorities--assessment, outreach to
    parents, and data-driven decision-making.

    Examples
        The Philadelphia Instructional Management System (IMS) is part of
    the School District of Philadelphia's comprehensive reform effort that
    includes new resources, a standardized curriculum, after school
    programs, and professional development. IMS provides teachers and
    administrators with immediate data on student learning aligned to State
    and District standards. A benchmark assessment, given every five weeks,
    allows teachers to differentiate instruction, provide immediate
    remediation, and identify those students who need additional
    assistance. Teachers, coaches, and administrators have access to
    student performance data through an online system. This system also
    provides suggested resources and strategies teachers can use to meet
    unique student needs. In 2003, before these technology tools were
    provided to teachers, only 9 of the 40 initial participating schools
    had met AYP; and 15 were identified for Corrective Action. At the end
    of the 2004 school year, 25 schools met their AYP targets, and only 10
    remained in Corrective Action II.
        In Vermont, school districts are using EETT funds to develop local
    student data systems or to join the statewide Vermont Data Consortium
    which is working with the Department of Education to create a statewide
    Education Data Warehouse. These data efforts support teachers using
    data to inform instruction and facilitate reporting of AYP data.
        States are finding that as they make more and more data available,
    teachers need help in understanding and using this data to inform their
    teaching and to help individualize and improve student learning. A good
    example of this is in the Blackfoot School District in Idaho where EETT
    funds are used with particular attention to K-12 mathematics. Through
    this program, teachers use data to identify student needs and then use
    technology to meet these needs. They are also able to provide ongoing
    professional development for teachers that otherwise would have been
    impossible without the Title II D funds.
        Maryland is using EETT funds for curriculum management systems. If
    a child is not mastering certain standards, this provides them with
    lesson plans and remediation activities to help get them up to par.

                      HELPING TO CLOSE THE ACHIEVEMENT GAP

    Key Facts
        The requirement for EETT funds to be targeted to high need
    districts ensures that students who are most at risk will benefit from
    additional opportunities. EETT funds are helping to close the
    achievement gap by providing students with access to software, web
    courses, and virtual learning opportunities that are aligned to state
    standards. This is particularly important in areas where teachers in
    certain disciplines are difficult to find, such as foreign language,
    Advanced Placement (AP), or higher level science and math courses. With
    access to online opportunities, students in rural or high need areas
    have opportunities similar to other students in the state.
        Many states have steered EETT funds to core-curricular areas, such
    as reading, math and science, by establishing content priorities in
    their competitive grant processes: 74 percent of states created funding
    priorities in reading or writing, while 38 percent focused on
    mathematics.

    Examples
        The Missouri eMINTS program provides classrooms with advanced
    software, intense professional development and Internet access to
    support standards-based instruction. Three years of data from a quasi-
    experimental evaluation of the eMINTS program showed a significant
    improvement in third and fourth grade achievement on the Missouri
    Assessment Program (MAP) test results for African Americans. The study
    also noted that the achievement gap was closed between those African
    American students who participated in the program and White students
    who did not. The success of the eMINTS program is now being replicated
    in the state of Utah.
        Researcher Dale Mann (ASBO, 2003) cited a direct correlation
    between pupil performance and technology in instruction through West
    Virginia's Basic Skills/Computer Education program. The study found
    that while per capita income had not changed between 1991 and 1998, the
    infusion of technology was the single factor that accounted for the
    state moving from 33rd among the states for student achievement to
    11th.
        In Virginia, EETT funds have been used to develop an online
    Advanced Placement school. This program provides benefits to Virginia's
    students who are most in need, primarily rural and urban students, who
    otherwise would not have access to AP teachers or courses. A similar
    West Virginia project provides foreign language opportunities using
    online technologies. Preliminary findings through a scientifically-
    based research evaluation indicate that courses delivered online are as
    effective as courses delivered face to face--expanding the
    opportunities for closing the achievement gap between students in
    remote areas.
        In region 4 of New York City, EETT funds have allowed student
    access to Cyber English, Social Studies, Math and Science classes. High
    schools are no longer limited by time and space and learning has become
    a 24/7 activity. This model has improved school attendance, engaged
    previously uninterested students, allowed students from diverse
    neighborhoods to collaborate, and finally provided parents a vehicle
    for becoming involved in their teenager's education.
        In North Carolina, the cuts will result in a limitation on nine
    very successful Community Technology Learning Centers. These centers
    have offered after-school and weekend programs for needy students and
    their parents. Most of these centers will either close or drastically
    scale back their services without EETT funding.
        North Dakota has established a rural consortium to implement the
    ``Unified Education Project (UEP), which focuses on creating
    individualized learning plans for each student based on his or her
    strengths and weaknesses. Using an electronic portfolio, the UEP helps
    teachers track needs and provide appropriate instruction and
    remediation, allows the students to view standards and expectations and
    assess their own work accordingly, and encourages parent communication.
    The UEP allows for individualized instruction to ensure that schools
    and districts can meet AYP.

             IMPROVING TEACHER TRAINING, RETENTION, AND RECRUITMENT

    Key Facts
        EETT requires that at least 25 percent ($147,000,000) of all EETT
    funds be used for professional development purposes, although most
    states use considerably more. EETT funds help to increase the access by
    providing online options that give teachers anytime, anyplace access to
    quality professional development. This is critical to ensure that
    teachers have the opportunity to increase content knowledge, improve
    instruction, and become highly qualified teachers.
    Examples
        Algebra I is often a predictor for success in high school and
    beyond. Louisiana implemented an on-line Algebra I course to provide
    additional opportunities for student achievement. Preliminary
    evaluations indicate that students in the on-line course, with similar
    pre-test scores are showing more significant achievement gains compared
    to the control group as indicated below:

    ------------------------------------------------------------------------
                                                                  Post-test
                         Group                        Pre-test     (spring)
                                                    (fall) mean      mean
    ------------------------------------------------------------------------
    Algebra I Online Students.....................         13.3         17.2
    Control Students..............................         13.4         15.6
    ------------------------------------------------------------------------

        In Nevada, a middle school science partnership is beginning to show
    evidence of closing the achievement gap in participating schools. The
    partnerships between the University of Nevada, Reno and five rural
    Nevada school districts provides professional development to teachers
    to make them better able to assess their students and use technology to
    increase student achievement in math. The ability of these teachers to
    have access to the rigorous university research and the professional
    development to effectively bring about increases in student achievement
    in science.
        The North Carolina IMPACT Model Schools Grant provides personnel,
    connectivity, hardware, software, and professional development to
    impact teaching and learning to improve student achievement in
    participating elementary or middle schools. One initial finding from
    this evaluation is that participating schools have dramatically
    improved their ability to attract and retain teachers. Teachers who are
    scheduled to retire often choose to stay in these IMPACT schools,
    others request transfers into them, and new teachers clamor to be
    hired. ``These teachers like the way technology is changing the way
    they teach, and the enthusiasm with which their students approach
    learning,'' says Frances Bryant Bradburn, Director of Instructional
    Technology for the North Carolina Department of Public Instruction.
        In the center of Wyoming, there are many small, rural school
    districts that do not have the capacity to create aggressive staff
    development plans. The local Board of Cooperative Education Services
    formed a partnership between six districts focused on helping teachers
    to improve instruction through learning environments. For the first
    time, classes are using smart boards, establishing wireless
    connections, conducting Internet research, and attending compressed
    video classes.
        In Massachusetts, reports from independent evaluators of the EETT
    grant projects and the year-end reports submitted by grant recipients
    show substantial improvement in teacher technology literacy. The use of
    the state's online interactive Technology Self-Assessment Tool (TSAT)
    helps in measuring the progress of teachers' technology skills in the
    different levels. For example, in a Gloucester Public Schools' project,
    there was an increase from 8.5 percent to 27 percent in the number of
    educators at the Proficient level and a decrease from 33.5 percent to
    20 percent in number at the Early Technology level (the lowest level).
        Iowa utilized EETT funds to implement comprehensive professional
    development programs for teachers targeted at core subject areas.
    Initial results from one consortium focusing on mathematics demonstrate
    an increase in student achievement among 4th grade students compared to
    the control group. Iowa is seeing similar results in reading throughout
    the state.

                             IMPACT OF CUTTING EETT

        Education technology is about more than technology--it's about
    education. The EETT program supports every tenet and goal of the No
    Child Left Behind Act. It would be impossible to effectively implement
    NCLB without the technical expertise and leadership the EETT program
    brings. As representatives of the states and districts who make the
    most critical use of educational technology, we urge you to restore the
    funding to $692 million, the funding level that was in place before the
    Omnibus appropriations in November 2004.
        Not only does EETT help improve student achievement through
    technology, it is an efficient use of federal funds. Dale Mann (ASBO,
    2003) notes that districts have two options when trying to increase
    reading scores by one month in grade-level gains: decreasing class size
    or utilizing technology. Class-size reduction would cost approximately
    $636 per student per year compared to $86 for instructional technology.
    EETT provides additional opportunities to help increase student
    achievement.
        The targeted funds for educational technology that are available
    through the EETT program are still very much needed as we work to
    ensure that all students are ready to compete in the global economy. It
    is unrealistic to assume that these technology funds and the leadership
    and innovation that accompany them would be effectively managed through
    other existing education title programs such as Title I and Title IIA.
    These Title programs have not received additional funds to pay for the
    mission critical technology components of their initiatives. Other
    Title programs, unlike EETT, support narrowly defined student
    populations and training purposes rather than the broader mission of
    supporting all students and all programs as EETT currently does.
    Finally, the leadership and expertise needed to implement successful
    data driven decision making, curriculum management systems, online
    professional development, and reporting processes for NCLB would be
    lost if there was an attempt to subsume educational technology planning
    and implementation under these already established programs.
    About SETDA--http://www.setda.org
        The State Educational Technology Directors Association (SETDA) is
    the principal association representing the state directors for
    educational technology. SETDA's membership includes educational
    technology directors and staff from the state departments of education
    of all fifty states, the District of Columbia and American Samoa.
                                     ______

        Prepared Statement of the National Education Knowledge Industry
                                  Association

        NEKIA appreciates the opportunity to inform the Subcommittee of
    NEKIA's appropriations proposals for fiscal year 2006. The mission of
    our association is to advance the development and utilization of
    research-based knowledge for the improvement of the academic
    performance of all children. NEKIA's members are committed to finding
    new and better ways to support and expand high-quality education
    research, development, dissemination, technical assistance, and
    evaluation at the federal, regional, state, tribal, and local levels.
        Our appropriations proposals seek greater federal investments that
    will support the use of research-based knowledge in America's K-12
    classrooms and spur the implementation of the No Child Left Behind Act
    and the Education Sciences Reform Act. These two laws ushered in a new
    era of evidence-based education in which classroom teachers are
    required to use instructional practices based on scientifically based
    research. Our proposals for fiscal year 2006 are also designed to
    address both greater demand for evidence-based education and under-
    funded supply.

