Statement on FY 2004 Appropriations
for the Department of Health and Human Services
Presented by: AAMC
Presented to: Subcommittee on Labor, Health and Human
Services, Education and Related Agencies Committee on Appropriations,
United States House of Representatives
Date: May 23, 2003
The AAMC represents the nation’s 126 accredited medical
schools, some 400 major teaching hospitals and health systems,
96 professional and scientific societies representing 105,000
faculty members, and the nation’s medical students and
residents. The Association appreciates the opportunity to
address five programs that play critical roles in assisting
medical schools and teaching hospitals to fulfill their missions
of education, research, and patient care: the National Institutes
of Health, health professions education funding through the
Bureau of Health Professions, the Agency for Healthcare Research
and Quality, the Centers for Disease Control and Prevention,
and the National Health Service Corps. The AAMC thanks the
Subcommittee for its steadfast support of these programs.
National Institutes of Health – As a result of
the long-standing bipartisan commitment of this subcommittee
and the Congress to the NIH, we have entered an exciting new
era in medicine. NIH-supported research continues to improve
the health and quality of life for all Americans in dramatic
ways. The diagnosis and treatment of many diseases have undergone
fundamental transformations thanks to NIH-funded research.
These innovations are relieving pain and suffering and enhancing
the quality of life of every American family touched by disease
and disability. They also are helping to reduce the cost of
health care. In addition, NIH-sponsored research has had a
significant economic impact. Research conducted and supported
by the NIH played a major role in the development of the biotechnology,
pharmaceutical, and medical device industries and provides
the basis for their continued success.
If we are to sustain this momentum and translate the promise
of science into the reality of better health, this nation
must maintain its commitment to medical research. The AAMC
supports the recommendation of the Ad Hoc Group for Medical
Research Funding, which calls for the Congress to add 10 percent
in FY 2004 to the recently doubled budget of the NH, which
would bring the total appropriation to $30 billion.
Within the NIH budget, the AAMC believes there are four major
areas of concern: peer-reviewed basic science, clinical research,
research resources, and research training. Peer-reviewed,
investigator-initiated basic research is the heart of NIH
research. These inquiries into the fundamental cellular, molecular,
and genetic events of life are essential if we are to make
real progress toward understanding and conquering disease.
Additional funding is needed to sustain and enhance basic
research activities, including increasing support for current
researchers and promoting opportunities for new investigators
and in those areas of biomedical science that have historically
been under funded.
The application of the results of basic research to the detection,
diagnosis, treatment, and prevention of disease is the ultimate
goal of medical research. Clinical research not only is the
pathway for applying basic research findings, but it often
provides important insights and leads to identify further
basic research opportunities. Recent increases in the NIH’s
overall budget have allowed the agency to support early translational
research on new molecular entities and new therapeutic strategies
of great promise, but which is still too uncertain to attract
significant investment from industry. The AAMC supports additional
funding for the continued expansion of clinical research and
clinical research training opportunities, including rigorous,
targeted post-doctoral training; developmental support for
new and junior investigators; career support for established
clinical investigators, especially to enable them to mentor
new investigators; and funding the recent expansion of the
clinical research loan repayment program to the extramural
community.
Anecdotal evidence suggests that changes in health care delivery
systems and other financial factors pose a serious threat
to the research infrastructure of America’s medical schools
and teaching hospitals, particularly for clinical research.
To enhance the research infrastructure, the AAMC supports
additional funding for the NIH’s National Center for
Research Resources (NCRR). NCRR provides numerous and varied
resources critical to a productive and cost-effective research
environment, which can be grouped into four categories: resources
for clinical investigations; instrumentation and emerging
technologies; animal and other research models; and research
infrastructure.
