[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
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Department of Health and Human Services
Department of Labor
Nondepartmental witnesses
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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
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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
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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
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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\
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\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.
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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.
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\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).
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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\
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\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.
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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.
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\1\ The Eye Diseases Prevalence Research Group: Prevalence of open-
angle glaucoma among adults in the United States. Arch Ophthalmol
122:532-538, 2004.
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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.
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\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.
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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 [email protected]), 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 [email protected] 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.
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\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.
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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\
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\1\ Obesity Research 1998; 6 (2): 97-106.
\2\ American Journal of Health Promotion 1998; 13 (2): 120-127.
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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/.
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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.
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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
([email protected] 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\
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\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.
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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.
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\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.
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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.
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\1\ Oral Health in America: A Report of the Surgeon General, 2000.
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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.
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\2\ Journal of the American Dental Association (133 JADA 1343).
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$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,
[email protected], 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
[email protected].
______
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: [email protected]
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
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