              NEKIA'S PROPOSALS ARE BASED ON THREE CRITICAL POINTS

        1. Now is the time to enhance and expand the federal system of
    education research, development, dissemination, and technical
    assistance.--Federally supported programs--specifically the Regional
    Educational Labs, the R&D Centers, the Comprehensive Centers and
    Comprehensive School Reform--are playing a vital role in meeting the
    tremendous needs for research-based practices and technical assistance.
    Each of these programs fills a unique role in the spectrum of knowledge
    utilization--from basic research to applied research, from development
    and dissemination to technical assistance, and ultimately student
    achievement. Given that more than 20,000 U.S. public schools are not
    making adequate yearly progress and 10,000 schools are in need of
    improvement under the No Child Left Behind Act, we must become more
    aggressive in using research-based education solutions in the
    classroom.
        NEKIA's members are fully supporting the implementation of No Child
    Left Behind through applied research, development, dissemination,
    technical assistance, and evaluation programs. For example:
        2. Current federal support for education research, development,
    dissemination, and technical assistance lags far behind other federal
    research investments.--While the No Child Left Behind Act clearly
    requires educators to use instructional practices and innovations
    supported by research, the Department of Education spends less than one
    percent of its budget on research, development, and statistics.
    Education is a $745 billion industry representing an estimated 7.2
    percent of the gross domestic product. However, only 0.03 percent is
    spent on research and development. That is only three cents for every
    hundred dollars spent on education. In comparison, other agencies' R&D
    budgets as percentage of their discretionary spending: Defense, 17
    percent; NASA, 68 percent; Energy, 37 percent; HHS, 42 percent; NSF, 74
    percent; and Agriculture, 4.6 percent. In other words, the Department
    of Education's research budget has been and remains among the smallest
    of any federal agency.
        3. To address this capacity crisis we urge Congress to double its
    investments in education knowledge utilization over the next 3 years.--
    Not only would increased investments help meet demand, they would also
    address a number of high priorities such as:
      --Improving teacher quality by providing research based information
            on best practices to teacher training institutions as well as
            information and technical assistance to schools districts
            implementing professional development programs.
      --Helping special populations of students meet state adequate yearly
            progress goals. These special populations include English
            language learners, special needs children, and students in
            rural areas.
      --Working with educators to interpret and manage a variety of data
            about student performance and classroom instruction.
      --Scaling up school improvement efforts at the local level so that
            reform efforts in single schools can expand to districtwide
            initiatives.
        To adequately respond to the capacity crisis and meet these
    priorities, NEKIA proposes the following investments:
    Priority Investment.--Fund the Regional Educational Laboratories at $70
            million--an increase of $3 million over fiscal year 2005
        The Regional Educational Laboratories are the nation's key
    institutions for applied education research and development that
    respond to the needs of educators and policy makers. A 2000 Department
    of Education independent evaluation found that educators considered the
    labs among the most trusted institutions in the nation for research
    support and reported they were highly responsive to customers. They are
    also highly responsive to local and regional needs. Regional governing
    boards--representing educators, parents, and businesses from each state
    of each lab region--set research and development priorities for each
    lab. The ability to respond to customers in their regions helps keep
    the laboratories' work focused on real world needs and creating valid
    research, development, tools and assistance in the successful
    implementation of the No Child Left Behind Act. Without the Regional
    Labs, the chain is broken. Without the regional labs, the link between
    basic research and technical assistance would cease to exist.
        Unfortunately, the Regional Education Lab program is at risk. The
    President's budget for fiscal year 2005 proposes to eliminate funding
    for the program. Last year, the Administration proposed eliminating the
    labs. Fortunately, Congress acted in a bipartisan way to fund it. We
    hope Congress will do so again for fiscal year 2006.
    Priority Investment.--Fund the Research and Development Centers
            (included in the Research, Development, and Dissemination Line)
            at $170 million--an increase of $5 million over fiscal year
            2005
        The centers address enduring issues of national significance in
    education through sustained and focused research programs. They address
    specific topics such as early childhood development and learning,
    student learning and achievement, at-risk students, adult learning, and
    education policy. The research done by the R&D centers is used by
    regional labs to develop programs, strategies and assessment tools
    which in turn are adapted by technical assistance providers
    (Comprehensive Centers) for the training and tools to implement their
    own programs to assist districts and schools.
    Priority Investment.--Fund the Comprehensive Regional Assistance
            Centers at $60 million--an increase of $3 million over fiscal
            year 2005
        The purpose of Title II of the Education Sciences Reform Act (ESRA)
    and specifically the newly reformed Comprehensive Centers program
    authorized within it, is to serve as part of a national technical
    assistance and dissemination system, which provides comprehensive
    technical assistance services to states, districts, tribes and schools
    in administering and implementing school reform efforts under No Child
    Left Behind. Their focus is to help schools and districts improve
    opportunities for all children to meet content and performance
    standards. Next year (fiscal year 2006), the 20 new centers will be
    fully operational. The new centers will include the scope of work of
    the current Comprehensive Regional Assistance Centers, the Eisenhower
    Regional Mathematics and Science Consortia, and the Regional Technology
    in Education Consortia.
    Priority Investment.--Fund the Comprehensive School Reform program at
            $233 million--an increase of $30 million over last year
        Comprehensive School Reform targets the neediest schools. Forty-
    five percent of CSR schools have poverty rates of 75 percent or
    greater--almost double the rate of Title I schools. And, almost half
    (46 percent) of CSR schools are low performing at the time of funding.
    CSR schools have baseline achievement scores lower than Title I school
    wide programs (in reading and math) at the time of funding. Finally,
    CSR Schools address the whole school and are more likely to use
    research-based models and measurable goals for student performance.
    Unfortunately, the Comprehensive School Reform program is at risk. The
    President's budget for fiscal year 2005 proposes to eliminate funding
    for the program. We hope Congress will act in a bipartisan fashion to
    preserve it.
        NEKIA is very heartened by the continuing interest Congress shows
    in the work of our member organizations to provide the research-based
    tools our children and teachers need to succeed. If we are to ensure
    even greater success for all our children, we must increase the federal
    investment in knowledge utilization efforts.
        Thank you. We appreciate your consideration of our proposals.
                                     ______

        Prepared Statement of the Science, Technology, Engineering, and
                     Mathematics (STEM) Education Coalition

        On behalf of the science, technology, engineering, mathematics,
    education and business groups listed here, we thank you for your
    efforts to secure $179 million for the fiscal year 2005 Math and
    Science Partnership program at the U.S. Department of Education (ED).
    The STEM (Science, Technology, Engineering, and Mathematics) Education
    Coalition greatly appreciates your continued support to improve STEM
    education at all levels.
        It is imperative that the work continues and additional funding be
    provided to the ED MSPs so we can ensure that all students receive a
    world-class education in science and math. We understand in these tight
    fiscal times, Congress is unable to provide the NCLB authorization of
    $450 million for the MSPs, but we do support substantial increases in
    order to prepare for the science assessments that will be required in
    2007. Therefore, we urge you to support the President's request of $269
    million for the fiscal year 2006 Math and Science Partnerships under
    Title II, Part B of NCLB.
        Additionally, we urge you to oppose the creation of a new
    initiative that would redirect $120 million of the funds away from the
    ED state-based MSP programs to create a new federal grant program. This
    would require a change to the NCLB statute, cut funds to the states,
    and greatly reduce state flexibility to meet their most critical needs.
        Funding for the ED MSPs goes directly to the states as formula
    block grants. States provide these funds through competitive grants to
    local partnerships of schools, higher education institutions and others
    for reform efforts to meet the NCLB math and science education
    obligations. Most grants go to high-need districts so they can
    strengthen teacher professional development and increase student
    performance in science, mathematics, and technology.
        In summary, we strongly urge Congress to fund the fiscal year 2006
    ED Math and Science Partnerships at $269 million and to oppose efforts
    to redirect $120 million of these funds away from the states.
        If we can provide any additional information or answer questions,
    please contact Patti Curtis at 202.785.7385.
                                     ______

                    Prepared Statement of Teach For America

        Mr. Chairman, Senator Harkin and Members of the Subcommittee: Thank
    you for the opportunity to submit testimony regarding the President's
    fiscal year 2006 budget proposal, which includes $4 million for Teach
    For America under the Corporation for National and Community Service.
    Mr. Chairman and Senator Harkin, I applaud your commitment to national
    service and desire to help AmeriCorps realize its full potential.
        I would like to take this opportunity to discuss Teach For America
    and our current growth plans. I will also focus on the $4 million line
    item in the President's fiscal year 2006 budget under the Corporation
    for National and Community Service and explain why it is critical to
    Teach For America's ability to grow to scale.
        As you know, Teach For America is the national corps of outstanding
    recent college graduates of all academic majors who commit 2 years to
    teach in urban and rural public schools and become lifelong leaders in
    the effort to ensure that all children in our nation have an equal
    chance in life. We are a private, national non-profit organization, as
    well as one of the original AmeriCorps programs. Our teachers receive a
    salary from their local school district as well as education awards
    through AmeriCorps. These education awards can be used for graduate
    level education courses necessary to obtain teacher certification, to
    pay back qualified student loans, or for future education.
        Since 1990, when I founded Teach For America, our organization has
    grown from 500 corps members teaching in 5 regions to what will soon be
    3,200 corps members teaching in 22 regions during the 2005-2006 school
    year. Teach For America corps members are having an impact throughout
    our nation, from St. Louis to Philadelphia, and from New Mexico's
    Navajo Nation to the Rio Grande Valley in South Texas.

                     TEACH FOR AMERICA MEETS CRITICAL NEEDS

        Our mission is to build a movement to eliminate the educational
    inequality that exists in our country today. By the age of nine,
    children in low-income areas are already three grade levels behind in
    reading ability (Source: National Center of Education Statistics,
    2000). As these children progress in the educational system, this
    achievement gap only widens, to the point that a child who grows up in
    a low-income community is seven times less likely to graduate from
    college than a child growing up in a more privileged area (Source:
    Education Trust, 1998).
        Our corps members help close the achievement gap for the students
    they reach during their 2-year commitment. At the same time, they gain
    insight and added commitment that shapes them into an important
    leadership force, working from inside of education and from other
    sectors, for long-term change.

                                  OUR PROGRAM

        We recruit the most highly sought-after college graduates of all
    academic majors, career interests, and backgrounds from leading
    colleges and universities. We then select corps members who demonstrate
    records of achievement and leadership, as well as a commitment to
    expanding opportunity for children in low-income areas.
        Admission to Teach For America is highly selective, with
    approximately 12 percent of our applicants gaining admission to the
    corps. Of our 2004 corps members, 93 percent held leadership positions
    on their campuses or in their communities. They earned average SAT
    scores of 1,310 and average GPAs of 3.5. In addition, 31 percent of
    corps members are people of color.
        This year, 17,319 young people applied for only 2,000 slots as
    first year teachers. At many top schools, Teach For America is
    considered one of the most prestigious post-graduate opportunities.
    This year, 12 percent of Spelman's senior class applied to the corps.
    And at top, larger universities, Teach For America attracted
    significant portions of the student body: 12 percent of Yale's seniors
    applied, as did 8 percent of seniors at Princeton and Harvard. All are
    competing for the opportunity to teach in America's neediest schools.
        Corps members are selected into Teach For America if they
    demonstrate strong leadership characteristics such as achievement
    orientation, critical thinking, personal responsibility for success,
    and the ability to influence and motivate others, as well as high
    expectations for students and families in low-income communities and
    the desire to work relentlessly toward this particular mission.
        Those selected attend a summer training institute where corps
    members teach in local public summer schools and participate in a full
    afternoon and evening schedule of professional development activities.
    We aim to ensure that corps members internalize the overarching
    approach utilized by the most successful teachers in urban and rural
    areas; and that they gain skills in instructional planning and
    delivery; building a strong classroom culture; literacy development;
    and teaching the specific content-area and grade-level they will be
    teaching.
        Following the institute, corps members assume teaching positions in
    school districts in 22 urban and rural areas. They are clustered in
    schools and receive extensive ongoing support and professional
    development through Teach For America and through local teacher
    education programs.
        Following their 2-year commitments, corps members can remain in
    teaching (and about 60 percent teach for at least a third year). We
    expect that they will ask themselves how they can have the greatest
    possible impact on the challenges they and their students experienced
    during their 2 years, and we provide a network of resources and support
    that they can tap into as they continue working in educational and
    social reform throughout their lives.