NCRR Resources for Clinical Research – The AAMC
strongly supports the General Clinical Research Centers (GCRC)
program, which funds 78 such clinical research centers at
university-based hospitals throughout the country. The GCRCs
are indispensable because they offer centralized and highly
specialized resources for patient-centered research aimed
at understanding disease processes and discovering better
therapies and cures for a host of conditions. This collection
of highly specialized staff and resources provides a supportive
environment for patients and enormously facilitates progress
in research on tomorrow's life-saving therapies and cures.
NCRR Instrumentation and Emerging Technologies –
The Shared Instrumentation Grant (SIG) program helps researchers
meet critical instrumentation needs by assisting institutions
and investigators to acquire commercially available, sophisticated
instrumentation that would be prohibitively expensive to support
on a single grant application (awarding between $100,000 and
$500,000 for the purchase of such equipment). These grants
maximize the utility of federal research funds by allowing
a number of scientists with similar large instrumentation
needs to share such equipment, and promote interactions among
scientists, frequently across scientific disciplines, thereby
catalyzing mutually rewarding new research collaborations.
For example, the new generation of high field nuclear magnetic
resonance (NMR) instruments (900 Megahertz to 1 Gigahertz)
can greatly extend the capabilities of biomedical researchers,
but cost more than $5 million and require specialized facilities
and support. Other research equipment, such as top-of-the-line
mass spectrometers or confocal microscopes, also cost in excess
of $1 million. The High-End Instrumentation Grant Program
provides resources for a growing number of investigators would
benefit from access to such high-end instrumentation.
NCRR Animal and Other Research Models – The NCRR
supports the development of unique and highly specialized
animal resources, including specialized laboratory animal
colonies, cell lines, genetic stock, and other collections,
and may include a broad range of species from microorganisms
to invertebrates to nonhuman primates. NCRR also sponsors
seven Regional Primate Research Centers and other primate
resources to provide specialized facilities for more than
1,400 scientists who work with nonhuman primates as the most
effective animal model in studies of reproductive medicine,
geriatrics, hypertension, AIDS, vaccine development and other
human health and disease problems.
The extraordinary advancements of the Human Genome Project
and other research, has dramatically increased the need for
and the costs of animal research. “Functional genomics”
requires that individual genes and sets of genes be studied
in complex physiological systems through the use of transgenic
mice and other specialized models. Veterinarian investigators
are of paramount importance to this research to correctly
identify and understand the pathological changes induced by
experimentation. They are also needed to discover new and
more effective means to safeguard the welfare of these valuable
animals. To address the critical need for training and career
development of young veterinarians and other researchers,
the NCRR has instituted special emphasis research career awards
in pathology and comparative medicine to assist veterinarians
motivated to pursue research careers. NCRR has also established
midcareer investigator awards for veterinarians in mouse pathobiology,
and is considering establishment of centers of clinical excellence
in veterinary medicine.
NCRR Research Facilities – The Research Facilities
Improvement Program provides grants to improve or construct
research facilities, including animal facilities, at institutions
funded by the Public Health Service. Congress passed legislation
in 2000 that authorizes up to $250 million annually for the
construction of “21st Century” laboratories. This
funding, allocated by merit review, would address perennially
documented shortfalls in research space and physical plant.
Federal funding is also beneficial in leveraging private philanthropy,
state and municipal bond issues, and debt financing.
Research training is the fourth area of concern. The AAMC
supports efforts to reinvigorate research training, including
developing expanded medical research opportunities for minority
and disadvantaged students. For example, the volume of data
being generated by the Human Genome Project, as well as the
increasing power and sophistication of computing assets on
the researcher’s lab bench, have created an urgent need,
both in academic and industrial settings, for talented individuals
well-trained in biology, computational technologies, bioinformatics,
and mathematics to realize the promise offered by modern interdisciplinary
research.
In addition, the Association urges the Subcommittee to provide
sufficient funds to allow NIH to fulfill its commitment, articulated
in March 2001, to increase stipends for graduate students
and postdoctoral fellows by at least 10 percent. In particular,
postdoctoral fellow stipends remain very low in view of their
high levels of education and the irreplaceable contributions
of these individuals to biomedical research in this country.
