AAMC Letter to House &
Senate Labor-HHS Subcommittees Regarding FY 2001 Appropriations
May 2, 2000
The Honorable John Edward Porter
Chairman
Subcommitee on Labor, Health and Human Services,
Education and Related Agencies
Committee on Appropriations
United States House of Representatives
2373 Rayburn House Office Building
Washington, DC 20515
Dear Mr. Chairman:
As your Subcommittee begins to consider its FY 2001 Labor-HHS-Education
appropriations bill, the Association of American Medical Colleges
(AAMC) urges you to consider the following recommendations.
Congressional support of medical research has produced a
wealth of scientific opportunities to address the pressing
health challenges that continue to confront us. If we are
to sustain this momentum and translate the promise of science
into the reality of better health, this nation must sustain
its commitment to medical research. The AAMC supports the
FY 2001 recommendation of the Ad Hoc Group for Medical Research
Funding, which advocates for an increase of $2.7 billion (15
percent) as the third step in the effort to double the National
Institutes of Health (NIH) budget by FY 2003.
Evidence is mounting that changes in the health care delivery
systems and other financial factors pose a serious threat
to the clinical research infrastructure of America's medical
schools and teaching hospitals. Within the NIH budget, the
AAMC supports four mechanisms for enhancing the research infrastructure.
First, the association advocates $295 million for the general
clinical research centers (GCRCs). The GCRC program - which
funds approximately 77 clinical research centers at university-based
hospitals throughout the country - supports inpatient and
outpatient research facilities, special laboratories, trained
research support staff, and other resources crucial to state
of-the art, patient-oriented research. Second, the AAMC strongly
supports the Shared Instrumentation Grant program, which provides
grants for expensive equipment such as high-resolution mass
spectrometers, high-throughput protein and nucleic acid sequencers,
and functional imaging devices that can only be justified
on a shared-use basis.
Third, the AAMC is concerned that the cap on extramural salaries
continues to hinder the
recruitment and retention of high-quality scientific clinical
investigators. Although we are grateful for the increase approved
in the FY 2000 appropriations process, the AAMC believes that
increasing the salary cap to Executive Level I, which is equivalent
to the Senior Biomedical Research Service, would provide further
incentive for investigators, particularly physicians, to engage
in clinical research. Finally, a 1998 study by the National
Science Foundation found that 67 percent of medical schools
reported inadequate laboratory space for the medical sciences.
Increased funding of facilities construction and renovation
through a merit evaluation process is needed to help support
the considerable expansion and upgrading of biomedical research
plant capacity that will be essential if the nation's medical
research effort is to continue to produce world-class science.
The AAMC urges the subcommittee to provide $250 million to
the NIH for extramural research construction in FY 2001.
The newly renamed and reauthorized Agency for Healthcare
Research and Quality (AHRQ) sponsors health services research
designed to improve the quality of health care and decrease
health care costs by translating research into measurable
improvements in the health care system. The AAMC supports
the Friends of AHRQ recommendation, which calls for a FY 2001
funding level of $300 million for AHRQ, $50 million above
the president's request. The Friends propose $10 million more
than the Administration for reduction of medical errors, $30
towards new grants and research, and $10 million to improve
the agency's role as an information resource. In addition,
the AAMC is troubled with the Administration's request that
all of the funding for AHRQ be derived from inter-agency transfers,
rather than direct appropriations, which could set an undesirable
precedent. The AAMC urges the Subcommittee to provide the
majority of the agency's funding through direct appropriations.
For the health professions and nursing education programs
authorized under Titles VII and VIII of the Public Health
Service, the AAMC recommends an appropriation of at least
$335 million. This figure does not include the $80 million
designated by the Administration for children's hospitals
graduate medical education. This recommendation, which is
endorsed by the Health Professions and Nursing Education Coalition
(HPNEC), represents a 10 percent increase over the amount
the Congress appropriated in FY 2000.
The AAMC is deeply concerned about the Administration's FY
2001 budget request for the health professions programs. While
we applaud the increase proposed for the Centers of Excellence
and the Health Careers Opportunity programs, the request for
the remainder of the health professions programs is seriously
compromised. The Administration's budget eliminates the primary
care, dentistry and geriatric programs, and reduces funding
for public health training. These cuts would result in the
closing of programs that train many students and health professionals
who practice in underserved areas. One half of students trained
in primary care under these programs practice in underserved
areas. These programs also are the sole source of federal
funding for establishing and maintaining academic departments,
predoctoral programs and faculty development in family medicine.
Additionally, many individuals rely on the primary and preventive
health services provided by these programs as their only means
of medical care.
The AAMC, which represents the nation's 125 accredited medical
schools, some 400 major teaching hospitals and health systems,
and 91 professional and scientific societies representing
87,000 faculty members, thanks you for your past support and
we hope that you will continue to provide the necessary resources
for these programs that are critical to the health of all
of our citizens.
Sincerely yours,
Jordan J. Cohen, M.D.
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