            IMMEDIATE IMPACT ON COMMUNITIES AND STUDENT ACHIEVEMENT

        Our success in recruiting and preparing exceptional classroom
    teachers has led education policy makers to highlight our impact on
    disadvantaged communities. Teach For America corps members impact the
    academic prospects of their students during their first 2 years in the
    classroom and continue to impact the quality of education in low-income
    communities beyond their initial commitments.
        A 2004 independent study by Mathematica Policy Research, Inc
    revealed Teach For America corps members in elementary grades affected
    greater gains than would typically be expected in a year. The study
    also showed corps members even outpaced fully certified and veteran
    teachers in their schools in moving their students ahead academically.
    To put corps members' value-added in context, Mathematica concludes the
    impact of having a Teach For America teacher compared to a non-Teach
    For America teacher (including veteran and certified teachers) is 65
    percent of the impact of reducing class size from 23 to 15 students
    (and is substantially less expensive). The impact of having a corps
    member versus another novice teacher is greater than the impact of
    reducing class size by eighty students. This study essentially
    replicated the results from an earlier study on Teach For America's
    impact by Stanford's Center for Research in Education Outcomes.
        Another way we evaluate corps member impact is through a bi-annual
    survey of principal satisfaction conducted by Kane, Parsons &
    Associates, Inc., an independent research firm. In a June 2004 survey
    by Kane, Parsons & Associates, principals credit Teach For America
    teachers as having positive effects on their schools and on student
    achievement. Nearly three out of four principals reported that corps
    members are more effective than their other beginning teachers. And
    principals rated corps members as good or excellent on multiple
    indicators of effective teaching, including:
      --90 percent--Instructional planning
      --95 percent--Motivation and dedication to teaching
      --96 percent--Achievement orientation and drive to succeed
      --93 percent--Working with other faculty and administrators
      --92 percent--Having high expectations for students; and
      --93 percent--Assuming responsibility for student achievement.

                                LONG-TERM IMPACT

        Teach For America is building a force of leaders and citizens with
    a lifelong commitment to addressing the issues they witness during
    their 2 years of service. Education Week, a leading national journal of
    K-12 education, profiled Teach For America's alumni in an article
    titled ``Most Likely To Succeed'' and called Teach For America a
    ``leader-making machine.''
        According to a survey conducted in the fall of 2004, our alumni are
    deeply influenced by their Teach For America experience:
      --Nationally, 63 percent of our alumni are working full-time in
            education, 39 percent as K-12 teachers and 28 percent as
            administrators, 4 percent in higher education, and 9 percent in
            education-related non-profits and other positions in the field
            of education; and
      --Nearly 200 Teach For America alumni have founded a school or a non-
            profit organization.
        Even more striking is the extent to which Teach For America alumni
    have already assumed leadership in the broader effort to improve
    education--they are running many of the most highly acclaimed charter
    schools in the country; they are turning around major urban schools as
    principals; they are winning some of the highest accolades teachers can
    win (as state and city teachers of the year); they are serving on
    school boards and advising Governors and Members of Congress on
    education policy; and they are leading model education reform, public
    health and economic development initiatives.

           TEACH FOR AMERICA NEEDS INCREASED FUNDING TO GROW TO SCALE

        Teach For America is in the midst of a 5-year expansion plan to
    more than double the size of its teacher corps. Currently, Teach For
    America has over 3,000 teachers in 22 communities and a budget of under
    $39 million. In the 2006-2007 school year, Teach For America will have
    nearly 3,500 corps members and will need to raise a budget in excess of
    $50 million. At that scale, Teach For America teachers will reach more
    than 300,000 public school students every day in this country's lowest-
    income neighborhoods.
        Seventy-five percent of our funding comes from private sources,
    much of it from the local communities where our teachers teach. We have
    a highly diversified base of more than 2,000 private donors from all
    over the country. Top donors include Don and Doris Fisher's Pisces
    Foundation; the Broad Foundation; New Profit; the Atlantic
    Philanthropies; and Wachovia Corporation.
        To raise our expanded budget, we must significantly increase our
    private funding base while growing our federal funding proportionately.
    With adequate federal funding, we can expand to reach more communities
    and engage more recent college graduates while continuing to provide
    highly qualified teachers for America's neediest classrooms. The
    Corporation for National and Community Service's $4 million fiscal year
    2006 budget line item would allow us to maintain our current ratio of
    federal to private funding and enable us to execute our growth plan.

                                   CONCLUSION

        I hope you will agree that we have demonstrated all the
    characteristics of an exemplary AmeriCorps program: we recruit talented
    young people into competitive positions in critical areas of public
    need; we have a significant impact in the communities we serve; we
    influence the civic commitment and career path of our corps members;
    and we leverage our public support for significant private resources.
    As we continue our efforts to more than double in size and reach
    hundreds of thousands of children each year, we seek your support so
    that Teach For America can expand its scale and impact. Mr. Chairman
    and Members of the Subcommittee, we hope you will support the
    President's request for $4 million for Teach for America in the fiscal
    year 2006 budget.
                                     ______

           Prepared Statement of the United Tribes Technical College

                               SUMMARY OF REQUEST

        For 36 years United Tribes Technical College (UTTC) has been
    providing postsecondary vocational education, job training and family
    services to Indian students from throughout the nation. Our request for
    fiscal year 2006 funding for tribally controlled postsecondary
    vocational institutions as authorized under Section 117 of the Carl
    Perkins Vocational and Applied Technology Act is:
      --$8.5 million under Section 117 of the Perkins Act, which is $1.1
            million over the fiscal year 2005 enacted level of $7,406,250.
            This funding is essential to our survival, as we receive no
            state-appropriated vocational education monies.
      --Ensure that the provision that has been included since fiscal year
            2002 in the Labor-HHS Education Appropriations Acts that waived
            the regulatory requirement that we utilize a restricted
            indirect cost rate is continued.
      --Funding for renovation of our facilities, many of which are
            original to the Fort Abraham Lincoln army installation. A
            recent study commissioned by the Department of Education shows
            a facility need for UTTC of $49 million.
      --We support the recommendations of the American Indian Higher
            Education Consortium, including $32 million for the
            Strengthening Developing Institutions Program for tribal
            colleges (Section 316).

                         RESTRICTED INDIRECT COST ISSUE

        Beginning in fiscal year 2002 the Labor-HHS-Education
    Appropriations Act provided that notwithstanding any law or regulation,
    that Section 117 Perkins grantees are not required to utilize a
    restricted indirect cost rate. We thank you for taking this action, and
    ask that it be continued in the fiscal year 2006 Act. We also point out
    that the pending Perkins reauthorization bills, S.250 and H.R. 366,
    contain a provision that would exempt Section 117 grantees from the
    requirement to utilize a restricted indirect cost rate.
        In 2001, the Department of Education, for the first time, directed
    Indian grantees (both Section 116 and 117 grantees) to apply a
    ``restricted indirect cost rate'' to their grants. This means each
    tribal grantee must obtain another indirect cost rate--exclusively for
    its Perkins Act grant--from its cognizant federal agency (which in most
    cases is the Inspector General for the Department of the Interior.)
        The Department gave two reasons for applying a restricted rate to
    these Perkins Act Indian programs: (1) The 1998 Amendments to the
    Perkins Act (Sec. 311(a)) prohibits the use of Perkins Act grant funds
    to supplant non-federal funds expended for vocational/technical
    programs. This ``supplement, not supplant'' limitation previously
    applied to State grants, only; and (2) A long-standing Department of
    Education regulation (promulgated years before the 1998 Perkins
    Amendments) automatically applies the restricted indirect cost rate
    requirement to any Department of Education grant program with a
    ``supplement, not supplant'' provision.
        UTTC has no quarrel with the bases and objectives of the
    ``supplement, not supplant'' rule and seeks no change to this statutory
    provision. The primary targets of this rule are States and possibly
    local government entities that run vocational education programs with
    State or local funds.
        By contrast, however, UTTC has little or no ability to violate this
    rule, as we have no source of non-federal funds to operate vocational
    education programs. Unlike States, we have no tax base and no source of
    non-federal funds to maintain a vocational education program. We depend
    on federal funding for our vocational/technical education program
    operations. Despite our inability to violate the supplanting
    prohibition, we are, nonetheless, being disadvantaged by a Department
    of Education regulation intended to enforce the prohibition against
    States who do have the ability to supplant.
      --Impact of new requirement on grantees.--Under DoEd regulations, a
            ``restricted indirect cost rate'' makes unallowable certain
            indirect costs that are considered allowable by other federal
            programs. Primarily, these are costs that DoEd believes the
            grantee would otherwise incur if it did not receive a Perkins
            grant, such as the cost of the grantee's chief officer and
            heads of departments who report to the CEO, as well as the
            costs of maintaining offices for these personnel.
        Prohibiting the Perkins grant from contributing its appropriate
    share to the grantee's indirect cost pool will most likely mean that
    other federal programs operated by the grantee would be expected to
    pick up a great share of the indirect cost pool. This outcome may well
    result in objections from the other program agencies that do not want
    to bear costs properly attributable to the Perkins grant.
        We are caught between conflicting federal agency requirements and
    will find ourselves unable to recover the necessary share of indirect
    costs attributable to each of the federal programs we operate.

