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Testimony

Statement to House Labor-HHS-Education Appropriations Subcommittee on FY 2002 Funding Recommendations for the U.S. Public Health Service Agencies and Programs

March 28, 2001

Mr. Chairman, the Coalition for Health Funding is pleased to provide the Subcommittee with testimony recommending FY 2002 funding levels for the agencies and programs of the 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 adequate resources for the agencies and programs within the Public Health Service. The Coalition for Health Funding is the nation's oldest, most broadly based alliance focused on the breadth of discretionary health spending.

The Coalition sincerely appreciates the strong and continued support that the Subcommittee has given to health discretionary programs in the past. The Coalition recognizes the considerable funding limitations that the Subcommittee is likely to face in Fiscal Year '02, but the Coalition urges you to seize every opportunity, as the process moves forward, to fund increases for critical public health programs.

On the cusp of the second year of the 21st Century, the nation, and the world, are at an unprecedented nexus of great promise and potential disaster. If we devote adequate resources to research opportunities at the National Institutes of Health we have the potential to advance our understanding of the biological basis of disease and unlock new strategies for disease prevention, diagnosis, treatment and cures. But we will not fully reap that potential for all Americans if we do not also invest in the other agencies and programs of the U.S. Public Health Service. We will not fully reap our investment in biomedical and behavioral research if we do not also invest in a strong public health infrastructure at the local, state, and federal level; translate biomedical and behavioral research into community-based prevention strategies; provide needed services for medically underserved populations; assure a well-distributed health and public health workforce in adequate numbers; and develop and translate the most cost-effective implementation of biomedical and behavioral research into medical practice. If we do not also do these things we risk disaster in the form of soaring medical care costs as the cohort of baby boomers ages with a host of preventable chronic diseases and there are not enough nurses, and other essential health care personnel, to care for them. We risk disaster if we do not continue to strengthen our seriously weakened public health infrastructure at the local, state and federal levels to prepare for a bioterrorist attack, a major outbreak of infectious disease such as the world experienced in the 1918 with pandemic flu, and to curb rapidly growing resistance to antibiotics used to treat serious bacterial infections. We risk disaster if we do not continue to try to meet growing demand for basic health and medical care services, particularly for mothers and children. A community is only as healthy as its weakest members. Failure to fully immunize children, adolescents, and vulnerable adults puts everyone at risk. Failure to respond to the health, mental health, and substance abuse needs of millions of uninsured Americans undermines the health of our workforce and undermines the health of our economy.

These are the major public health challenges ahead in the 21st Century. To address them and reap the potential of enormous positive returns requires adequate investment across the continuum of public health activity. The coalition's members recognize that no one component of the public health continuum can be effective in achieving the overall goal of improved health outcomes without the strong support of the components.

Each year, the Coalition for Health Funding works with other health alliances to determine an appropriate level of federal support for all health discretionary programs. For FY '02 the Coalition is recommending ---$44.2 billion be provided to address the nation's needs in the areas of biomedical, behavioral, and health services research; disease prevention and health promotion; health services for medically underserved populations; health professions education; and substance abuse and mental health services. The Coalition's recommendation also includes funding for the Indian Health Service and the Food and Drug Administration, which are not within the jurisdiction of this Subcommittee, but are important agencies within the U.S. Public Health Service. The Coalition appreciates that these funding levels, 20 percent over FY '01, may appear excessive, but they reflect both the professional judgment within the various agencies as well as our own members' assessment of community and national need. The Coalition presents these recommendations to the Subcommittee in the hope that it will view them as important targets for optimal health outcomes.

The following is a partial list of the Coalition's findings and recommendations; the attached table provides the Coalition's recommendations for all the public health agencies:

National Institutes of Health (NIH)

The Coalition supports an additional $3.4 billion in funding for NIH in FY 2002, for a total of $23.7 billion, as the fourth installment toward doubling the NIH budget by 2003. But in recognition of the difficulty in achieving this goal, the Coalition cautions that this increase must not come at the expense of other public health programs.