These stipends increases are necessary if biomedical research
is to remain an attractive career option for the brightest
U.S. students. Attracting the most talented students and postdoctoral
fellows is essential if the United States is to retain its
position of world leadership in biomedical and behavioral
research.
Health Professions Education – The AAMC thanks
the Subcommittee for providing increased funding for Titles
VII and VIII of the Public Health Service Act in FY 2003.
The AAMC joins the Health Professions and Nursing Education
Coalition (HPNEC) to support a FY 2004 appropriation of at
least $550 million for health professions programs. These
programs work to improve the quality, geographic distribution,
and ethnic diversity of the public health and health care
workforce, particularly in underserved areas.
The AAMC is disappointed with the President’s proposal
to eliminate funding for most of the Title VII programs, which
help meet health care delivery needs throughout the country.
Indeed, at times these programs serve as the only source of
health care in many rural and disadvantaged communities. In
addition, these programs provide an essential and stable infrastructure
for the training and education of health professionals, with
a needed emphasis on primary care and preventive medicine
across the life-span, from pediatrics to geriatrics.
A November 2002 report by the Advisory Committee on Training
in Primary Care Medicine and Dentistry emphasizes the essential
role of the Title VII programs in enhancing public health
training for the primary care health workforce. In its recommendations,
the committee notes that in 1998, 42 to 56 percent of graduates
from the Title VII-supported primary care programs entered
practice in underserved areas, compared to a mean of 10 percent
of health professions graduates overall. Data from 1998 also
indicate that 35 to 50 percent of graduates of these programs
represented minority or disadvantaged groups, compared to
10 percent minority representation overall.
The Institute of Medicine report, released April 8, 2003,
“Health Professions Education: A Bridge to Quality,”
responds to the landmark 2001 report on quality, “Crossing
the Quality Chasm: A New Health System for the 21st Center.”
The new report makes a number of recommendations to better
prepare health care providers to serve patients in the changing
health care system. One of the core competencies cited that
all clinicians should possess, is the ability to work in interdisciplinary
teams. The Title VII and VIII health professions programs,
particularly through its interdisciplinary-community based
linkages, emphasize the value of interdisciplinary training
to prepare providers to work in these settings.
The Institute of Medicine report released March 20, 2002,
“Unequal Treatment: Confronting Racial and Ethnic Disparities
in Health Care,” targets the severe health care gap between
racial and ethnic groups in the United States and focuses
on strategies for eliminating health care disparities in the
system. It calls for increased representation of racial and
ethnic diversity in the health professions, as “racial
and ethnic minorities are more likely than their non-minority
colleagues to serve in minority and medically underserved
communities.” Title VII and VIII programs, such as Centers
of Excellence, Health Careers Opportunities Programs, Scholarships
for Disadvantaged Students, and the Nurse Workforce Diversity
programs, are designed to meet this need by bringing more
underrepresented minorities into the health workforce.
During their 40-year existence, the Title VII and VIII programs
have created a network of initiatives across the country that
supports the training of many disciplines of health providers.
These are the only federal programs designed to create infrastructures
at our schools and in our communities that facilitate customized
training designed to bring the latest emerging national priorities
to the populations at large and meet the health care needs
of special, underserved populations. The AAMC urges the Subcommittee
to continue its commitment to the Title VII and VIII health
professions programs
Agency for Healthcare Research and Quality –
Complementing the medical research conducted at NIH, the
Agency for Healthcare Research and Quality (AHRQ)
sponsors health services research designed to improve
the quality of health care, decrease health care costs,
and provide access to essential health care services by
translating research into measurable improvements in the
health care system. The AAMC firmly believes in the value
of health services research as this nation continues to
strive to provide high-quality, efficient, and cost-effective
health care to all of its citizens. The AAMC supports
the Friends of AHRQ recommendation, which calls for a FY
2004 funding level of $390 million for AHRQ. As the lead
federal agency to improve health care quality, AHRQ's overall
mission is to support research and disseminate information
that improves the delivery of health care by identifying
evidence based medical practices and procedures.