                          UTTC PERFORMANCE INDICATORS

        UTTC has:
      --An 85 percent retention rate
      --A placement rate of 95 percent (job placement and going on to 4-
            year institutions)
      --A projected return on federal investment of 11 to 1 (2003 study
            comparing the projected earnings generated over a 29-year
            period of UTTC Associate of Applied Science graduates with the
            cost of educating them.)
      --The highest level of accreditation. The North Central Association
            of Colleges and Schools has accredited UTTC again in 2001 for
            the longest period of time allowable--10 years or until 2011--
            and with no stipulations. We are also the only tribal college
            accredited to offer on-line associate degrees.
        The demand for our services is growing and we are serving more
    students.--For the 2003-2004 school year we enrolled 661 Indian
    students. For the 2004-2005 school year we enrolled 753 Indian
    students, for an increase of 13 percent over the prior year. The 753
    Indian students we enrolled are from 54 tribes and 22 states. The
    majority of our students are from the Great Plains states, an area
    that, according to the 2001 BIA Labor Force Report, has an Indian
    reservation jobless rate of 75 percent. UTTC is proud that we have an
    annual placement rate of 95 percent. We hope to enroll 2000 adult
    students by 2008.
        In addition, as of the 2004-2005 year, we have served 257 students
    in our Theodore Jamerson Elementary school, and 226 children in our
    infant-toddler and pre-school programs.
        The total population for whom we provided direct services to in the
    2004-2005 academic year is 1,236. This is an increase in our overall
    total population of 17 percent from the 2003-2004 school year.
        UTTC course offerings and partnerships with other educational
    institutions.--We offer 17 AAS degrees, 5 of which have been approved
    to be offered on-line, and 11 certificate degrees. We are accredited by
    the North Central Association of Colleges and Schools. Our course which
    has the highest number of students is the Licensed Practical Nursing
    program.
         We are very excited about the recent additions to our course
    offerings, and the particular relevance they hold for Indian
    communities. These programs are: (1) Injury Prevention, (2) On-Line
    Education, (3) Nutrition and Food Services, (4) Tribal Government
    Management, (5) Tourism, and (6) Tribal Environmental Science.
        Tribal Environmental Science.--Our newest course offering is Tribal
    Environmental. Science. It is being established through a National
    Science Foundation Tribal College and Universities Program grant. The
    5-year project will support UTTC in planning and implementing an
    innovative environmental science program. The program is slated to be
    developed by this summer, beginning with a three week intense student
    skill-building program. The course work will lead to a 2-year associate
    of applied science degree in Tribal Environmental Science.
        Injury Prevention.--Through our Injury Prevention Program we are
    addressing the injury death rate among Indians, which is 2.8 times that
    of the U.S. population. We received assistance through Indian Health
    Service to establish the only degree-granting Injury Prevention program
    in the nation. Injuries are the number one cause of mortality among
    Native people for ages 1-44 and the third for overall death rates.
        On-Line Education.--We are working to bridge the ``digital divide''
    by providing web-based education and Interactive Video Network courses
    from our North Dakota campus to American Indians residing at other
    remote sites and as well as to students on our campus. This semester
    have 45 students, a number of whom are campus-based, taking on-line
    courses. We are accredited by the North Central Association of Colleges
    and Schools to provide on-line associate degrees. This approval is
    required in order for us to offer federal financial aid to students
    enrolled in these on-line courses.
        On-line courses provide the scheduling flexibility students need,
    especially those students with young children. Our on-line education is
    currently provided in the areas of Early Childhood Education, Injury
    Prevention, Health Information Technology, Nutrition and Food Service
    and Elementary Education. We are the only tribal college accredited to
    offer on-line associate degrees.
        Computer Technicians.--In the second year of implementation, the
    Computer Support Technician program is at maximum student capacity. In
    order to keep up with student demand, we will need more classrooms,
    equipment and instructors. Our program includes all of the Microsoft
    Systems certifications that translate into higher income earning
    potential for graduates.
        Nutrition and Food Services.--UTTC will meet the challenge of
    fighting diabetes in Indian Country through education. As this
    Subcommittee knows, the rate of diabetes is very high in Indian
    Country, with some tribal areas experiencing the highest incidence of
    diabetes in the world. About half of Indian adults have diabetes
    (Diabetes in American Indians and Alaska Natives, NIH Publication 99-
    4567, October 1999).
        We offer a Nutrition and Food Services Associate of Applied Science
    degree in an effort to increase the number of Indians with expertise in
    nutrition and dietetics. Currently, there are only a handful of Indian
    professionals in the country with training in these areas. Future
    improvement plans include offering a Nutrition and Food Services degree
    with a strong emphasis on diabetes education and traditional food
    preparation.
        We also established the United Tribes Diabetes Education Center to
    assist local tribal communities and our students and staff in
    decreasing the prevalence of diabetes by providing diabetes educational
    programs, materials and training. We published and made available
    tribal food guides to our on-campus community and to tribes.
        Tribal Government Management/Tourism.--Another of our new programs
    is tribal government management designed to help tribal leaders be more
    effective administrators. We continue to refine our curricula for this
    program.
        A recently established education program is tribal tourism
    management. We developed the core curricula for the tourism program and
    are partnering with three other tribal colleges (Sitting Bull, Fort
    Berthold, and Turtle Mountain) in this offering. The development of the
    tribal tourism program was timed to coincide with the planned
    activities of the national Lewis and Clark Bicentennial in 2003.
        Job Training and Economic Development.--UTTC is a designated
    Minority Business Center serving Montana, South Dakota and North
    Dakota. We also administer a Workforce Investment Act program and an
    internship program with private employers.
        Economic Development Administration funding was made available to
    open a ``University Center.'' The Center is used to help create
    economic development opportunities in tribal communities. While most
    states have such centers, this center is the first-ever tribal center.
        Upcoming Endeavors.--We are seeking to develop a Memorandum of
    Understanding with the BIA's Police Academy in New Mexico that would
    allow our criminal justice program to be recognized for the purpose of
    BIA and Tribal police certification, so that Tribal members from the
    BIA regions in the Northern Plains, Northwest, Rocky Mountain, and
    Midwest areas would not have to travel so far from their families to
    receive training. Our criminal justice program is accredited and
    recognized as meeting the requirements of most police departments in
    our region.
        We are also interested in developing training programs that would
    assist the BIA in the area of provision of trust services. We have
    several technology disciplines and instructors that are capable of
    providing those kinds of services with minimum of additional training.
    We also provide training in health records technology that that fit
    within the training needs of the Indian Health Service.
        Department of Education Study Documents our Facility/Housing
    Needs.--The 1998 Vocational Education and Applied Technology Act
    required the Department of Education to study the facilities, housing
    and training needs of our institution. That report was published in
    November 2000 (``Assessment of Training and Housing Needs within
    Tribally Controlled Postsecondary Vocational Institutions, November
    2000, American Institute of Research''). The report identified the need
    for $17 million for the renovation of existing housing and
    instructional buildings and $30 million for the construction of housing
    and instructional facilities.
        We continue to identify housing as our greatest need. We have a
    current waiting list of 64 families. Some families must wait from 1 to
    3 years for admittance due to lack of available housing. In 2003-2004,
    we were forced to find housing off campus for 52 families. In 2004-2005
    we housed 105 families off campus, a 50 percent increase over the prior
    year. In order to accommodate the enrollment increase, UTTC partners
    with local renters and two county housing authorities (Burleigh,
    Morton).
        UTTC has a new 86-bed single-student dormitory on campus. It is
    already completely full as are all of our other dormitories and student
    housing. To build the dormitory, we formed an alliance with the U.S.
    Department of Education, the U.S. Department of Agriculture, the
    American Indian College Fund, the Shakopee-Mdewakanton Sioux Tribe and
    other sources for funding. Our new dormitory has at the same time
    created new challenges such as shortages in classroom, office and other
    support facility space. However, more housing must be built to
    accommodate those on the waiting list and to meet expected increased
    enrollment. We also have housing which needs renovation to meet safety
    codes.
        Thank you for your consideration of our request. We cannot survive
    without the basic vocational education funds that come through the
    Department of Education's Perkins funds. They are essential to the
    operation of our campus and essential to the welfare of Indian people
    throughout the Great Plains region and beyond.
                                     ______

                                RELATED AGENCIES

    Prepared Statement of the National Federation of Community Broadcasters

        Thank you for the opportunity to submit testimony to this
    Subcommittee regarding the appropriation for the Corporation for Public
    Broadcasting (CPB). As the President and CEO of the National Federation
    of Community Broadcasters, I speak on behalf of nearly 257 community
    radio stations and related organizations across the country. Nearly
    half our members are rural stations and half are minority controlled
    stations. In addition, our members include many of the new Low Power FM
    stations that are putting new local voices on the airwaves. NFCB is the
    sole national organization representing this group of stations which
    provide service in the smallest communities of this country as well as
    the largest metropolitan areas.
        In summary, the points we wish to make to this Subcommittee are
    that NFCB:
      --Requests $430 million in funding for CPB for fiscal year 2008, a
            $30 million increase over the fiscal year 2006 advance
            appropriation;
      --Requests $45 million in fiscal year 2005 for conversion of public
            radio and television to digital broadcasting. Also supports
            funding for the Public TV interconnection system;
      --Requests that advance funding for CPB is maintained to preserve
            journalistic integrity and facilitate planning and local
            fundraising by public broadcasters;
      --Requests report language to ensure that CPB utilizes digital funds
            it receives for radio as well as television needs;
      --Supports CPB activities in facilitating programming and services to
            Native American and Latino radio stations;
      --Supports CPB's efforts to help public radio stations utilize new
            distribution technologies and requests that the Subcommittee
            ensure that these technologies are available to all public
            radio services and not just the ones with the greatest
            resources.
        Community Radio fully supports $430 million in federal funding for
    the Corporation for Public Broadcasting in fiscal year 2008.--Federal
    support distributed through CPB is an essential resource for rural
    stations and for those stations serving minority communities. These
    stations provide critical, life-saving information to their listeners
    and are often in communities with very small populations and limited
    economic bases, thus the community is unable to financially support the
    station without federal funds.
        In larger towns and cities, sustaining grants from CPB enable
    Community Radio stations to provide a reliable source of noncommercial
    programming about the communities themselves. Local programming is an
    increasingly rare commodity in a nation that is dominated by national
    program services and concentrated ownership of the media.
        For the past 29 years, CPB appropriations have been enacted 2 years
    in advance. This insulation has allowed pubic broadcasting to grow into
    a respected, independent, national resource that leverages its federal
    support with significant local funds. Knowing what funding will be
    available in advance has allowed local stations to plan for programming
    and community service and to explore additional non-governmental
    support to augment the federal funds. Most importantly, the insulation
    that advance funding provides ``go[es] a long way toward eliminating
    both the risk of and the appearance of undue interference with and
    control of public broadcasting.'' (House Report 94-245.)
        For the last few years, CPB has increased support to rural stations
    and committed resources to help public radio take advantage of new
    technologies such as the Internet, satellite radio and digital
    broadcasting. We commend these activities which we feel provide better
    service to the American people but want to be sure that the smaller
    stations with more limited resources are not left out of this
    technological transition. We ask that the Subcommittee include language
    in the appropriation that will ensure that funds are available to help
    the entire public radio system utilize the new technologies,
    particularly rural and minority stations.
        NFCB commends CPB for the leadership it has shown in supporting and
    fostering the programming services to Latino stations and to Native
    American stations. For example, Satelite Radio Bilingue provides 24
    hours of programming to stations across the United States and Puerto
    Rico addressing issues in Spanish of particular interest to the Latino
    population. At the same time, American Indian Radio on Satellite
    (AIROS) is distributing programming for the Native American stations,
    arguably the fastest growing group of stations. There are now over 30
    stations controlled by and serving Native Americans, primarily on
    Indian reservations.
        This year CPB funded the establishment of the Center for Native
    American Public Radio (CNAPR). Based on a comprehensive assessment of
    the Native American Radio System, CNAPR will develop new funding
    sources for stations and programming; provide direct services to the
    Native Radio System; encourage collaborations; and represent the Native
    Radio System. These stations are critical in serving local isolated
    communities (all but one are on Indian Reservations) and in preserving
    cultures that are in danger of being lost. CPB's assessment recognized
    that ``. . . Native Radio faces enormous challenges and operates in
    very difficult environments.'' CPB funding is critical to these rural,
    minority stations. CPB's funding of the Intertribal Native Radio Summit
    in 2001 helped to pull these isolated stations together into a system
    of stations that can support each other. The CPB assessment goes on to
    say ``Nevertheless, the Native Radio system is relatively new, fragile
    and still needs help building its capacity at this time in its
    development.'' The Center for Native American Public Radio promises to
    leverage additional, new funding to ensure that these stations can
    continue to provide essential services to their communities.
        CPB also funded a Summit for Latino Public Radio which took place
    in September 2002 in Rohnert Park, California, home of the first Latino
    Public Radio station. These Summits have expanded the circle of support
    for Native and Latino Public Radio and identified projects that will
    improve efficiency among the stations through collaborations and
    explore new ways of reaching the target audiences.
        CPB plays a very important role for the public and Community Radio
    system. They are the convener of discussions on critical issues facing
    us as a system. They support research so that we have a better
    understanding of how we are serving listeners. And they provide funding
    to programming, new ventures, expansion to new listeners, and projects
    that improve the efficiency of the system. This is particularly
    important at a time when there are so many changes in the radio and
    media environment with new distribution technologies and media
    consolidation. An example of this support is the grant that NFCB
    received to update and publish our Public Radio Legal Handbook online.
    This provides easy-to-read information to stations about complying with
    governmental regulations so that stations can function legally and use
    their precious resources for programming instead of legal fees.
        Finally, Community Radio supports $45 million in fiscal year 2006
    for conversion to digital broadcasting by public radio and
    television.--It is critical that this digital funding be in addition to
    the on-going operational support that CPB provides. The President's
    proposal that digital money should be taken from the fiscal year 2006
    CPB appropriation would effectively cut stations' grants by more than
    25 percent. This would have a devastating impact as stations trying to
    recover from hard economic times. And it would come at a time when the
    local voices of community and public radio are especially important to
    notify and support people during emergency situations and to help
    communities deal with the loss of loved ones--things that commercial
    radio is no longer able to do because of media consolidation.
        While public television's digital conversion needs are mandated by
    the FCC, public radio is converting to digital to provide more public
    service and to keep up with what commercial radio is doing. The Federal
    Communications Commission has approved a standard for digital radio
    transmission. CPB has provided funding for 301 transmitters in 42
    states to convert to digital, is supporting additional research on AM
    radio conversion, and is working with radio transmitter and receiver
    manufacturers to build in the capacity to provide a second channel of
    programming. Most exciting to public and community radio is the
    encouraging results of tests that National Public Radio has conducted,
    with funding from CPB, that indicate that stations can broadcast two
    high-quality signals, even while they continue to provide the analog
    signal. The development of second audio channels will potentially
    double the public service that public radio can provide, particularly
    in service to unserved and underserved communities. This initial
    funding still leaves more than 500 radio transmitters that will
    ultimately need to convert to digital or be left behind.
        Federal funds distributed by the CPB should be available to all
    public radio stations eligible for Federal equipment support through
    the Public Telecommunications Facilities Program (PTFP) of the National
    Telecommunications and Information Agency of the Department of
    Commerce. In previous years, Federal support for public radio has been
    distributed through the PTFP grant program. The PTFP criteria for
    funding are exacting, but allow for wider participation among public
    stations. Stations eligible for PTFP funding and not for CPB funding
    include small-budget, rural and minority controlled stations and the
    new Low Power FM service.
        Community Radio also supports funding for the public television
    interconnection system. Interconnection is vital to the delivery of the
    high quality programming that public broadcasting provides to the
    American people.
        We appreciate Congress' direction to CPB that it utilize its
    digital conversion fund for both radio and television and ask that you
    ensure that the funds are used for both media. Congress stated, with
    regard to fiscal year 2000 digital conversion funds:

        ``The required (digital) conversion will impose enormous costs on
    both individual stations and the public broadcasting system as a whole.
    Because television and radio infrastructures are closely linked, the
    conversion of television to digital will create immediate costs not
    only for television, but also for public radio stations (emphasis
    added). Therefore, the Committee has included $15,000,000 to assist
    radio stations and television stations in the conversion to
    digitalization . . . .'' (S. Rpt. 105-300)

        This is a period of tremendous change. Digital is transforming the
    way we do things; new distribution avenues like digital satellite
    broadcasting and the Internet are changing how we define the business
    we are in; the concentration of ownership in commercial radio makes
    public radio in general, and Community Radio in particular, more
    important as a local voice than we have ever been. New Low Power FM
    stations are providing new local voices in their communities. Community
    radio is providing essential local emergency information, programming
    about the local impact of the major global events taking place,
    culturally appropriate information and entertainment in the language of
    the native culture, as well as helping to preserve cultures that are
    dying out.
        During this time, the role of CPB as a convener of the system
    becomes even more important. The funding that it provides will allow
    the smaller stations to participate along with the larger stations
    which have more resources, as we move into a new era of communications.
        Thank you for your consideration of our testimony. If the
    Subcommittee has any questions or needs to follow-up on any of the
    points expressed above, please contact: Carol Pierson, President and
    CEO, National Federation of Community Broadcasters, Telephone: 510 451-
    8200 Fax: 510-451-8208 E-mail: carol@nfcb.org
        The NFCB is a 30-year-old grassroots organization which was
    established by, and continues to be supported by, our member stations.
    Large and small, rural and urban, the NFCB member stations are
    distinguished by their commitment to local programming, community
    participation and support. NFCB's 257 members come from across the
    United States, from Alaska to Florida, from every major market to the
    smallest Native American reservation. While the urban member stations
    provide alternative programming to communities that include New York,
    Minneapolis, San Francisco and other major markets, the rural members
    are often the sole source of local and national daily news and
    information in their communities. NFCB's membership reflects the true
    diversity of the American population: 41 percent of the members serve
    rural communities and 46 percent are minority radio services.
        On Community Radio stations' airwaves examples of localism abound:
    on KWSO in Warm Springs, Oregon, you will hear morning drive programs
    in their Native language; throughout the California farming areas in
    the central valley, Radio Bilingue programs five stations targeting
    low-income farm workers; in Chevak, Alaska, on KCUK you will hear the
    local weather reports and public service announcements in Cup'ik/Yup'ik
    Eskimo; in Dunmore, West Virginia, you will hear coverage of the local
    school board and county commission meetings; KABR in Alamo, New Mexico
    serves its small isolated Native American population with programming
    almost exclusively in Navajo; and on WWOZ you can hear the sounds and
    culture of New Orleans throughout the day and night.
        In 1949 the first Community Radio station went on the air. From
    that day forward, Community Radio stations have been reliant on their
    local community for support. Today, many stations are partially funded
    through the Corporation for Public Broadcasting grant programs. CPB
    funds represent under10 percent of the larger stations' budgets, but
    can represent up to 50 percent of the budget of the smallest rural
    stations.
                                     ______

        Prepared Statement of the National Minority Public Broadcasting
                                   Consortia

      --National Asian American Telecommunications Association
      --National Black Programming Consortium
      --Latino Public Broadcasting Project
      --Native American Public Telecommunications
      --Pacific Islanders in Communications
        The National Minority Public Broadcasting Consortia (Minority
    Consortia) submits this statement on the fiscal year 2008 appropriation
    for the Corporation for Public Broadcasting (CPB) and CPB's fiscal year
    2006 digital conversion funding. Our primary missions are to bring a
    significant amount of programming from our communities into the
    mainstream of PBS and public broadcasting. In summary, we ask the
    Committee to:
      --Encourage CPB to increase its efforts for diverse programming with
            commensurate increases for minority programming and the
            Minority Consortia;
      --Encourage CPB to continue its support for the Native radio system;
      --Reject the Administration's proposal to end advance funding for the
            Corporation for Public Broadcasting;
      --Reject the Administration's proposal to divert $82 million of
            already-appropriated fiscal year 2006 funds to digital
            conversion and satellite interconnection and to rescind an
            additional $10 million;
      --Recommend at least $430 million for CPB core funding for fiscal
            year 2008, a $30 million increase over fiscal year 2007;
      --Support CPB's request of $45 million in fiscal year 2006 funds for
            digital conversion, but require that some of it be made
            available to independent producers. Also support CPB request of
            $52 million for the interconnection system for public radio and
            television.
        We are dismayed at the Administration's continued proposals
    regarding public broadcasting. The quality gap between network
    television and public television has never been wider, and it continues
    to grow with each new ``reality'' show. Administration proposals to end
    forward funding of CPB and to divert already appropriated funds would
    dramatically reduce the development of programming for public
    broadcasting.
        Advance Funding.--We strongly oppose the Administration's proposal
    that the advance funding for CPB be eliminated, a proposal that would
    stop CPB funding for two years. We appreciate that Congress has
    rejected this proposal each of the last four years. Reasons to continue
    advance funding for CPB include:
      --The production of programming for public broadcasting usually takes
            several years and substantial lead time is needed for planning.
      --Public broadcasting programs are supported by multiple funding
            sources, and two years advance knowledge of the amount of
            federal funding allows CPB to better leverage its federal funds
            to bring in other sources of revenue.
      --The Minority Consortia administers a significant amount of CPB
            programming monies, and elimination of advance funding would
            negatively affect our organizations' planning and fundraising
            activities.
        Proposed Diversion of Fiscal Year 2006 CPB Funds.--We are extremely
    concerned about the Administration's proposal to rescind $10 million
    and divert an additional $82 million of already appropriated fiscal
    year 2006 CPB funds to digital conversion and satellite
    interconnection. Such a rescission/diversion of funds would wreck havoc
    on our organizations and the independent producers that we help support
    as well as many radio and television stations. We would be faced with a
    25 percent reduction of CPB funds should Congress approve this proposal
    by the Administration.
        CPB Fiscal Year 2008 Appropriation.--We support a fiscal year 2008
    federal appropriation for CPB of at least $430 million. This would be a
    reasonable, albeit modest, contribution toward our national treasure of
    public broadcasting. The debate of the past several years regarding
    public television and public radio has highlighted the great esteem in
    which they are held.
        Public broadcasting, including PBS and NPR, is particularly
    important for our nation's growing minority and ethnic communities.
    While there is a niche in the commercial broadcast and cable world for
    quality programming about our communities and our concerns, it is in
    the public broadcasting industry where minority communities and
    producers are more able to bring quality programming for national
    audiences. Additionally, public television and radio is universally
    available.
        Digital Conversion Assistance.--We support CPB's request for $45
    million in fiscal year 2006 funds for digital conversion funding for
    CPB.
        With stations able to broadcast on multiple channels, there will be
    a need for a tremendous amount of new, quality public broadcasting
    programming. There are costs involved in the conversion which go beyond
    the significant equipment and hardware needs of stations. It will also
    take additional money to produce programming for digital broadcast. All
    producers face these new, higher costs.
        Part of the equation in bringing more high quality diverse
    programming to public broadcasting is that independent producers be
    able to transition to digital production. Federal funding for digital
    conversion should include assistance for independent producers.
        About the National Minority Public Broadcasting Consortia.--With
    primary funding from the Corporation for Public Broadcasting, the
    Minority Consortia serves as an important component of American public
    television. By training and mentoring the next generation of minority
    producers and program managers we are able to ensure the future
    strength of public television and radio television programming from our
    communities. Individually, each Consortia organization is engaged in
    cultivating ongoing relationships with the independent producer
    community by providing technical assistance, program funding,
    programming support and distribution. We also provide numerous hours of
    programming to individual public television and radio stations.
        Through our outreach we help bring an awareness of the value of
    public media among communities which have historically been untapped by
    public television. Through innovative outreach campaigns, local
    screenings of works destined for public television, and promotion of
    web-based information and programming, communities of color are
    embraced rather than ignored. The Minority Consortia's work in
    educational distribution further increases the value of public
    television programming by sharing its works with thousands of students.
        While the Consortia organizations work on projects specific to
    their communities, the five organizations also work collaboratively.
    One example is our joint effort on the public television four-part
    series, Matters of Race that aired in the Fall of 2003. That series
    explored the complexity of our rapidly changing multiracial,
    multicultural society in America. The project resulted in more than
    television programming. The project was designed so that modules could
    be pulled out for classroom use. It was also formatted for radio
    broadcast and for the internet, and included extended interviews. This
    project provided a great opportunity for extensive and diverse
    community outreach and collaboration throughout its development,
    distribution, and use.
        We also worked with American Public Television on 6 one-hour
    programs (named Colorvision) featuring the work of Native American,
    Asian American, Pacific Islander, Latino and African American
    filmmakers and television producers. It is now in national distribution
    for all public television stations.
        The programming we, both as individual organizations and
    collaboratively, help bring to public television is beyond the
    production reach of most local television stations. We support the
    bill's proposal for increased funding for the production of local
    programming but believe there is also a great need for increased
    funding for major programming efforts such as those we and other
    independent producers undertake.
        From 1997 to 2002, the Minority Consortia delivered over 88.5 hours
    of quality public television programming. Collectively, we have also
    funded 250 projects and 440 producers/directors. These accomplishments
    have been recognized with over 123 prestigious national and regional
    awards, including numerous Emmys. While most of our work is focused on
    film, of note is that the Native American Public Telecommunications
    (NAPT) also works in the area of public radio. NAPT developed the
    Native American public radio satellite network (AIROS) that provides
    live radio streaming 24 hours a day to over 70 Native American and
    mainstream public radio stations in the United States (including
    Alaska).
        CPB Funds for the Minority Consortia.--The National Minority Public
    Broadcasting Consortia currently receives funds from two portions of
    the CPB budget, organization support funds from the Systems Support and
    programming funds from the Television Programming sections. CPB
    financial support is critical to the work of our organizations. We
    believe that we make a major contribution to public broadcasting with a
    very modest amount of funding, but there is so much more that should be
    done.
        The organizational support funds we receive from CPB are used not
    only for operations requirements but for also for a broad array of
    programming support activities and for outreach to our communities. We
    received $2 million in fiscal year 2005 CPB funds for organizational
    support ($400,000 for each organization). This represents 0.51 percent
    of the fiscal year 2005 CPB appropriation. We have received only very
    small increases in operations support funds in the past several years.
        The programming funds we receive from CPB are re-granted to
    producers, used for purchase of broadcast rights and other related
    programming activities. Each organization solicits applications from
    our communities for these programming funds. We received $3.1 million
    in fiscal year 2005 CPB funds for programming ($636,363 for each
    organization). This represents 0.81 percent of the fiscal year 2004 CPB
    appropriation. Our CPB programming funds have remained virtually flat
    over the past nine years, despite increases in CPB appropriations.
        The Minority Consortia works closely with CPB. We value our
    relationship with CPB and appreciate the financial and technical
    assistance provided to us by that organization. We do not doubt CPB's
    commitment to increasing the diversity of programming on public
    television and radio but also believe they can do more with the
    resources at hand. The oft-stated commitment of CPB and Congress for
    increased multicultural programming combined with seven years of
    funding increases should translate into significant progress. We ask
    this Committee to urge CPB to increase its support for the Minority
    Consortia as part of an effort to bring more quality multicultural
    programming to public television.
        Native Radio.--Native American Public Telecommunications--one of
    the five Minority Consortia organizations--works with both the radio
    and television sides of public broadcasting. NAPT operates American
    Indian Radio on Satellite (AIROS) which distributes programming to
    Native-owned and other radio stations. Koahnic Broadcasting
    Corporation, headquartered in Alaska, also produces and distributes
    Native American programming.
        Native-owned radio is the fastest growing area of community radio.
    There are currently 33 Native-owned stations, all but one of which is
    located in Indian country. We greatly appreciate CPB's central role in
    the establishment late last year of the Center for Native American
    Public Radio (CNAPR), an organization that will provide technical and
    other services to Native radio stations. CNAPR's mission also includes
    developing new sources of revenue for the Indian radio system and being
    an advocate for Native radio. CPB is providing $1.5 million over a
    three-year period for CNAPR.
        We ask that this Committee urge CPB to continue its support for
    Native radio.
        Thank you for your consideration of our recommendations. We see new
    opportunities to increase diversity in programming, production,
    audience, and employment in the new media environment, and thank you
    for your long time support of our work on behalf of our communities.