The Coalition recognizes the critical importance of the research conducted at the NIH and that increases provided in FY 1999, 2000, and 2001 must be continued in order to fully reap our investment. Three main reasons for continuing on the path to doubling the NIH budget include the many research challenges still confronting us, the burgeoning scientific opportunities that are now available in this post-genomic world, and the large economic benefits that accrue as we make progress against diseases. Examples of past investments in NIH research that have yielded important benefits include identifying a gene that contributes to susceptibility to type 2 diabetes, developing a vaccine to nearly eliminate infections caused by Haemophilus influenzae type b, using magnetic resonance imaging (MRI) measurements to predict who will get Alzheimer's disease, making landmark strides in the diagnosis and treatment of depression and schizophrenia, uncovering a hormone involved in the onset of osteoporosis, and growing replacement heart valves in the laboratory.

The Coalition appreciates that medical research is a vision not a precise blueprint. It must be flexible enough to respond to society's changing health care needs and dynamic enough to open the way to ever more promising frontiers of fundamental research. Scientific discoveries are the result of a series of incremental steps that pave the way for future breakthroughs. This process needs sustained support. With it, and support for other public health partners, we will be ready to meet the challenges of the future.

Centers for Disease Control and Prevention (CDC)

The Coalition for Health Funding recommends an overall funding level of $5 billion for CDC in FY 2002. 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 is very pleased that Congress provided $181 million in FY '01 to continue the process of re-building the nation's seriously eroded public health infrastructure in order to prepare for bioterrorism. The Coalition notes that landmark legislation passed last year, the Public Health Threats and Emergencies Act, builds on the three years of bioterrorism funding, to further strengthen public health infrastructure at all levels of government, but particularly the local and state levels. The Act authorizes $524 million in FY '02 to address three major threats: bioterrorism, antimicrobial resistance and major infectious disease outbreaks. The Coalition urges the Subcommittee to provide full funding for this critical effort; strengthening basic public health capacity also lays a foundation for addressing all disease and disabling conditions.

CDC administers many programs that utilize the research findings of the National Institutes of Health, and other public health agencies and programs, to develop community-based strategies to prevent disease and disabling conditions and promote improved health. Programs needing increases include those addressing chronic and environmental diseases such as cardiovascular diseases, diabetes, cancer, and asthma. This program line received a substantial, 40 percent increase in FY '01, but because there are over 40 separate programs included, some received significant increases, others small increases, and some no increases. Chronic diseases combined constitute the nation's most costly health problem, but we still do not reach all states with adequate funding to implement cost-saving and life-enhancing prevention efforts.

In the area of infectious diseases, the Coalition believes that significant increases are needed to enable CDC to fully implement its comprehensive plan, " Preventing Emerging Infectious Diseases: A Strategy for the 21st Century." In today's global society, it is possible for a new disease to spread internationally within days, perhaps hours. Since 1973, more than 35 new infectious diseases have been identified, including E. coli 0157:H7, airborne Ebola virus, and West Nile virus. Serious challenges lie ahead as these newly emerging and re-emerging diseases are identified, while at the same time, multi-drug resistant organisms, such as Staphylococcus aureus, proliferate. More than 90 percent of strains of Staphylococcus aureus in U.S. hospitals are resistant to penicillin. In some areas of the United States, more than 30 percent of the pneumococci resist penicillin, a drug once effective against almost all pneumococcal pneumonia and meningitis.

Increases are also needed for prevention of HIV transmission, which is receiving new focus within CDC. 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. There are 40,000 new infections every year with one-half occurring in individuals under the age of 25.

Elimination of TB and STDs, especially syphilis, are now within our grasp. These welcome opportunities, if adequately funded now, will save millions in annual health care costs in the future.

Finally, also in the area of infectious diseases, significant increases are needed for immunization. An important IOM report on immunizations published last year entitled, Calling the Shots, stated that unstable funding for state immunization programs threatens coverage for specific populations and age groups. The report recommended an increase of $75 million for CDC's operations/infrastructure state grant program. Congress provided $42.5 million of this increase in FY '01; the full increase is needed in FY '02. In addition, significant increases are also needed for the domestic vaccine purchase program to meet the costs of the newly recommended pneumococcal conjugate vaccine, as well as the costs of expanding vaccines to the 1 million two-year-olds that are not fully vaccinated, and to adolescents and adults. Finally, increases are also needed for CDC's global immunization program.

In response to legislation enacted last year, CDC has created a new Center on Birth Defects and Developmental Disabilities. This exciting, strengthened focus on many preventable diseases and disabling conditions, as well as on improving the lives of those who live with disabilities, also needs new resources.