In support of this mission, AHRQ's budget includes a number
of research initiatives designed to enhance consumer and
clinical decision making, provide improved health care
services, and promote efficiency in the organization of
public and private systems of health care delivery. To
build an evidence base for clinical practice, AHRQ funds
thirteen Evidence-based Practice Centers to review relevant
literature about selected topics and publish evidence reports
summarizing such information. In an effort to improve medical
outcomes, AHRQ supports studies to evaluate the effectiveness
of treatment strategies for many of the country's most
prevalent and costly diseases.
In recognition of the immediate need for closer examination
of medical errors and how to prevent them, the AAMC strongly
supports the Centers for Education and Research in Therapeutics
(CERTs). The AAMC believes the agency is perfectly positioned
to take the lead on improving the quality of health care through
the reduction of errors. AHRQ is also the leader in research
on reducing health care costs, strengthening the translation
of research into practice, and increasing access to medical
technology. Additionally, to foster its important research,
AHRQ provides an array of intramural and extramural predoctoral
and postdoctoral educational and career development grants
and opportunities in health services research.
While AAMC is pleased with the increased support for the
agency, in recent years much of its funding has been derived
from inter-agency transfers, rather than direct appropriations.
The AAMC urges the Subcommittee to provide the majority of
the agency's funding through direct appropriations.
Centers for Disease Control and Prevention –
As the nation’s lead prevention agency, the Centers for
Disease Control and Prevention (CDC) is responsible for promoting
health and quality of life by preventing and controlling disease,
injury and disability. CDC works with states, local public
health agencies and partners across the nation to monitor
health, detect and investigate disease outbreaks, conduct
research to enhance prevention, develop and implement sound
health policies, foster healthy environments and provide needed
leadership and training in public health. The CDC is an important
part of the public health continuum and the AAMC’s member
institutions play a significant role in the support of CDC’s
extramural programs, activities and research. Given the challenges
of terrorism and disaster preparedness, new and re-emerging
infectious diseases and our many unmet public health needs
and missed prevention opportunities, the Association supports
the recommendation of the CDC Coalition that the agency will
require funding of at least $7.9 billion in FY 2004 to sustain
a network of successful programs in illness and injury prevention
and health promotion and to move cutting-edge health programs
from idea to implementation.
National Health Service Corps – The National
Health Service Corps (NHSC) is the most effective mechanism
through which the federal government can intervene to redress
the present and future inadequacies of health services delivery
and inequities in health status and disease burden. The primary
mission of the NHSC is to assist underserved communities to
develop, recruit, and retain community-responsive, culturally
competent, primary care clinicians dedicated to practicing
in health professional shortage areas. Open to doctors, dentists,
nurse-midwives, nurse practitioners, physician assistants,
and mental health professionals practicing in primary care,
the NHSC administers the NHSC Scholarship program, which provides
students with funding for tuition, fees, other reasonable
education expenses, and a monthly stipend in return for a
minimum two-year commitment to serve in a designated area;
and the Loan Repayment program, which offers fully-trained
primary care providers up to $25,000 per year for the first
two years of service in a designated area.
Currently, the NHSC meets approximately 12% of the health
care needs for the 47 million Americans who live in health
professional shortage areas. The AAMC supports the Administration’s
proposal for $213 million for the NHSC in FY 2004 for additional
scholarships and loan repayment contracts that would allow
for increased access to health care in underserved areas by
developing new delivery sites and a larger number of clinicians
providing care.
In conclusion, the AAMC emphasizes the essential linkage
between robust support of medical research and support for
health services and public health research to ensure that
the benefits of basic and clinical medical research will flow
to all Americans. We appreciate the continued support the
Subcommittee has given these programs and look forward to
working with Subcommittee members to sustain these worthy
initiatives.
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