           LIST OF WITNESSES, COMMUNICATIONS, AND PREPARED STATEMENTS

                                  ----------
                                                                       Page

    Academic Family Medicine Advocacy Alliance, prepared statement...   397
    AIDS Action, prepared statement..................................   401
    Alamo Navajo School Board, Inc., prepared statement..............   622
    Alexander, Dr. Duane, Director, National Institute of Child
      Health and Human Development, NIH, DHHS, prepared statement....   207
    Alpha-1 Foundation, prepared statement...........................   497
    Alving, Dr. Barbara, Acting Director, National Center for
      Research Resources, prepared statement.........................   205
    American:
        Academy of:
            Family Physicians, prepared statement....................   405
            Pediatrics, prepared statement...........................   407
            Physician Assistants, prepared statement.................   412
        Association:
            For Geriatric Psychiatry, prepared statement.............   500
            Of:
                Colleges of Nursing, prepared statement..............   625
                Nurse Anesthetists (AANA), prepared statement........   415
        Autoimmune Related Diseases Association, prepared statement..   505
        Brain Coalition, prepared statement..........................   506
        Chemical Society, prepared statement.........................   629
        College of:
            Cardiology, prepared statement...........................   508
            Obstetricians and Gynecologists, prepared statement......   418
            Rheumatology, prepared statement.........................   630
        Dental:
            Education Association, prepared statement................   632
            Hygienists' Association, prepared statement..............   509
        Diabetes Association, prepared statement.....................   512
        Geological Institute, prepared statement.....................   635
        Heart Association, prepared statement........................   421
        Indian Higher Education Consortium, prepared statement.......   636
        Lung Association, prepared statement.........................   514
        Nurses Association, prepared statement.......................   427
        Psychological:
            Association, prepared statement..........................   517
            Society, prepared statement..............................   520
        Public Health Association (APHA), prepared statement.........   430
        Society:
            For Microbiology, prepared statements..................528, 531
            Of Hematology, prepared statement........................   525
        Thoracic Society, prepared statement.........................   534
    Americans:
        For Nursing Shortage Relief Alliance, prepared statement.....   425
        For the Arts, prepared statement.............................   362
    Andrew von Eschenbach, M.D., Director, National Cancer Institute,
      National Institutes of Health, Department of Health and Human
      Services.......................................................   177
    Association of:
        Academic Health Sciences Libraries, prepared statement.......   651
        Maternal and Child Health Programs, prepared statement.......   433
        Minority Health Professions Schools, prepared statement......   639
        University Centers on Disabilities, prepared statement.......   642
        Women's Health, Obstetric and Neonatal Nurses, prepared
          statement..................................................   437

    Battey, James F., Jr., M.D., Ph.D., Director, National Institute
      on Deafness and Other Communication Disorders, National
      Institutes of Health, Department of Health and Human Services..   177
    Berg, Dr. Jeremy M., Director, National Institute of General
      Medical Sciences, NIH, DHHS, prepared statement................   210
    Blue Cross and Blue Shield Association, prepared statement.......   441
    Boaz, David, Executive Vice President, Cato Institute............   334
        Prepared statement...........................................   335
    Byrd, Senator Robert C., U.S. Senator from West Virginia,
      question submitted by..........................................    71

    Centers for Disease Control and Prevention (CDC) Coalition,
      prepared statement.............................................   537
    Chao, Elaine L., Secretary, Office of the Secretary, Department
      of Labor.......................................................    73
        Prepared statement...........................................    75
        Summary statement............................................    75
    Charcot-Marie-Tooth Association (CMTA), prepared statement.......   541
    Charles R. Drew University of Medicine and Science, prepared
      statement......................................................   644
    Coalition:
        For:
            American Trauma Care, prepared statement.................   542
            Health Funding, prepared statement.......................   545
        Of Northeastern Governors, prepared statement................   443
    Cochran, Senator Thad, U.S. Senator from Mississippi, opening
      statements.................................................7, 74, 267
    Collins, Dr. Francis S., Director, National Human Genome Research
      Institute, NIH, DHHS, prepared statement.......................   212
    Community Medical Centers, prepared statement....................   444
    Council of State:
        Administrators of Vocational Rehabilitation (CSAVR), prepared
          statement..................................................   646
        And Territorial Epidemiologists, prepared statement..........   445
    Crohn's and Colitis Foundation of America, prepared statement....   549

    Developmental Disabilities Research Centers Association, prepared
      statement......................................................   550
    DeWine, Senator Mike, U.S. Senator from Ohio:
        Questions submitted by.......................................    50
        Statement of.................................................   194
    Dickman, Martin J., Inspector General, Railroad Retirement Board,
      prepared statement.............................................   382
    Digestive Disease National Coalition, prepared statement.........   554
    Doris Day Animal League, prepared statement......................   557
    Durbin, Senator Richard J., U.S. Senator from Illinois:
        Prepared statement...........................................   338
        Questions submitted by.....................................140, 314
        Statement of.................................................   199
    Dystonia Medical Research Foundation, prepared statement.........   559

    FacioScapuloHumeral Muscular Dystrophy Society, Incorporated (FSH
      Society, Inc.), prepared statement.............................   562
    Fauci, Anthony S., M.D., Director, National Institute of Allergy
      and Infectious Diseases, National Institutes of Health,
      Department of Health and Human Services........................   177
        Prepared statement...........................................   198
    Federation of American Societies for Experimental Biology,
      prepared statement.............................................   567
    Florida Department of Education, prepared statement..............   648
    Friends of the:
        Health Resources and Services Administration (HRSA), prepared
          statement..................................................   449
        National Institute:
            Of Environmental Health Sciences (NIEHS), prepared
              statement..............................................   570
            On Drug Abuse Coalition, prepared statement..............   571
    Gallaudet University, prepared statement.........................   649
    Grady, Dr. Patricia A., Director, National Institute of Nursing
      Research, prepared statement...................................   215
    Gregg, Senator Judd, U.S. Senator from New Hampshire, questions
      submitted by...................................................   306

    Harkin, Senator Tom, U.S. Senator from Iowa:
        Opening statements......................................20, 87, 178
        Questions submitted by.................................52, 107, 307
    Harrison, Patricia, President and Chief Executive Officer,
      Corporation for Public Broadcasting............................   320
        Prepared statement...........................................   321
    Heart Rhythm Society, prepared statement.........................   575
    Hemophilia Federation of America, prepared statement.............   576
    Hepatitis Foundation International, prepared statement...........   578
    Hodes, Dr. Richard J., Director, National Institute on Aging,
      NIH, DHHS, prepared statement..................................   217
    Hrynkow, Dr. Sharon H., Acting Director, Fogarty International
      Center, NIH, DHHS, prepared statement..........................   220
    Humane Society of the United States, prepared statement..........   490

    Inouye, Senator Daniel K., U.S. Senator from Hawaii:
        Prepared statement...........................................   344
        Questions submitted by.................................56, 137, 308
        Statement of.................................................   342
    Insel, Dr. Thomas R., Director, National Institute of Mental
      Health, NIH, DHHS, prepared statement..........................   223
    International Foundation for Functional Gastrointestinal
      Disorders, prepared statement..................................   580
    InterTribal Bison Cooperative, prepared statement................   452

    Jones, C. Todd, Associate Deputy Secretary for Budget and
      Strategic Accountability, Department of Education..............     1

    Katz, Dr. Stephen I., Director, National Institute of Arthritis
      and Musculoskeletal and Skin Diseases, NIH, DHHS, prepared
      statement......................................................   225
    Kohl, Senator Herb, U.S. Senator from Ohio, questions submitted
      by............................................................312, 57

    Landis, Dr. Story C., Director, National Institute of
      Neurological Disorders and Stroke, NIH, DHHS, prepared
      statement......................................................   232
    Landrieu, Senator Mary L., U.S. Senator from Louisiana:
        Prepared statement...........................................    35
        Questions submitted by.......................................    67
    Lawson, John M., President and Chief Executive Officer,
      Association of Public Television Stations......................   329
        Prepared statement...........................................   331
    Leavitt, Michael O., Secretary, Office of the Secretary,
      Department of Health and Human Services........................   177
        Prepared statement...........................................   180
        Summary statement............................................   179
    Li, Dr. Ting-Kai, Director, National Institute on Alcohol Abuse
      and Alcoholism, NIH, DHHS, prepared statement..................   228
    Lindberg, Dr. Donald A.B., Director, National Library of
      Medicine, NIH, DHHS, prepared statement........................   234
    Lummi Indian Nation, prepared statement..........................   454
    Lymphoma Research Foundation, prepared statement.................   583

    March of Dimes Birth Defects Foundation, prepared statement......   586
    Medical Library Association, prepared statement..................   651
    Mended Hearts, Inc., prepared statement..........................   585
    Mitchell, Hon. Pat, President and Chief Executive Officer, Public
      Broadcasting Service...........................................   325
        Prepared statement...........................................   326
    Motivation, Education and Training, Inc., prepared statement.....   385
    Murray, Senator Patty, U.S. Senator from Washington:
        Questions submitted by......................................59, 138
        Statement of.................................................   196

    Nabel, Elizabeth G., M.D., Director, National Heart, Lung, and
      Blood Institute, NIH, DHHS, prepared statement.................   238
    National AHEC Organization, prepared statement...................   657
    National:
        Association of:
            Children's Hospitals, prepared statement.................   654
            County and City Health Officials, prepared statement.....   457
            Foster Grandparent Program Directors, prepared statement.   459
            Home Builders, prepared statement........................   386
        Coalition for:
            Heart and Stroke Research, prepared statement............   590
            Homeless Veterans, prepared statement....................   388
        Education Knowledge Industry Association, prepared statement.   664
        Federation of Community Broadcasters, prepared statement.....   672
        Hemophilia Foundation, prepared statement....................   592
        Job Corps Association, Inc., prepared statement..............   392
        League for Nursing, prepared statement.......................   462
        Mental Health Association, prepared statement................   463
        Minority Public Broadcasting Consortia, prepared statement...   675
        Multiple Sclerosis Society, prepared statement...............   594
        Nursing Centers Consortium, prepared statement...............   467
        Organizations Responding to AIDS (NORA) Coalition, prepared
          statement..................................................   468
        Prostate Cancer Coalition, prepared statement................   599
        Sleep Foundation, prepared statement.........................   601
    NephCure Foundation, prepared statement..........................   597
    North American Brain Tumor Coalition, prepared statement.........   473
    NTM Info & Research, Inc., prepared statement....................   602