The Preventive Health and Health Services Block Grant is the only source of flexible funding to enable state public health officials to achieve Healthy People 2010 goals, address health gaps in discretionary funding, and respond to unexpected crises such as the emergence of West Nile Virus. The Block Grant was cut nearly $15 million (10 percent) in FY '00 to $135 million and level funded in FY '01. State health officials are requesting a 50 percent increase in the Prevention Block Grant for FY '02.

Prevention Centers and Prevention Research, important programs in the nation's foremost health prevention agency, should receive significant increases reflecting their importance. Prevention research is mentioned as a priority area in President Bush's February budget blueprint.

Other important programs needing increases are: the National Center for Health Statistics, NIOSH; health disparities demonstration research; and injury control.

Health Resources and Services Administration (HRSA)

The Coalition for Health Funding recommends an overall funding level of $6.7 billion for HRSA in FY 2002. This is the total funding level 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 expressed his support for the effort to double funding for the Consolidated Health Centers program over the next five years. Last year, Congress provided the first down payment on this goal bringing the current funding levels to $1.169 billion. The Coalition for Health Funding supports a second down payment in FY '02 to help reach the goal of building 1,200 new health center sites and doubling the patient capacity of the entire health center program over the next five years.

The Coalition's recommendation also includes increases for the programs of the Ryan White CARE Act. HIV/AIDS is an extremely serious epidemic facing Americans and people throughout the world. The programs of the Ryan White CARE Act target needed health care, and other support services, including expensive drug therapies, to Americans suffering from HIV/AIDS.

The Coalition supports an increase for the Title X family planning program in FY '02. This funding would support 4,600 family planning clinics across the U.S. It would pay for comprehensive services including screenings for cancer, HIV, and other diseases as well as contraception, and teen pregnancy prevention including educational activities that encourage young people to postpone sexuality.

Preliminary information indicates the President's budget may cut funding for Graduate Medical Education for free-standing children's teaching hospitals which was a new initiative in FY '00, and received $235 million in funding in FY '01. This important program that trains physicians that provide direct care for children, needs to continue, and needs increased, not decreased, funding. The Coalition also supports increased funding for the Children's Emergency Medical Services program which ensures that emergency care provided for children is appropriate for their specific needs, and funding at the authorized level for HRSA's new trauma care program.

The Coalition is disappointed that the Maternal and Child Health Block Grant has been level funded for the past several years at $710 million. This program provides comprehensive, preventive care for mothers and young children, as well as an array of coordinated services for children with special needs. MCH programs are facing increased demands for services due largely to two trends: continued growth in the numbers of uninsured that is outpacing targeted efforts, such as the Child Health Insurance Program, to cover them; as more eligible children for CHIP are identified, often by MCH outreach efforts, more children are identified as needing MCH services. This increased demand, and the findings of a recent Institute of Medicine report entitled, From Neurons to Neighborhoods, which concludes that new science about early childhood development demonstrates urgent need to expand the kind of services that the MCH Block Grant provides, the Coalition believes this program should be funded at its fully authorized amount in FY '02.

The Coalition is also very disappointed that the President's budget blueprint proposes to cut the Health Professions and Nursing Education Programs. These programs provide support to students, programs, departments and institutions to improve the racial and ethnic diversity, accessibility, and quality of the health and public healthffff workforce. In particular, these programs help meet the health care delivery needs of over 2,800 Health Professions Shortage Areas in this country, at times serving as the only source of health care in many rural and disadvantaged communities. The Coalition believes this program needs increased, not reduced, funding in FY '02.

Substance Abuse and Mental Health Services Administration (SAMHSA)

The Coalition recommends that $4.057 billion be provided to SAMHSA in FY 2002. This agency, particularly the mental health programs, has received relatively few resources over the past decade compared with other public health service agencies.

For mental health programs, the Coalition recommends a total of $1.357 billion for the Center for Mental Health Services (CMHS). The expanded funding will allow CMHS to provide services targeted to the unmet needs of communities and enable it to maintain its role in fostering the development of innovative community-based programs through services research.