    Olden, Dr. Kenneth, Director, National Institute of Environmental
      Health Sciences, NIH, DHHS, prepared statement.................   240
    Oncology Nursing Society, prepared statement.....................   474
    Opportunities Industrialization Center of Washington, prepared
      statement......................................................   390
    Ovarian Cancer National Alliance, prepared statement.............   605

    Patient Services Incorporated (PSI), prepared statement..........   484
    Procter & Gamble Company, prepared statement.....................   477
    Pulmonary Hypertension Association, prepared statement...........   607

    Reid, Senator Harry, U.S. Senator from Nevada, questions
      submitted by...................................................   311
    Ruffin, Dr. John, Director, National Center on Minority Health
      and Health Disparities, NIH, DHHS, prepared statement..........   243
    Rural Opportunities, Inc., prepared statement....................   396

    Schwartz, Michael S., Chairman, Railroad Retirement Board,
      prepared statement.............................................   380
    Science, Technology, Engineering, and Mathematics (STEM)
      Education Coalition, prepared statement........................   665
    Sieving, Dr. Paul, Director, National Eye Institute, NIH, DHHS,
      prepared statement.............................................   246
    Skelly, Thomas, Director, Budget Service, Department of Education     1
        Summary statement............................................    29
    Society for:
        Animal Protective Legislation, prepared statement............   479
        Investigative Dermatology, prepared statement................   615
        Neuroscience, prepared statement.............................   488
        Nuclear Medicine, prepared statement.........................   610
    Specter, Senator Arlen, U.S. Senator from Pennsylvania:
        Opening statements..................................1, 73, 177, 317
        Prepared statements.........................................74, 178
        Questions submitted by.............................37, 97, 288, 365
    Spellings, Margaret, Secretary, Office of the Secretary,
      Department of Education........................................     1
        Prepared Statement...........................................     5
        Summary statement............................................     2
    Spiegel, Dr. Allen M., Director, National Institute of Diabetes
      and Digestive and Kidney Diseases, NIH, DHHS, prepared
      statement......................................................   248
    Spina Bifida Association of America, prepared statement..........   612
    State Educational Technology Directors Association (SETDA),
      prepared statement.............................................   660
    Stevens, Senator Ted, U.S. Senator from Alaska, statement of.....   341
    Straus, Dr. Stephen E., Director, National Center for
      Complementary and Alternative Medicine, NIH, DHHS, prepared
      statement......................................................   250

    Tabak, Dr. Lawrence A., Director, National Institute of Dental
      and Craniofacial Research, NIH, DHHS, prepared statement.......   253
    Teach For America, prepared statement............................   666
    The National Alliance for Eye and Vision Research, prepared
      statement......................................................   284
    Tomlinson, Kenneth Y., Chairman, Board of Directors, Corporation
      for Public Broadcasting........................................   317
        Prepared statement...........................................   318
        Summary statement............................................   318
    Tri-Council for Nursing, prepared statement......................   482

    United Tribes Technical College, prepared statement..............   669
    Upper County Branch of the Montgomery County, Maryland Stroke
      Club, prepared statement.......................................   621

    Voices for National Service, prepared statement..................   492

    Weems, Kerry, Acting Assistant Secretary for Budget, Technology,
      and Finance, Department of Health and Human Services...........   177
    Whitescarver, Dr. Jack, Director, Office of AIDS Research, NIH,
      DHHS, prepared statement.......................................   255
    Women's Health Research Coalition, prepared statement............   617

    Young, Jennifer, Assistant Secretary for Legislation, Department
      of Health and Human Services...................................   177

    Zerhouni, Elias, M.D., Director, National Institutes of Health,
      Department of Health and Human Services........................   177
        Prepared statement...........................................   190
        Summary statement............................................   179

                                 SUBJECT INDEX

                                  ----------

                      CORPORATION FOR PUBLIC BROADCASTING

                                                                       Page

    Audience Demographics............................................   342
    Bill Moyers......................................................   351
    CPB:
        Advance Funding..............................................   332
        Digital......................................................   333
            Transition Funds.........................................   331
        Interconnection Request......................................   352
        Polling......................................................   354
        Use of Consultants....................................354, 355, 359
    Digital Conversion...............................................   349
    House:
        Action.......................................................   332
        Appropriation Bill...........................................   341
    Importance of Federal Funding....................................   344
    Journal Editorial Report.........................................   355
    Next Generation Interconnection System.........................331, 333
    ``Now With Bill Moyers''.......................................355, 357
    Patricia Harrison Background.....................................   358
    Political Balance in Public Broadcasting.........................   345
    Public Television Interconnection System.........................   348
    Ready to Learn, Ready to Teach.................................331, 333
    The Digital Age..................................................   332
    Voice of America.................................................   356

                            DEPARTMENT OF EDUCATION

                            Office of the Secretary

    Accountability Under High School Intervention Initiative.........    38
    Adequacy of NCLB Funding--Studies Supporting.....................    52
    Adjunct Teachers and Highly Qualified Teachers...................    41
    Adult Education..................................................    42
        Research.....................................................    55
        State Grants.................................................    55
    Advanced Placement...............................................    38
    Arts in Education................................................    39
    Assistive Technology State Grant Program.........................    53
    Charter Schools..................................................    56
    Civic Education..................................................    43
    College:
        Affordability................................................     4
        Enrollment Gap--Federal Trio and Gear Up Programs............    48
    Community College Access Grants..................................     4
    Comprehensive Centers............................................    54
    Continuing Priorities............................................  4, 6
    Contracts With Public Relations Firms, Advertising Agencies, and
      the Media in Fiscal Year 2006..................................    32
    Core Components of Reading Instruction...........................    39
    Cost of Assessments..............................................    37
    D.C.:
        Voucher Program..............................................    59
            Evaluaton................................................    60
    Disadvantaged High School Students...............................    61
    E-Rate...........................................................    58
    Education Programs Proposed for Budget Cuts......................    67
    Educational Technology...........................................    40
    Effects of Proposed High School Initiative.......................    61
    Elementary and Secondary School Counseling Program...............    66
    Elimination of Small Programs....................................    30
    Enhanced Assessment Instruments Grants...........................    55
    Even Start and Family Literacy...................................    41
    Evidence on the Effectiveness of the Regional Labs...............    54
    Expanding Options for Student and Parents........................     6
    Federal Share of Education Funding...............................     8
    Foreign Language Assistance Program..............................    20
    Funding for:
        Community Colleges...........................................    26
        No Child Left Behind.........................................    57
    Future of Vocational Education...................................    57
    Grants for Enhanced:
        Assessment Instruments.......................................    32
        Assessments..................................................    34
    High School:
        Assessments..................................................37, 53
        Initiative...................................................    22
        Intervention.................................................    62
            Initiative............................................... 3, 49
            Program and Striving Readers.............................    62
            Preparedness.............................................    60
        Reform.......................................................  2, 5
    Highly Qualified Special Educators...............................    44
    Immigrant:
        Education....................................................    71
        Literacy.....................................................    65
    Impact:
        Of the Advanced Placement Program............................    38
        On Wisconsin Pell Grant Recipients of Revised Tax Tables.....    28
    Improving Teacher Quality State Grants...........................    66
    Information Collection and Reporting Requirements................    51
    Leveraging Educational Assistance Partnerships...................    40
    Loans for Short-Term Training....................................    47
    Math and Science Partnerships Program............................    42
    Native Hawaiian Education........................................    56
    New Budget Resources.............................................    37
    No Child Left Behind.............................................     6
        And Flexibility..............................................    48
        Requirements.................................................    22
    Outreach and Communication on Federal Programs...................    32
    Parental Information and Resource Centers........................    46
    Pell Grant Eligibility and Tax Tables............................    27
    Pell Grants......................................................27, 47
    Per Pupil Education Costs in the United States...................    70
    Perkins Vocational Education and Perkins Loan Programs...........    56
    Presidential Math and Science Scholars...........................     4
    Program:
        Reductions:..................................................
            And Departmental Staffing................................    29
            (Description)............................................    16
        Terminations (Descriptions)..................................    10
    Programs Proposed for:
        Elimination..................................................     9
        Reduction in Fiscal Year 2006................................    16
    Proposed:
        Elimination of Vocational Education Funds....................    25
        Program Eliminations.........................................     8
        Reduction:
            In Total Education Funding...............................    21
            To Education Programs....................................    15
            To Federal Education Budget..............................     8
    Providing for More Challenging Curricula.........................     3
    Public School Choice Requirement of the No Child Left Behind Act.    45
    Publicizing the No Child Left Behind Act.........................    31
    Raising Reading and Math and Teacher Incentives..................     3
    Reading by Third Grade...........................................    71
        Reading First Program........................................    39
    Reading First:
        Grants.......................................................    58
        State Grants.................................................     3
    Reducing the Deficit and Improving Results.......................  2, 5
    Regional Advisory Committee Assessments..........................    55
    Rehabilitation Services Administration's Training Program........    63
    Robert C. Byrd Scholarships......................................    71
    Safe Drug-Free School Communities................................    50
        Uniform Management Information and Reporting System..........    50
    School Counseling Services.......................................    67
    Special Allowance on Loans Funded From Tax-Exempt Securities.....    62
    Special Education:
        Full Funding.................................................    58
        Teacher Shortage.............................................    44
    State:
        Programs of Under-Graduate Need-Based Student Grants.........    41
        Scholars Capacity Building...................................    45
    Student:
        Aid Administration...........................................    41
        Loan Programs................................................    24
    Teacher:
        Incentive Fund...............................................    47
            And Teacher Training.....................................    47
        Quality Enhancement Program..................................65, 66
        State Grants and Competitive Grants..........................    51
    Title IV Information Collection and Reporting Requirements.......    50
    Transition to Teaching Program...................................    66
    TRIO Programs....................................................    31
    U.S. Constitution Initiative.....................................    34
    Upward Bound, Talent Search and Gear Up Program Assessments......    49
    Use of Authorizing and Appropriations Processes..................    23
    Vocational:
        Education Funds..............................................    27
        Technical Education--Postsecondary Students Attainment and
          Completion Targets.........................................    64

                              DEPARTMENT OF LABOR

                            Office of the Secretary

    Appalachian Council and the Working for America Institute........    85
    Asbestos Violations..............................................    86
    Association Health Plan Legislation..............................   105
    Budget Request...................................................    74
    Child Labor:
        Issue........................................................    96
        Violations...................................................    90
    Civil Monetary Penalties for Violations of FLSA..................   105
    Community College Grants.........................................    98
    Faith Based:
        Community Initiatives........................................   103
        Initiative...................................................    86
    Fewer Workers Trained............................................   143
    Fiscal Year 2006 Priorities......................................    76
    H-1B Skills Training Grants......................................   105
    H-2A Enforcement.................................................   138
    Halliburton......................................................    89
    High Growth Job Training:
        Initiative...................................................   111
        Program......................................................    95
    International Labor Affairs Bureau...............................    92
    Job Corps........................................................   109
        Management Fee...............................................    98
        Program......................................................    83
    Legislative Savings..............................................   100
    Loan Guarantee...................................................    83
    Medical Leave Program............................................    81
    Migrant Farm Workers.............................................    88
    MSHA Cost Dust Monitors..........................................   104
    National:
        Agricultural Workers Study (NAWS)............................   107
        Emergency Grants.............................................   108
        Farmworker Jobs Program......................................   106
        Labor Market Information.....................................   109
    Nursing Shortage in Rural Areas..................................   137
    ODEP MOU With SBA................................................   107
    One-Stop System Electronic Tools.................................    99
    OSHA Resources Target Ergonomic Hazards..........................   103
    Other Programs...................................................    80
    Overhead.........................................................   106
    Overtime Regulations.............................................   104
    PBGC.............................................................   139
    Personal Re-Employment Accounts.................................85, 140
    Preparing Workers for New Opportunities..........................    78
    President's Budget...............................................    75
    Program Administration...........................................    98
    Proposed Change to CES Survey....................................   141
    Protecting:
        Veterans' Employment Rights..................................    78
        Workers......................................................    76
            Pay, Benefits, and Union Dues............................    76
    Recent Accomplishments...........................................    76
    Retirement.......................................................    95
    Sanitary Facilities and Female Education.........................   108
    Social Security..................................................    96
    Substance Abuse Treatment Workforce..............................    97
    Unemployed.......................................................    88
        Rate.........................................................    95
    Veterans.........................................................    88
    Worker Overtime Protection.......................................   140
    Workforce Challenges.............................................    88
    Youthful Offender Program........................................    82

                    DEPARTMENT OF HEALTH AND HUMAN SERVICES

                         National Institutes of Health

    A Vision for the Future of the NHLBI.............................   238
    About NAEVR......................................................   284
    Advanced Technology Initiatives..................................   203
    Advances in Transplantation Research.............................   205
    Age-Related Macular Degeneration.................................   314
    Alzheimer's Disease..............................................   296
        And the Neuroscience of Aging................................   218
    Animal Models Predisposed to Environmental Risk..................   241
    Arthritis and Other Rheumatic Diseases...........................   227
    At the Crossroads................................................   231
    Autism...........................................................   242
    Avian Influenza..................................................   280
    Basic:
        Behavioral Research..........................................   298
        Research.....................................................   234
    Behavioral Research..............................................   310
    Biodefense:
        And Technology Resources.....................................   206
        Funding......................................................   291
        Research.....................................................   198
    Bioengineering: Building a Tooth.................................   254
    Biomarkers of Disease............................................   226
    Bioterror Threats................................................   290
    Blueprint for Neuroscience Research..............................   225
    Bone and Musculoskeletal Diseases................................   227
    Building Nursing Research Capacity...............................   217
    Burden of Mental Illness.........................................   223
    Cancer:
        And Ethnicity................................................   309
        Biomedical Informatics Grid..................................   292
        Council of the Pacific Islands...............................   308
        Prevention...................................................   294
        Survivorship.................................................   293
    Caring for the Caregivers........................................   216
    Cataract.........................................................   247
    Challenges and Opportunities.....................................   204
    Charting NCCAM'S Future..........................................   253
    Chronic Fatigue Syndrome.........................................   311
    Clinical:
        Research.....................................................   232
            And Academic Health Centers..............................   294
    Community-Based Participatory Research and Outreach..............   245
    Complementary and Alternative Medicines..........................   267
    Compounds in Mothers' Milk Protect Against Diarrhea..............   208
    Comprehensive AIDS Research Plan and Budget......................   257
    Computers Model Complex Systems..................................   211
    Corneal Diseases.................................................   246
    Demography.......................................................   220
    Determining the Effects of Acupuncture...........................   251
    Developing Advanced Technologies.................................   291
    Diversity Drives Discovery.......................................   212
    Drug Research and Development....................................   314
    Early Diagnosis to Prevent Dental Caries.........................   253
    Effort to Improve Relevance of Animal Models.....................   241
    Epilepsy Research................................................   312
    Examples of Basic and Clinical Research Enhancements.............   250
    Expanding the Horizon............................................   212
    Explanation of Epigenetic and Genetic Changes....................   277
    Exploring Mind-Body Medicine.....................................   251
    Eye and Vision Research Responds to the Nation's Top Public
      Health Challenges and Touches the Lives of all Americans.......   285
    Federal:
        Funding for Stem Cell Research...............................   276
        Research Collaborations......................................   245
    Fiscal Year 2006:
        Budget Summary...............................................   193
        Initiatives..................................................   222
        NIH AIDS Research By-Pass Budget Estimate....................   194
    From:
        Carnivorous Snails to a Novel Pain Treatment.................   211
        The Laboratory Bench to the Patient's Bedside................   248
    Funding:
        For Highest Priority Research................................   257
        The War on Cancer............................................   264
    Genetic Differences in Susceptibility to Drugs and Environment...   241
    Glaucoma and Optic Neuropathies..................................   246
    Global Burdens of Ill Health.....................................   221
    Guidelines on Ethics.............................................   272
    Health:
        Communications and Promotion.................................   220
        Disparities..................................................   247
            In Rural Communities.....................................   216
    HIV/AIDS Research................................................   200
    Human Cancer Genome Project......................................   282
    Impact of Fogarty Programs.......................................   221
    In the Pipeline..................................................   229
    Influenza........................................................   289
    Informatics and Interdisciplinary Science........................   206
    Information:
        For Scientists and Health Professionals......................   235
        Services for the Public......................................   236
    Interagency Collaborations.......................................   204
    International AIDS Research......................................   258
    Investigating Dietary Supplements and Foods......................   251
    Irritable Bowel Syndrome.........................................   313
    K30 Grant Awards.................................................   313
    Kids may say Otherwise, but Parents Matter.......................   209
    Lab on a Chip: Salivary Diagnostics..............................   254
    Loan Repayment and Scholarship Program...........................   192
    Long-Term Goal...................................................   202
    Lymphoma.........................................................   260
    Making the Right Choices.........................................   189
    Medication Development...........................................   229
    Meeting the Diverse Needs of Selected Populations................   252
    Mothers and Their Young Children With Asthma.....................   215
    Muscle Diseases..................................................   227
    Muscular Dystrophy...............................................   302
        Centers......................................................   301
    NAEVR Requests Fiscal Year 2006:
        NEI Funding at $711 Million as Vision Health is a ``Top
          Priority'' Among Many Priorities...........................   285
        NIH Funding at $30 Billion to Maintain the Momentum of
          Discovery..................................................   284
    Nanotechnology...................................................   243
    National:
        Cancer Institute.............................................   264
        Institute for Biomedical Imaging and Bioengineering..........   268
        Institutes of Health Buildings and Facilities Program........   193
    Nature of Success Rates..........................................   279
    NCMHD Health Disparities Impact..................................   244
    Neuroscience and Metabolism......................................   230
    New Initiatives..................................................   214
    NIH:
        Health Disparities Strategic Plan............................   243
        Neuroscience Blueprint.......................................   248
        Roadmap................................204, 206, 210, 225, 248, 255
            And Environmental Health Research........................   243
            For Medical Research.....................................   190
    NINR and the NIH Roadmap.........................................   217
    Obesity:
        And the Built Environment....................................   242
        Research.....................................................   288
        Studies Aided by Animal and Clinical Resources...............   205
    Office of AIDS Research..........................................   194
        Budget Development Process...................................   195
        By-Pass Budget:
            Estimate.................................................   196
            Priorities...............................................   195
        Comprehensive Plan...........................................   194
    Office of Portfolio Analysis and Strategic Initiatives...........   193
    OMB Part.........................................................   194
    Ongoing NHGRI Initiatives........................................   213
    Oral Cancer: Early Detection is Key to Saving Lives..............   254
    Other:
        Aging-Related Research.......................................   219
        Areas of Interest............................................   215
    Pain: Translating Targets Into Treatments........................   255
    Palliative and End-of-Life Care in Rural and Frontier areas......   217
    Paradigm-Shifting Ideas and Their Application....................   210
    Parkinson's Disease..............................................   242
    Participating in Trans-NIH Initiatives...........................   253
    Past NEI-Funded Research is Resulting in Treatments and Therapies
      to Slow the Progression of Vision Loss and Restore Vision......   287
    Peer Review on Muscular Dystrophy................................   305
    Pending Conflict of Interest Rules...............................   270
    Personalized Medicine............................................   292
    Polycystic Kidney Disease......................................297, 307
    Priority Setting.................................................   223
    Proposal to Create the Office of Portfolio Analysis and Strategic
      Initiatives....................................................   189
    Public Access..................................................307, 315
    Rehabilitation Networks Seek to Improve Quality of Life..........   209
    Research:
        Enhances Learning............................................   208
        In Children..................................................   226
        Leads to Better Health for Women.............................   208
        On:
            Care at the End of Life..................................   216
            Other Emerging and Re-Emerging Infectious Diseases.......   200
            Research on Immune-Mediated Diseases.....................   202
        To Improve Information Products and Infrastructure...........   237
    Results From Accelerating our Knowledge..........................   259
    Retinal Diseases.................................................   246
    Return on Investment.............................................   261
    Revealing the Biological Basis of Mental Disorders...............   224
    Roadmap for NIH Aids Research....................................   257
    Role in the Research Mission.....................................   193
    Sister Study of Breast Cancer....................................   242
    Skin Diseases....................................................   228
    Spinal Muscular Atrophy..........................................   300
    Stem Cell Research...............................................   275
    Stock Divestiture................................................   274
    Strabismus, Amblyopia and Visual Processing......................   247
    Strategic:
        Goals and Objectives.........................................   267
        Planning and Future Initiatives..............................   206
        Research Initiatives.........................................   203
    Success Rates....................................................   261
    The:
        Best Pharmaceuticals for Children Act........................   209
        Economic and Societal Costs of Vision Impairment and Eye
          Disease are Significant; Funding NEI is a Cost-Effective
          Investment.................................................   287
        Eye is a Unique Biological System Offering Exceptional
          Experimental Advantages in Which to Conduct Genetic,
          Neuroscience and Cellular Mechanism Research...............   286
        National Children's Study....................................   209
        NIH:
            Blueprint for Neuroscience Research......................   234
            Roadmap for Medical Research.............................   226
        Office of:
            AIDS Research............................................   190
            Behavioral and Social Sciences Research..................   191
            Disease Prevention.......................................   191
            Research on Women's Health...............................   191
            Science Education........................................   192
        Past, the Present, and the Future for NIH....................   179
        Road Ahead: Merging Scientific Vision and Technology
          Development................................................   253
        Shapes of Things to Come.....................................   211
        U.S. Epidemic................................................   256
        War on Cancer................................................   260
    Theme:
        Four: Communication..........................................   240
        One: Discovery...............................................   238
        Three: Interactions..........................................   239
        Two: Translation.............................................   239
    Translational Research...........................................   233
    Travel Risks Associated With Avian Influenza.....................   282
    Treatments for Recovery..........................................   224
    Umbilical Cord Blood Stem Cells..................................   306
    Understanding:
        Disease Requires Understanding Normal Function...............   210
        Who Uses CAM and why.........................................   251
    Various Sources of Funding.......................................   280
    Vision Impairment and Eye Disease is a Major Public Health
      Problem That Disproportionately Affects the Aging and Minority
      Populations....................................................   286
    Women and Minorities.............................................   258
    Work With Publishers.............................................   299
    Worldwide Pandemic...............................................   255
    Youth:
        At Risk......................................................   230
        Initiative...................................................   231

                            Office of the Secretary

    Abstinence.......................................................   202
    Access to Health Insurance.......................................   201
    Affordable Health Insurance......................................   200
    Best Pharmaceuticals for Children Act (BPCA).....................   206
    Community Alternative Funding Systems............................   194
    Dietary Supplements..............................................   203
    Disabled.........................................................   205
    Enhancing Public Health and Protecting America...................   183
    Flexibility in Medicaid..........................................   195
    Flu Vaccine......................................................   192
    Global AIDS Fight................................................   206
    Head Start.....................................................197, 198
    Health:
        IT...........................................................   201
        Savings Accounts.............................................   201
    HIV/AIDS Drugs...................................................   195
    Improving HHS Management.........................................   187
    Iowa Army Ammunition Plant.......................................   189
    Medicaid.......................................................179, 200
        And Medicare.................................................   199
        Funding......................................................   194
        Protection...................................................   187
        Reform.......................................................   200
    Medicare Modernization--Part D...................................   191
    Migrant Health Centers...........................................   197
    Olmstead Act.....................................................   204
    On-Patent Drugs..................................................   206
    Pandemic Flu Vaccine.............................................   192
    Providing Access to Quality Health Care..........................   181
    Social Security..................................................   199
    Supporting a Compassionate Society...............................   185
    Title X..........................................................   201
    Treatment of Children With HIV/AIDS..............................   195

                                       -