In July, 1999, the U.S. Supreme Court issued a decision finding that unjustified institutionalization of individuals with mental illnesses constitutes discrimination under the Americans with Disabilities Act (ADA). The decision in Olmstead v. L.C. and E.W. was strongly supported by the U.S. Department of Health and Human Services, which is developing policies and mechanisms to help states develop community-based service networks. In addition, as part of a "New Freedom Initiative" announced in January, 2001, the Bush Administration pledged support for expanding community-based services to implement the Olmstead decision. States have begun their own initiatives, channeling dollars from their state mental health budgets to address this issue. For example, Governor Pataki put forward a plan in early 2001 that would direct $107 million dollars to community-based care. The funds would be used to fund more than 2,700 special housing units as well as other community-support services. It is important that there be a federal commitment to this policy as well. Enhanced funding of CMHS's Performance Partnership Block Grant is the best way to move people with serious mental illness to the community and provide them with needed supports - a policy widely supported in the mental health field.

Increased funding for CMHS will also allow for the continued development of new programs which have targeted other critical needs in communities. These new programs include youth anti-violence grants, early intervention services for children and adolescents, suicide prevention for children and adolescents, and aftercare services for juvenile offenders returning to the community. The funding will also support the development of systems of care for children with serious emotional disturbances.

To respond to the enormous unmet need for drug and alcohol treatment and prevention services, the Coalition for Health Funding recommends that FY '02 funding for the Substance Abuse and Treatment Block Grant, the primary federal funding source for substance abuse treatment, be increased to $2 billion from the FY '01 level of $1.665 billion. According to SAMHSA's 1999 National Household Survey on Drug Abuse, approximately 11.8 million people were dependent on alcohol or illegal drugs, but only about 2.8 million, or 24 percent, received some form of treatment. Waiting lists for treatment are six months long; entitlement programs reforms have moved more individuals with alcohol or drug dependence off financial support and into the workforce while simultaneously reducing the reimbursement available causing increased demands and reduced resources for already stressed treatment programs. It is imperative that the federal government take significant steps to close the treatment gap.

The Coalition also supports $350 million each for the Center for Substance Abuse Treatment and the Center for Substance Abuse Prevention. Through their Knowledge Development and Application programs and Targeted Capacity Expansion programs, these centers can improve, and expand services, for individuals that suffer from, or are at risk of, substance abuse problems.

Agency for Healthcare Research and Quality (AHRQ)

The Coalition recommends $400 million for AHRQ in FY 2002. The Coalition believes this level of funding is needed for the Agency to fully carry out its Congressional mandate to improve health care quality, including reducing errors in medicine and advancing health outcomes information. The Coalition's recommendation will permit the Agency to:

Expand investigator-initiated grants. In its final conference report for FY '01, the appropriations conferees urged AHRQ to enhance its investigator-initiated research funding. In order to achieve this goal, $60 million is needed to fund new investigator-initiated grants. These grants are needed to provide research into critical areas of study such as: efforts to control rising costs, improve quality, reduce disparities among racial and ethnic groups, improve disease management, assure appropriate utilization, assess impact of site of care changes over time, evaluate effects of technological change, and expenditure differentials by health status among different age-gender groups.

Provide leadership in improving patient safety and reducing medical errors. The impact of medical errors on patient health has been well established by the recent report from the IOM, which estimated as many as 44,000 to 98,000 people die each year because of medical errors. AHRQ research has demonstrated that many errors are the result of system failures. For FY '01, Congress has appropriated $50 million to, among other items, support the development of guidance on the collection of uniform data related to patient safety; establish a competitive demonstration program for health care facilities to determine the causes of medical errors; and accelerate AHRQ's commitment to the Centers for Education and Research in Therapeutics. The Coalition supports providing an additional $50 million to enable the Agency to establish a National Center for Patient Safety and take the other needed steps outlined in the IOM report to prevent medical errors.

Begin fulfilling the research needs expressed in the IOM report: Crossing the Quality Chasm. A New Health System for the 21st Century. The IOM calls on Congress to establish a $1 billion innovation fund to facilitate the translation of research into clinical practice. In addition to the IOM report, Translating Research into Practice (TRIP) studies show that less than half of Americans are getting high quality care for major health problems, including diabetes, asthma, depression, and schizophrenia among others.

Meet consumer, employer and provider demand for better information on health care quality and outcomes. AHRQ serves as a resource to consumers, employers, providers, and policymakers in making health care decisions. Currently the agency relies primarily upon public and private partners and its website to disseminate this critical information.

The Coalition sincerely appreciates this opportunity to provide its funding recommendations to the Subcommittee for the agencies and programs of the U.S. Public Health Service. The Coalition, and its member organizations, look forward to working with the Subcommittee in the weeks ahead to improve the health of all Americans.

©2008 Coalition for Health Funding